Section R9-28-1307. Notice of Adverse Action

A.      The requirements under R9-28-411(D)(1) apply.

B.       Advance notice of a change in eligibility, share of cost, or pre- mium amount. Advance notice means a notice of proposed action that is issued to the member at least 10 days before the effective date of the proposed action. Except under subsection (C), advance notice shall be issued whenever an adverse action is taken to:

1.        Discontinue eligibility,

2.        Increase a person’s share-of-cost,

3.        Increase the premium amount, or

4.        Reduce benefits from ALTCS to acute care services.

C.      Exceptions from advance notice. A notice shall be issued to the member to discontinue eligibility no later than the effective date of action if:

1.        A member provides a clearly written statement, signed by that member, that services are no longer wanted;

2.        A member provides information that requires termination of eligibility or reduction of services, indicates that the member understands that termination of eligibility or reduction of services will be the result of supplying the information and signs a written statement waiving advance notice;

3.        A member cannot be located and mail sent to the mem- ber’s last known address has been returned as undeliver- able. A member whose eligibility is discontinued under this subsection is subject to reinstatement of discontinued services under 42 CFR 431.231(d);

4.        A member has been admitted to a public institution where a person is ineligible for coverage;

5.        A member has been approved for Medicaid in another state; or

6.        The Administration receives information confirming the death of a member.

Historical Note

New Section made by exempt rulemaking at 9 A.A.R. 99, effective January 1, 2003 (Supp. 02-4). Section amended

by final rulemaking at 15 A.A.R. 269, effective March 7, 2009 (Supp. 09-1).