Md. Code Regs. 10.67.02.02

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.67.02.02 - Enrollment

A. The Department shall make available through its website and upon request provide a paper copy of the following:

(1) Materials regarding each MCO providing services in the eligible individual's county of residence including, but not limited to:

(a) Information about how to access the provider directory and drug formulary, with instructions for how to request paper copies if needed;

(b) A schedule of the benefits offered, including any benefits offered beyond the basic required package described in COMAR 10.67.67;

(c) Which, if any, benefits are provided directly by the Department;

(d) If applicable, a list of services that the MCO does not provide, reimburse for, or provide coverage of, because of moral or religious objections, and information about where and how to obtain these services;

(e) The requirements for each MCO to provide adequate access to covered services, including the network adequacy standards established in COMAR 10.67.66; and

(f) Quality and performance indicators for each MCO, including enrollee satisfaction; and

(2) Materials about the managed care program, including:

(a) The MCO enrollment and disenrollment process; and

(b) The basic features of managed care.

(3) Any forms necessary to select an MCO; and

(4) The toll-free telephone number of the enrollment unit.

B. Only the Department, or its designee, is authorized to enroll individuals into MCOs.

C. A participant found eligible for Maryland Medicaid under 42 U.S.C§ 1902(a)(10) A(i) shall be assigned to:

(1) The MCO the participant chooses at the time of application; or

(2) If the participant does not choose, an MCO with available capacity that is accepting new participants in the participant's service area.

D. Except for a participant found eligible as described in §C of this regulation, a participant, including a child in foster care or kinship care, shall:

(1) Have 28 days from the day the Department mails its eligibility notification in which to select an MCO; or

(2) Be assigned to an MCO with available capacity that is accepting new participants in the participant's service area.

E. All Managed Care Program eligible family members who live in the same household shall be assigned to the same MCO.

F. Newborns.

(1) A newborn shall be automatically enrolled from birth in its biological mother's MCO.

(2) The MCO is responsible for the newborn's health care from birth until the newborn enrolls into another MCO.

(3) A newborn, automatically assigned to its biological mother's MCO, is not eligible to change MCOs for family unity as described in COMAR 10.67.63.06A(1)(b) and (c) during the first 90 days of enrollment.

G. Effective Date of Enrollment. Enrollment in an MCO shall be effective at 12:01 a.m. on the 10th calendar day beginning with the day on which the Department notifies the MCO of the enrollment.

H. Upon the approval of the Department and the MCO, a participant may select an MCO that does not serve the participant's service area.

I. The Department or its designee shall submit the enrollee's choice of PCP to the enrollee's selected MCO at the time of enrollment.

Md. Code Regs. 10.67.02.02

Regulations .02 recodified from 10.09.63.02 effective 46:22 Md. R. 976, eff. 11/1/2019