1. A. Contents of notice. The Administration or its designee shall issue a notice by mail, personal delivery, or electronic means when an action is taken regarding a person’s eligibility or premiums. The notice shall contain the following information:

   1. 1. The date of the notice issued;
   2. 2. A statement of the action being taken;
   3. 3. The effective date of the action;
   4. 4. The specific reason for the intended action;
   5. 5. If eligibility is being discontinued due to income in excess of the income standards, the actual figures used in the eligibility determination and the amount by which the person exceeds income standards;
   6. 6. If a premium is imposed or increased, the actual figures used in determining the premium amount;
   7. 7. The specific law or regulation that supports the action, or a change in federal or state law that requires an action;
   8. 8. An explanation of the member’s rights to an appeal and continued benefits.

2. B. Advance notice of changes in eligibility or premiums. “Advance notice” means a notice that is issued to a person at least 10 days before the effective date of the change. Except as specified in subsection (C), advance notice shall be issued whenever the following adverse action is taken:

   1. 1. To discontinue or suspend or reduce eligibility or covered services; or
   2. 2. To impose a premium or increase a person’s premium.

3. C. The Administration or its designee shall issue a Notice of Adverse Action to a member no later than the effective date of action if:

   1. 1. The Administration or its designee receives a request to withdraw;
   2. 2. A person provides information that requires termination of eligibility or an increase or imposition of the premium and the person signs a clear written statement waiving advance notice;
   3. 3. A person cannot be located and mail sent to that person has been returned as undeliverable;
   4. 4. A person has been admitted to a public institution where the person is ineligible under R9-22-310;
   5. 5. A person has been approved for Medicaid or CHIP in another state; or
   6. 6. The Administration or its designee has information that confirms the death of the person.

Historical Note

Adopted effective August 30, 1982 (Supp. 82-4). Amended subsections (A) and (B), added subsection (D) effective October 1, 1983 (Supp. 83-5). Former Section R9-22-312 repealed, new Section R9-22-312 adopted effective November 20, 1984 (Supp. 84-6). Amended effective October 1, 1985 (Supp. 85-5). Amended subsection (A) effective October 1, 1986 (Supp. 86-5). Change in heading only effective January 1, 1987, filed December 31, 1986 (Supp. 86-6). Amended subsection (A) effective October 1, 1987 (Supp. 87-4). Amended effective April 13, 1990 (Supp. 90-2). Amended effective September 29, 1992 (Supp. 92-3). Amended under an exemption from the provisions of the Administrative Procedure Act, effective July 1, 1993 (Supp. 93-3). Section repealed by final rulemaking at 5 A.A.R. 294, effective January 8, 1999 (Supp. 99-1). New Section R9-22-312 made by final rulemaking at 20 A.A.R. 192, with an immediate effective date of January 7, 2014 (Supp. 14-1).