37.84.122    HELP ACT: COMMUNITY ENGAGEMENT ACTIVITY PARTICIPATION: COVERAGE SUSPENSION

(1) A participant who does not meet the age-based exclusion found in ARM 37.84.117(2)(a) or an income, standard, or hardship exemption and fails to comply with the community engagement activity participation requirements will have a grace period of 180 days after the end of the reporting period to come into compliance.

(2) A participant who does not come into compliance within the 180-day grace period will have their coverage suspended.

(3) The suspension period will end 180 days after the date of suspension or upon determination by the department that the participant is:

(a) exempt from community engagement activity participation requirements;

(b) compliant with community engagement activity participation requirements for 30 days; or

(c) eligible for another category not subject to community engagement activity participation requirements.

(4) A participant who has their coverage reinstated during a suspension period shall be monitored by the department to ensure continued compliance.

(5) Upon the end of the suspension period, a participant shall have coverage reinstated so long as the participant continues to be eligible for the HELP program.

(6) Prior written notice of an adverse action, which shall include information on how to come into compliance with community engagement activity participation requirements, will be sent to a participant informing them of the pending suspension of coverage.

(7) The department shall implement and enforce this rule only upon receiving approval from the U.S. Secretary of Health and Human Services of the department's 1115 waiver application filed August 30, 2019, and in accordance with the terms and conditions of the approval.

History: 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA; IMP, 53-2-215, 53-6-101, 53-6-113, 53-6-1302, 53-6-1303, 53-6-1304, 53-6-1305, 53-6-1308, 53-6-1309, MCA; NEW, 2020 MAR p. 2438, Eff. 1/1/21.