MAPP Segment End Date Reason Codes Crosswalk

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Code New Code # Code to be discontinued 11/1/18
Current Code Description New Code Description New Definition Current Segment Type New Segment Type Code used for Disenrollment
01     Transferred to another HH no change Member is working with, or wants to work with, another HH agency. Both no change  
02     Member opted-out (pre consent only) Individual opted-out (pre-consent only) Individual has voluntarily opted-out. Individual does not want to be a Health Home member and receive Health Home services. Both Outreach  
03     Transferred to another CMA no change Individual is working with another CMA within the same HH. Both no change  
04     Member deceased Individual deceased HH has been informed that individual is deceased. Both no change
05     Member has a new CIN Inidividual has new CIN If Medicaid changes an individual´s CIN, segment is ended under the old, and new segment created using the new CIN. Both no change  
07     Closed for Behavior Closed for health, welfare and safety concerns for member and/or staff Disenrollment due to health, welfare, and safety concerns for member and/or staff (formerly for behavior). Both Enrollment
08   Member moved out of service area          
09     Member moved out of state Individual moved out of state Member moved out of New York State. Both no change
11     Member incarcerated Individual incarcerated Individual is incarcerated where the length of stay is expected to be longer than 6 mos. Both no change
12   Refused to sign or rescinded consent          
13     Patient of inpatient facility Individual is in an inpatient facility Member is in an excluded setting and the length of stay is expected to be longer than 6 mos. Both no change
14     Enrolled Health Home member lost to services Enrolled Health Home member disengaged from Care Management services Member is considered disengaged when Diligent and Continued Search efforts do not result in location of member. Enrollment no change
15   Member dissatisfied with services          
16     Inability to contact/locate member Inability to contact/locate individual Individual is unreachable during outreach attempts. Outreach no change  
17   Member not interested in HH services          
18     Member interested in HH at a future date no change For individuals not yet ready for HH services who express future interest. Outreach no change  
19     Member doesn´t meet HH criteria Individual doesn´t meet HH eligibilty/appropriateness criteria Individual does not/no longer meets eligibility criteria required for enrollment. Both no change
21     Member no longer requires HH services Member has graduated from the HH Program Individual can successfully self-manage and monitor their chronic conditions. Enrollment no change
23   Member disenrolled          
24     Member is no longer eligible for Medicaid Individual is not/no longer eligible for Medicaid Individual no longer qualifies or meets eligibility requirements for Medicaid. Both no change
25     Member moved from Outreach to Enrollment (can be system generated) Individual moved from Outreach to Enrollment (can be system generated) When user selected, end of outreach segment when individual is found and is eligible for HH services. Outreach no change  
27   Member not eligible for HH program          
28     Health Home change MMIS ID Provider ID no change   Both no change  
29     Member withdraws consent Member withdrew consent to enroll Member chooses to disenroll from the Health Home program. Enrollment no change
32     Closure Provider Closed For use when HH or CMA closes business and member is transferred to another HH and/or CMA. Both no change  
33     Merger no change In the instance of a merger between two HH or CMAs. Both no change  
35   Member refused consent          
  41     Coverage not compatible Individual´s Medicaid coverage is not compatible with HH.   Both
  42     Program not compatible Individual chooses to move to another program not compatible with HH program.   Both
  43     Individual moved between HHSC and HHSA When a member who previously received services as a child transitions to adult, or an adult transitioning back to HHSC.   Both  
  44     Segment Correction For use only if directed by DOH in order for HH RE codes to be correctly attributed to the member.   Enrollment  
99   Other Other - FOR DOH USE ONLY Formerly "Other,". Can no longer be used by HH - for DOH use only. Reach out to DOH if the appropriate segment end reason code cannot be found. Both Providers can not use