Sec. 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.