Transitional Living Program: Notice of Approval or Denial for Transitional Living Services

(A) Notice of Approval. If the MassHealth agency approves a prior authorization request for transitional living services, the MassHealth agency will send written notice to the member and the transitional living provider about the frequency, duration, and intensity of care authorized, as well as the effective date of the authorization. (B) Notice of Denial and Right of Appeal. (1) If the MassHealth agency denies a prior authorization request for transitional services, the MassHealth agency notifies both the member and the transitional living provider. The notice states the reason for the denial and informs the member of the right to appeal and of the appeal procedure. (2) If the MassHealth agency denies a PA request for transitional living services, a member may appeal by requesting a fair hearing from the MassHealth agency. The request for a fair hearing must be made in writing to the MassHealth Board of Hearings in accordance with the timelines 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 conducts fair hearings in accordance with 130 CMR 610.000: MassHealth: Fair Hearing Rules.