Md. Code Regs. 10.67.12.01

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.67.12.01 - General

A. An MCO shall establish a corrective managed care plan that, at minimum, provides for:

(1) The identification of an enrollee that has abused MCO pharmacy benefits; and

(2) The enrollment of an enrollee that has been determined to have abused MCO pharmacy benefits in the MCO's corrective managed care plan.

B. Enrollee abuse exists when an enrollee:

(1) Has engaged in behaviors identified in COMAR 10.67.24.14-1; or

(2) Engages in Medicaid fraud as defined under COMAR 10.67.24.14.

Md. Code Regs. 10.67.12.01

Regulations .01 recodified from 10.09.75.01 effective 46:22 Md. R. 976, eff. 11/1/2019