Md. Code Regs. 10.67.12.03

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

Section 10.67.12.03 - Enrollee Notice

The MCO shall provide an enrollee determined to have abused MCO benefits a written notice that includes the following:

A. An explanation of the reason or reasons for the determination that the enrollee abused benefits;

B. A statement that the enrollee has 20 days to provide:

(1) Additional information for the MCO to consider before enrollment will become effective; and

(2) The address where the additional information shall be sent;

C. A statement that the enrollee will be enrolled in corrective managed care and the effective date and duration of that enrollment;

D. An explanation that the effective date will be tolled pending the MCO's review of any additional information the enrollee provides pursuant to §B of this regulation;

E. A statement that the enrollee may identify a preference for an assigned primary medical care provider, specialty care provider, or pharmacy; and

F. An explanation of the enrollee's right to appeal the MCO's determination as described in Regulation .05 of this chapter.

Md. Code Regs. 10.67.12.03

Regulations .03 recodified from 10.09.75.03 effective 46:22 Md. R. 976, eff. 11/1/2019