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 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.

(C) JFS 01711 "Notice of Right to Terminate Membership in Your Managed Care Plan for Just Cause," (rev. 8/2003), shall be used.

Effective: 02/28/2014
R.C. 119.032 review dates: 11/18/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 5101.35
Rule Amplifies: 5101.35 , 5160.011
Prior Effective Dates: 5/31/04, 9/1/08