Participating in Albright LIFE: Enrollment and Disenrollment

Enrollment
You, and if you wish, your family or caregiver, will meet with the program representative to review and come to an agreement about your participation in the Albright LIFE program before you sign an Enrollment Agreement.
At this meeting you have an opportunity to discuss:

• The plan of care recommended for you by the health care team.
• That when you are enrolled in Albright LIFE, all of your Medicare and Medicaid services must be authorized or coordinated by the health team. (Remember, approval is not required for emergency care.)
• What to do if you are unhappy with the Albright LIFE program. You will be given information about the Participant Grievance Procedure.

Final Approval and Enrollment
If you decide to join Albright LIFE, we will ask you to sign the Enrollment Agreement. Upon signing this agreement, you will receive:

• A copy of the Enrollment Agreement.
• A sticker with Albright LIFE’s emergency telephone numbers and an instruction sheet to put on or by your telephone telling you what to do in an emergency.
• An identification card that replaces your Medicare and Medicaid cards indicating that you are enrolled in Albright LIFE.

Since Albright LIFE provides comprehensive care for its participants, enrollment in Albright LIFE results in disenrollment from any other Medicare or Medicaid prepayment plan.

All Albright LIFE services are provided and admissions and referrals are made without regard to race, sex, color, national origin, ancestry, religious creed, sexual orientation, or handicap. Complaints of discrimination may be filed with the following agencies:

Voluntary Disenrollment
Your social worker will assist you in transitioning your care to the appropriate Medicare and Medicaid Programs. You will need to sign a Disenrollment Form, which will indicate that you will no longer be entitled to services through Albright LIFE. Your voluntary disenrollment is effective on the first day of the month following the date that Albright LIFE receives your notice of voluntary disenrollment.

Albright LIFE will make appropriate referrals and ensure medical records are made available to new providers within 30 days. Albright LIFE will work with CMS and the State administering agency to reinstate the participant in other Medicare and Medicaid programs for which the participant is eligible.

You may not disenroll from Albright LIFE at a Social Security office. Choosing to enroll in any other Medicare and Medicaid prepayment plan or optional benefit, including the hospice benefit, after you enrolled in Albright LIFE, is considered a voluntary disenrollment from Albright LIFE.

The Medicare or Medicaid program you enroll into upon disenrollment from Albright LIFE may not provide you with the full range of services available to you through Albright LIFE.

Involuntary Disenrollment
A participant may be involuntarily disenrolled from Albright LIFE for any of the following reasons:

• The participant, after a 30-day grace period, fails to pay or make satisfactory arrangements to pay any premium due the PACE organization.
• The participant, after a 30-day grace period, fails to pay or make satisfactory arrangements to pay any applicable Medicaid spend down liability or any amount due under the post-eligibility treatment of income process.
• The participant or the participant’s caregiver engages in disruptive or threatening behavior.
• The participant moves out of the PACE program service area or is out of the service area for more than 30 consecutive days, unless the PACE organization agrees to a longer absence due to extenuating circumstances.
• The participant is determined to no longer meet the State Medicaid nursing facility level of care requirements and is not deemed eligible.
• The PACE program agreement with CMS and the State administering agency is not renewed or is terminated.
• The PACE organization is unable to offer health care services due to the loss of State licenses or contracts with outside providers.

NOTE: In Pennsylvania, individuals who reside in personal care boarding homes are not nursing home eligible. Therefore, any individual who relocates to a personal care boarding home will be involuntarily disenrolled from the LIFE program.

• A participant’s involuntary disenrollment occurs after Albright LIFE meets regulatory requirements and is effective on the first day of the next month that begins 30 days after the day Albright LIFE sends notice of the disenrollment to the participant. During this time, LIFE participants must continue to use LIFE organization services and remain liable for any premiums. The LIFE organization will continue to provide all needed services.
• Your involuntary disenrollment will automatically be considered an appeal if you are involuntary disenrolled for not complying with your care plan or meeting conditions of participation, engaging in disruptive or threatening behavior, failing to pay or make satisfactory arrangement to pay, or are out of the service area for more than 30 days without prior approved arrangements. An impartial party will review the involuntary disenrollment.
• If you are disenrolled due to failure to pay the monthly fee, you can re-enroll simply by paying the monthly fee in full. Provided you make this payment before the effective date of disenrollment, there will be no break in coverage

Contact information for filing an appeal for disenrollment: