Md. Code Regs. 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.
Notes
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