Ohio Admin. Code 5101:6-2-36 - State hearings: notice of denial of just cause request for termination of managed care plan membership
(A) Following the bureau of managed health
care's determination that the request does not meet one of the criteria for
just cause termination of managed care plan membership, the Ohio department of
medicaid, bureau of managed care,
must
shall send a notice to an individual.
(B) The notice shall contain:
a clear and
understandable statement that the request was denied, explain why the request
for just cause termination of managed care plan membership did not meet the
criteria for just cause termination of managed care plan membership, cite the
applicable regulations, explain the individual's right to and the method of
obtaining a state hearing, and contain a telephone number to call about free
legal services.
(1)
A clear and understandable statement that the request
was denied.
(2)
An explanation about why the request for just cause
termination of managed care plan membership did not meet the criteria for just
cause termination of managed care plan membership.
(3)
Citations of the
applicable regulations.
(4)
An explanation of the individual's right to and the
method of obtaining a state hearing.
(5)
A telephone
number to call about free legal services.
(C)
The JFS
01711 "Notice of Right to Terminate Membership in Your Managed Care Plan for
Just Cause," (rev. 8/2003), shall be used.
Notes
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35, 5160.011
Prior Effective Dates: 05/31/2004, 09/01/2008, 02/28/2014
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