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(1) Any voluntary action by the MCO which will reduce the level of service by the MCO to injured workers or result in significant changes to one or more of the plan elements in ARM 24.29.2331 cannot be taken without the approval of the department. MCOs may add members without the approval of the department.

(a) The MCO must submit an explanation of the changes or modifications to the plan and the impact of the change on service to injured workers, the financial stability of the MCO, or any other significant impact.

(b) Within 30 days of receipt of the proposed change, the department will advise the MCO whether the proposed change is acceptable. A MCO that is aggrieved of a decision of the department may request administrative review of the decision or request a contested case hearing.

(2) The MCO must notify the department within 10 days of any event or circumstance which will impair the MCO's ability to fulfill the requirements of the plan.

(a) The MCO must explain what has happened and the effect of the change.

(b) The MCO must describe how it will respond to the change.

(c) The department will advise the MCO whether the action proposed by the MCO is adequate to maintain certification of the MCO.

History: Sec. 39-71-203, 39-71-1103 and 39-71-1105 MCA; IMP, Sec. 39-71-1103 and 39-71-1105 MCA; NEW, 1994 MAR p. 420, Eff. 3/1/94.

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