Regulation .03 Enrollee Notice.
Regulation .03 Enrollee Notice.LinkCopy Citation
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.