Sec. 10.67.12.05. Enrollee Appeal

Latest version.

A. An enrollee shall have 20 days to appeal an MCOs determination of benefit abuse.

B. Except for the time frame specified in §A of this regulation, an appeal shall be handled as specified in COMAR 10.67.09.05.

C. If the appeal results in a hearing, an MCO shall:

(1) Attend the hearing; and

(2) Provide justification for enrollment in the program.

                    
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