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COMAR 10.09.24.01-.16 1732 State of Maryland Medical Assistance Manual Revised July 2012

(2) Provider originally selected refuses to serve as the recipient's provider;

(3) Program determines that the provider is not reasonably accessible to the recipient or does not meet accepted standards of medical or pharmacy practice;

(4) Recipient has not responded affirmatively to the imposition of restrictions; or

(5) Recipient's best interest in achieving appropriate use of the health care system and of Medical Assistance benefits would, in the Program's sole discretion, be better served by an alternative designation.

I. A recipient who has chosen to enroll in a Health Maintenance Organization—Medical Assistance may select another Health Maintenance Organization—Medical Assistance or elect to have the Program designate new primary medical and pharmacy providers without cause, but shall first complete and process for voluntary disenrollment specified in the Program's contract with the Health Maintenance Organization—Medical Assistance.

J. Time of Period of Enrollment for the Corrective Managed Care Program. (1) The period of enrollment is 24 months. (2) A recipient who has completed the period of enrollment and who is subsequently found, through the procedures specified under §C of this regulation, to have resumed abusive practices, shall be enrolled for an additional period of 36 months.

(3) A recipient found to have abused Medical Assistance benefits while enrolled in the Corrective Managed Care Program shall have the enrollment period extended for 24 months.

(4) A recipient who has been found on three separate determinations under §C(5)—(7) of this regulation to have abused Medical Assistance benefits shall be enrolled for a period of 60 months.

K. If an enrolled recipient loses and regains eligibility for Medical Assistance benefits, the recipient shall be re-enrolled at the resumption of eligibility for a full enrollment period.

L. The final determination of abuse, the decision to enroll the recipient for the Corrective Managed Care Program, and the designation of primary medical and pharmacy providers shall be the responsibility of the Chief, Division of Utilization and Eligibility Review.

M. The recipient shall be given notice of an opportunity for a hearing in conformity with Regulation .13 of this chapter.