Notification of Denial

The Division or its agent notifies the member, the hospital, and the member's attending physician whenever it determines that the hospital admission or continued stay, or any part thereof, is not medically or administratively necessary. The Division or its agent notifies the hospital and the member's attending physician whenever it determines that the hospital stay is no longer appropriate at a chronic disease or rehabilitation hospital level of care, but is administratively necessary. The Division or its agent notifies the member, the hospital, and the member's attending physician whenever it determines that the hospital stay is no longer administratively necessary due to the refusal of an appropriate placement in accordance with 130 CMR 435.413.