53-6-706. Requirements relating to enrollees. (1) All individuals enrolled in the program must be provided with a full written explanation of all fee-for-service and managed health care plan options as provided by rule. The department shall provide to enrollees, upon enrollment in the program and at least annually, notice of the process for requesting an appeal under the department's administrative appeal procedures. The department shall maintain a toll-free telephone number for program enrollees' use in reporting problems with managed health care entities.
     (2) If an individual becomes eligible for participation in the program while the individual is hospitalized, the department may not enroll the individual in the program until after the individual has been discharged from the hospital. This subsection does not apply to a newborn infant whose mother is enrolled in the program.
     (3) The department shall, by rule, establish rates for managed health care entities that:
     (a) are certified to be actuarially sound, in accordance with the department's current payment system;
     (b) take into account any difference of cost to provide health care to different populations based on age and eligibility category. The rates for managed health care entities must be determined on a capitated basis.
     (c) are based on treatment settings reasonably available to enrollees.

     History: En. Sec. 6, Ch. 502, L. 1995.