Sec. 10.67.06.29. Optional Services

A. An MCO may provide its enrollees with additional health care services that are not required by this chapter.

B. Optional health care services that an applicant intends to include in its benefits package shall be specified, including the terms and conditions for, and limitations to the provision of these services, in the applicant's initial application to the Department, as well as for periodic Departmental review.

C. An MCO's provision of optional services that it has represented to be available to its enrollees is subject to monitoring of complaints and consumer satisfaction surveys, and to random audits.

D. An MCO's provision of additional services that are not required by this regulation may not be taken into account when setting the MCO's capitation rate.

E. Effective January 1, 2015, any changes to the health care services being offered by the MCO under §A of this regulation, including reducing or waiving pharmacy co-pays, shall be effective for an entire calendar year.

F. An MCO shall notify the Department of any changes to their optional services by September 15 for the following calendar year.

G. The Department may waive the requirement under §E of this regulation if the Department determines that the circumstance warrant, including but not limited to a reduction in rates outside the normal rate setting process.