Current through Register Vol. 30, No. 38, September 20, 2024
A. Contents of
notice. The Administration or its designee shall issue a notice by mail,
personal delivery, or electronic means when an action is taken regarding a
person's eligibility or premiums. The notice shall contain the following
information:
1. The date of the notice
issued;
2. A statement of the
action being taken;
3. The
effective date of the action;
4.
The specific reason for the intended action;
5. If eligibility is being discontinued due
to income in excess of the income standards, the actual figures used in the
eligibility determination and the amount by which the person exceeds income
standards;
6. If a premium is
imposed or increased, the actual figures used in determining the premium
amount;
7. The specific law or
regulation that supports the action, or a change in federal or state law that
requires an action;
8. An
explanation of the member's rights to an appeal and continued
benefits.
B. Advance
notice of changes in eligibility or premiums. "Advance notice" means a notice
that is issued to a person at least 10 days before the effective date of the
change. Except as specified in subsection (C), advance notice shall be issued
whenever the following adverse action is taken:
1. To discontinue or suspend or reduce
eligibility or covered services; or
2. To impose a premium or increase a person's
premium.
C. The
Administration or its designee shall issue a Notice of Adverse Action to a
member no later than the effective date of action if:
1. The Administration or its designee
receives a request to withdraw;
2.
A person provides information that requires termination of eligibility or an
increase or imposition of the premium and the person signs a clear written
statement waiving advance notice;
3. A person cannot be located and mail sent
to that person has been returned as undeliverable;
4. A person has been admitted to a public
institution where the person is ineligible under
R9-22-310;
5. A person has been approved for Medicaid or
CHIP in another state; or
6. The
Administration or its designee has information that confirms the death of the
person.
