Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 403.000 - Home Health Agency
Section 403.411 - Notice of Approval or Denial of Prior Authorization
Universal Citation: 130 MA Code of Regs 130.403
Current through Register 1531, September 27, 2024
(A) Notice of Approval. For all approved prior authorization requests for home health services, the MassHealth agency or its designee sends written notice to the member and the home health agency about the frequency, duration, and intensity of care authorized, and the effective date of the authorization.
(B) Notice of Denial or Modification and Right of Appeal.
(1) For all denied or modified prior
authorization requests, the MassHealth agency or its designee notifies both the
member and the home health agency of the denial or modification, and the
reason. In addition, the member will receive information about the member's
right to appeal, and appeal procedure.
(2) A member may request a fair hearing if
the MassHealth agency or its designee denies or modifies a prior authorization
request. The member must request a fair hearing in writing within 30 days after
the date of receipt of the notice of denial or modification. The Office of
Medicaid Board of Hearings conducts the hearing in accordance with 130 CMR
610.000: MassHealth: Fair Hearing Rules.
Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
