438.404—Notice of action.
(a) Language and format requirements.
The notice must be in writing and must meet the language and format requirements of § 438.10(c) and (d) to ensure ease of understanding.
(4)
If the State does not require the enrollee to exhaust the MCO or PIHP level appeal procedures, the enrollee's right to request a State fair hearing.
(7)
The enrollee's right to have benefits continue pending resolution of the appeal, how to request that benefits be continued, and the circumstances under which the enrollee may be required to pay the costs of these services.
(1)
For termination, suspension, or reduction of previously authorized Medicaid-covered services, within the timeframes specified in §§ 431.211, 431.213, and 431.214 of this chapter.
(3)
For standard service authorization decisions that deny or limit services, within the timeframe specified in § 438.210(d)(1).
(i)
Give the enrollee written notice of the reason for the decision to extend the timeframe and inform the enrollee of the right to file a grievance if he or she disagrees with that decision; and
(ii)
Issue and carry out its determination as expeditiously as the enrollee's health condition requires and no later than the date the extension expires.
(5)
For service authorization decisions not reached within the timeframes specified in § 438.210(d) (which constitutes a denial and is thus an adverse action), on the date that the timeframes expire.