Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1181 - NURSING FACILITY CARE
Subchapter D - NURSING HOME REFORM-STATEMENT OF POLICY
APPEALS OF ADVERSE DETERMINATIONS
Section 1181.565 - What an appeal is required to contain

An appeal from an adverse determination may be made by letter. No formal pleadings are required. The letter shall identify the name of the individual on whose behalf the appeal is being filed, the name of the nursing facility involved, the date of the written notice of the adverse determination, the agency or provider that issued the adverse determination and the address of the person to whom information from the Office of Hearings and Appeals should be sent. In addition, the appeal shall include a copy of the written notice of adverse determination in question. There are no filing fees or other charges.