Code of Massachusetts Regulations
651 CMR - EXECUTIVE OFFICE OF ELDER AFFAIRS
Title 651 CMR 15.00 - Prescription Advantage Program
Section 15.14 - Notification

Universal Citation: 651 MA Code of Regs 651.15

Current through Register 1531, September 27, 2024

(1) All notifications issued by the Plan shall include information regarding an Applicant's or Member's rights to Review. Unless otherwise provided in these regulations, notice will be issued at least ten business days in advance of the action to be taken by the Plan.

(2) Written notification shall be mailed by the Plan to an Applicant or Member or their authorized representative regarding the following:

(a) an Applicant's submission of an incomplete application;

(b) the determination of a Member's Membership Category and applicable Enrollment Fee, Co-payments and Deductibles; Effective Date of Coverage; or continued enrollment in the Plan;

(c) the voluntary or involuntary termination of a Member's enrollment;

(d) a Member's failure to make a timely an Enrollment Fee, if applicable;

(e) the denial of Prior Authorization for Covered Benefits;

(f) any Plan change regarding Membership Category and applicable Enrollment Fees, Co-payments or Deductibles;

(g) the Re-determination process and confirmation of a Member's status;

(h) a Reconsideration determination made by the Plan; and

(i) an Administrative Review determination made by the Plan.

(3) Any written notification rendered by the Plan pursuant to 651 CMR 15.00 shall be deemed received three Business Days after deposit in the U.S. mail, first class mail, postage pre-paid.

(4) Any written notification required by 651 CMR 15.14 shall comply with applicable federal and state law regarding communication accessibility.

(5) At the written request of an Applicant or Member, all written material mailed by the Plan shall be sent to the Applicant's or Member's authorized representative.

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