Notification and Right of Appeal

(A) MassHealth or its agent will notify the member or applicant and the referral source or nursing facility who submitted the request for institutional services on the member’s behalf of the approval or denial of the request for authorization of nursing facility services. If authorization for nursing facility services is denied, the notification will contain the following information: (1) the reason for the denial; (2) the explanation of the member's right to appeal; and (3) a description of the appeal procedure. (B) If MassHealth or its agent has denied a request for authorization of payment of nursing facility services, the member or applicant may request a fair hearing from the MassHealth Board of Hearings. The request for a fair hearing must be made in writing within 30 days after the date the member receives a written denial notice from MassHealth or its agent. The appeal procedure and hearing will be administered and conducted by the Board of Hearings, in accordance with the regulations set forth in 130 CMR 610.000: MassHealth: Fair Hearing Rules. (C) An individual who was screened and/or evaluated pursuant to PASRR may request a fair hearing from the Board of Hearings to challenge a determination by the applicable PASRR authority or authorities. The request for a fair hearing must be made in writing within 30 days after the date the individual receives a written notice of the determination from the applicable PASRR authority or authorities. The appeal procedure and hearing will be administered and conducted by the Board of Hearings, in accordance with the regulations set forth in 130 CMR 610.000: MassHealth: Fair Hearing Rules.