Adverse Action

Adverse Action A. Advance notice of an adverse action is required if the eligibility decision results in: 1. Termination of benefits, 2. Conversion to a reduced services coverage group, or 3. Termination of a nursing facility vendor per-diem payment 4. Change from Medicaid to CHIP or vice versa. B. During the advance notice period, the beneficiary is allowed ten (10) days’ notice plus five (5) days mailing time before the date of the adverse action. During this fifteen (15) day adverse action notice time period, the beneficiary can fully comply with unmet redetermination requirements, provide information or verification that will alter the decision to terminate or reduce benefits or request a Fair Hearing with continued benefits.