<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.67.12.03" title_num="10" subtitle_num="67" chapter_num="12" heading="Enrollee Notice.">
  <text>The MCO shall provide an enrollee determined to have abused MCO benefits a written notice that includes the following:</text>
  <paragraph num="A.">
    <text>An explanation of the reason or reasons for the determination that the enrollee abused benefits;</text>
  </paragraph>
  <paragraph num="B.">
    <text>A statement that the enrollee has 20 days to provide:</text>
    <paragraph num="(1)">
      <text>Additional information for the MCO to consider before enrollment will become effective; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The address where the additional information shall be sent;</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A statement that the enrollee will be enrolled in corrective managed care and the effective date and duration of that enrollment;</text>
  </paragraph>
  <paragraph num="D.">
    <text>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;</text>
  </paragraph>
  <paragraph num="E.">
    <text>A statement that the enrollee may identify a preference for an assigned primary medical care provider, specialty care provider, or pharmacy; and</text>
  </paragraph>
  <paragraph num="F.">
    <text>An explanation of the enrollee’s right to appeal the MCO’s determination as described in Regulation .05 of this chapter.</text>
  </paragraph>
</regulation>