Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 425.000 - Psychiatric Inpatient Hospital Services
Section 425.415 - Notification and Right of Appeal
Current through Register 1531, September 27, 2024
(A) The MassHealth agency or its agent will send a written notification of approval or denial to the member and to the medical practitioner or facility who submitted the request for psychiatric inpatient hospital services. If authorization for psychiatric inpatient hospital services is denied, the notification will inform the member and the medical practitioner or facility of the reason for the denial, the member's right to appeal, and the appeal process.
(B) Following the decision of the MassHealth agency or its agent to deny services in a psychiatric inpatient hospital, a member may appeal by requesting a fair hearing from the MassHealth agency. The request for a fair hearing must be made, in writing, within 30 days after receipt of the notice of the denial. The appeal procedure and fair hearing will be administered and conducted by the Board of Hearings in accordance with 130 CMR 610.000: MassHealth: Fair Hearing Rules.
