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12		✓	Refused to sign or rescinded consent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