(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, mustshall 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.

(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

Certification: CERTIFIED ELECTRONICALLY

Date: 02/05/2019

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