TITLE 42 - PUBLIC HEALTH

CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER C - MEDICAL ASSISTANCE PROGRAMS

PART 438 - MANAGED CARE

subpart i - SANCTIONS

438.710 - Due process: Notice of sanction and pre - termination hearing.

  (a) Notice of sanction. Except as provided in 438.706(c), before imposing any of the intermediate sanctions specified in this subpart, the State must give the affected entity timely written notice that explains the following: (1) The basis and nature of the sanction.

  (2) Any other due process protections that the State elects to provide.

  (b) Pre-termination hearing(1) General rule. Before terminating an MCO or PCCM contract under 438.708, the State must provide the entity a pre-termination hearing.

  (2) Procedures. The State must do the following: (i) Give the MCO or PCCM written notice of its intent to terminate, the reason for termination, and the time and place of the hearing; (ii) After the hearing, give the entity written notice of the decision affirming or reversing the proposed termination of the contract and, for an affirming decision, the effective date of termination; and (iii) For an affirming decision, give enrollees of the MCO or PCCM notice of the termination and information, consistent with 438.10, on their options for receiving Medicaid services following the effective date of termination.