Integrated Notice. Beneficiaries will be notified of all applicable Demonstration, Medicare and Medicaid Appeal rights through a single notice. The form and content of the notice must be based on elements of OMB approved CMS-1003 and prior approved by CMS and ODM. The ICDS Plan shall notify the Beneficiary of its decision at least fifteen (15) calendar days in advance of the date of its action, and simultaneous with the decision, when applicable.
2.10.3.6.1. The notice must explain:
2.10.3.6.1.1. The action the ICDS Plan has taken or intends to take;
2.10.3.6.1.2. The reasons for the action;
2.10.3.6.1.3. The citation to the regulations supporting such action;
2.10.3.6.1.4. The Beneficiary’s or the authorized representative’s right to file an Appeal;
2.10.3.6.1.5. Procedures for exercising Beneficiary’s rights to Appeal;
2.10.3.6.1.6. Circumstances under which expedited resolution is available and how to request it;
2.10.3.6.1.7. If applicable, the Beneficiary’s rights to have benefits continue pending the resolution of the Appeal;
2.10.3.6.1.8. The date the notice is being issued;
2.10.3.6.1.9. Oral interpretation is available for any language;
2.10.3.6.1.10. Written alternative formats may be available as needed; and
2.10.3.6.1.11. How to access the ICDS Plan’s interpretation and translation services as well as alternative formats that can be provided by the ICDS Plan.
2.10.3.6.2. Written material must use easily understood language and format, be available in alternative formats, and in an appropriate manner that takes into consideration those with special needs.
Integrated Notice. The State will use a new simplified, integrated model notice for appeals explanations, developed and approved by CMS. The new notice will retain all essential information for Enrollees and be used, with modifications as needed, throughout the Demonstration.
Integrated Notice. Enrollees will be notified of all applicable Demonstration, Medicare and Medicaid Appeal rights through a single notice. The form and content of the notice must be prior approved by CMS and DMAS.
2.14.1.4.1. The notice must explain:
2.14.1.4.1.1. The action the Contractor has taken or intends to take;
2.14.1.4.1.2. The reasons for the action;
2.14.1.4.1.3. The citation to the law or policy supporting such action 2.
Integrated Notice. Enrollees will be notified of all applicable Demonstration Medicare and Medicaid Appeal rights through a single notice. The form and content of the notice must be prior approved by CMS and the Department. The Contractor shall notify the Enrollee of its decision at least ten (10) days in advance of the date of its Adverse Action.
Integrated Notice. Enrollees will be notified of all applicable Medicare and Medicaid appeal rights through a single notice specific to the service or item type in question, developed jointly by the State and CMS.
Integrated Notice. Enrollees will be notified of all applicable Demonstration Medicare and Medicaid Appeal rights through a single notice. The form and content of the notice must be prior approved by CMS and the Department. The Contractor shall notify the Enrollee of its decision at least ten (10) days in advance of the date of its Adverse Benefit Determination. The Contractor must give notice of Adverse Benefit Determination on the day of the action when the action is a denial of payment
2.12.6.1 The notice must explain:
2.12.6.1.1 The action the Contractor intends to take;
2.12.6.1.2 The reasons for the action;
2.12.6.1.3 The citation to the regulations supporting such action;
2.12.6.1.4 The Enrollee’s or the Provider’s right to file an Appeal;
2.12.6.1.5 Procedures for exercising the Enrollee’s rights to Appeal;
2.12.6.1.6 Circumstances under which expedited resolution is available and how to request it; and
2.12.6.1.7 If applicable, the Enrollee’s rights to have benefits continue pending the resolution of the Appeal, and the circumstances under which the Enrollee may be required to pay the costs of these services.
2.12.6.2 The notice must use easily understood language and format, be available in alternative formats, and in an appropriate manner that takes into consideration those with special needs. All Enrollees and Potential Enrollees must be informed that information is available in alternative formats and how to access those formats.
2.12.6.3 The notice must be translated for the individuals who speak Prevalent Languages.
2.12.6.4 The notice must include language clarifying that oral interpretation is available for all languages and how to access it.
Integrated Notice. Enrollees will be notified of all applicable Demonstration Medicare and Medicaid Appeal rights through a single notice. The form and content of the notice must be prior approved by CMS and the Department. The Contractor shall notify the Enrollee of its decision at least ten (10) days in advance of the date of its Adverse Action.
2.12.6.1 The notice must explain:
2.12.6.1.1 The action the Contractor intends to take;
2.12.6.1.2 The reasons for the action;
2.12.6.1.3 The citation to the regulations supporting such action;
2.12.6.1.4 The Enrollee’s or the Provider’s right to file an Appeal;
2.12.6.1.5 Procedures for exercising the Enrollee’s rights to Appeal;
2.12.6.1.6 Circumstances under which expedited resolution is available and how to request it; and
2.12.6.1.7 If applicable, the Enrollee’s rights to have benefits continue pending the resolution of the Appeal, and the circumstances under which the Enrollee may be required to pay the costs of these services.
2.12.6.2 The notice must use easily understood language and format, be available in alternative formats, and in an appropriate manner that takes into consideration those with special needs. All Enrollees and Potential Enrollees must be informed that information is available in alternative formats and how to access those formats.
2.12.6.3 The notice must be translated for the individuals who speak Prevalent Languages.
2.12.6.4 The notice must include language clarifying that oral interpretation is available for all languages and how to access it.
