Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 422.000 - Personal Care Attendant Services
Section 422.417 - PCA Program: Notice of Approval, Denial, or Modification of Prior-authorization Request

(1) If the MassHealth agency denies or modifies a prior-authorization request for PCA services, the MassHealth agency will send written notice to the member, the PCM agency, and the fiscal intermediary. The notice will state the reason for the denial or modification and will inform the member of the right to appeal and of the appeal procedure.

(2) If the MassHealth agency denies or modifies a prior-authorization request for PCA services, a member may appeal by requesting a fair hearing. The request for a fair hearing must be made in writing to the MassHealth Board of Hearings in accordance with the time lines described in 130 CMR 610.015(B): Time Limitation on the Right of Appeal. Requests for continuation of services during an appeal must be made in accordance with 130 CMR 610.036: Continuation of Benefits Pending Appeal. The MassHealth Board of Hearings will conduct the fair hearing in accordance with 130 CMR 610.000: MassHealth: Fair Hearing Rules.