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COMAR 10.09.24.01-.16 1730 State of Maryland Medical Assistance Manual Revised July 2012

under §A(1), (2), or (3) of this regulation. The medical reviewer shall consider all relevant and available information including Program payment records and information secured from interviews, if conducted, in making a decision. The reviewer may, when appropriate, obtain records from other sources, including providers of medical services.

(7) When a case is referred for administrative review, a determination shall be made by the Chief, Division of Utilization and Eligibility Review, or his designee, regarding whether the recipient's use of benefits constitutes abuse as defined under §A(4) of this regulation.

(8) If a recipient has been convicted of a crime involving use of Medical Assistance benefits, as defined in §A of this regulation, the Program may consider the recipient to have committed abuse as described under §A(4) of this regulation.

D. Notice. A recipient determined to have abused the Program shall receive notice to that effect. Notice includes the following:

(1) A statement of the reason or reasons why the recipient was found to have abused the Program;

(2) A statement that the recipient will be enrolled in the Corrective Managed Care Program and the effective date and duration of that enrollment;

(3) A statement regarding an opportunity to provide additional information which will be considered before enrollment becomes effective;

(4) A statement regarding an opportunity to identify a preference for an assigned primary medical care provider or pharmacy; and

(5) A statement of appeal rights under Regulation .13 of this chapter. E. Consideration of Recipient Information. (1) Additional information received from the recipient under §D(3) of this regulation is considered relative to the appropriateness of the recipient's enrollment in the Corrective Managed Care Program.

(2) Notice of the Program's determination regarding the additional information shall be sent to the recipient by the Department. The notice shall either confirm or reverse the decision to enroll the recipient.

(3) Information received from the recipient under §D(4) of this regulation is considered relative to the designation of a primary medical provider or pharmacy in accordance with §G(7) of this regulation.

F. Corrective Managed Care Program.