Lawriter - OAC - 5101:6-2-36 State hearings: notice of denial of just cause request for termination of managed care plan membership.

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, shall send a notice to an individual.

(B) The notice shall contain:

(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.


Effective: 3/1/2019
Five Year Review (FYR) Dates: 11/29/2018 and 03/01/2024
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