R9-34-205. Content of the Notice of Action

A contractor shall ensure that the Notice of Action explains the following: 1. The action the contractor has taken or intends to take; 2. The reasons for the action; 3. The enrollee’s right to file an appeal with the contractor; 4. The procedures for exercising the rights specified in this Article; 5. The circumstances under which an expedited resolution is available and how to request it; and 6. The circumstances under which an enrollee has a right to have services continue pending resolution of the appeal, how to request that services be continued, and the circumstances under which the enrollee is liable for the costs of services.