Section 4520.50  Notice of Nonrenewal or Termination

a)         All provider agreements shall provide for at least 60 days notice by the provider for termination with cause, as defined in the provider agreement, and at least 90 days notice by the provider for termination without cause.  Upon receipt of the notice, the health care plan shall notify enrollees within 30 days after the termination and the proper steps to be taken for selecting a new health care provider.  In the event the provider violates the provider agreement and does not give a notice of termination in the appropriate timeframe, the health care plan must provide immediate notice to the enrollees.  The health care plan must inform the Department  immediately of any known or intended termination, with or without cause, of an MCO.

b)         A health care plan must give at least 60 days notice of nonrenewal or termination of a health care provider to the health care provider and to the enrollees served by the health care provider.  The notice shall include a name and address to which an enrollee or health care provider may direct comments and concerns regarding the nonrenewal or termination.  Immediate written notice may be provided without 60 days notice when a health care provider's license has been disciplined by a State licensing board.  The notice shall inform the enrollee of the availability of transitional services and that the enrollee must request transitional services within 30 days from receipt of this notice.

(Source:  Amended at 38 Ill. Reg. 2253, effective January 2, 2014)