Section R9-34-205. Content of the Notice of Action

A contractor shall ensure that the Notice of Action explains the fol­ lowing:

I.    The action the contractor has taken or intends to take;

2.        The reasons for the action;

3.        The enrollee's right to file an appeal with the contractor;

4.        The procedures for exercising the rights specified in this Article;

5.        The circumstances under which an expedited resolution is available and how to request it; and

6.        The circumstances under which an enrollee has a right to have services continue pending resolution of the appeal, how to request that services be continued, and the cir­ cumstances under which the  enrollee is liable  for the costs of services.

Historical Note

New Section made by final rulemaking at 10 A.A.R. 828, effective April 3, 2004 (Supp. 04-1).