Notices of Action. (See 42 CFR 438.210)
a. The Health Plan shall notify the provider and give the enrollee written notice of any decision to deny a service authorization request, or to authorize a service in an amount, duration, or scope that is less than requested.
b. For standard authorization decisions, the Health Plan shall provide notice as expeditiously as the enrollee’s health condition requires and within no more than fourteen (14) calendar days following receipt of the request for service.
c. The timeframe can be extended up to fourteen (14) additional calendar days if the enrollee or the provider requests extension or the Health Plan justifies the need for additional information and how the extension is in the enrollee’s interest.
d. Expedited authorization is required when a provider indicates or the Health Plan determines that following the standard timeline could seriously jeopardize the enrollee’s life of health or ability to attain, maintain, or regain maximum function. An expedited decision must be made no later than three (3) business days after receipt of the request for service.
e. The Health Plan may extend the three (3) business days for expedited cases by up to fourteen (14) calendar days if the enrollee requests an extension or if the Health Plan justifies the extension as prescribed in subparagraph 16.c. above. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract
Notices of Action. An institutional holder, insurer or guarantor of a first Mortgage who provides written request to the Association (such request to state the name and address of such holder, insurer or guarantor and the street address of the Unit to which its Mortgage relates, thereby becoming an “Eligible Holder”), will be entitled to timely written notice of:
(i) Any condemnation loss or any casualty loss which affects a material portion of the Community or which affects any Unit on which there is a first Mortgage held, insured or guaranteed by such Eligible Holder;
(ii) Any delinquency in the payment of assessments or charges owed by a Unit subject to the Mortgage of such Eligible Holder, where such delinquency has continued for a period of at least sixty (60) days, or any other violation of the Declaration or Bylaws relating to such Unit or the Owner or occupant which is not cured within sixty (60) days. Notwithstanding this provision, any holder of a first Mortgage is entitled to written notice upon request from the Association of any default in the performance by an Owner of a Unit of any obligation under the Declaration or Bylaws which is not cured within sixty (60) days;
(iii) Any lapse, cancellation or material modification of any insurance policy maintained by the Association; or
(iv) Any proposed action which would require the consent of a specified percentage of Eligible Holders.
Notices of Action. An Institutional Lender that provides a written request to the Association (such request to state the name and address of such holder, insurer, or guarantor and to identify with particularity the Lot, thereby becoming an "Eligible Holder"), will be entitled to timely written notice of:
A. Any delinquency in the payment of Assessments or charges owed by an Owner of the Residential Property subject to the Mortgage of such Eligible Holder, where such delinquency has continued for a period of sixty (60) days; provided, however, notwithstanding this provision, any Eligible Holder, upon request, is also entitled to written notice from the Association of any default in the performance by an Owner of any obligation under the Governing Documents which is not cured within sixty (60) days;
B. Any condemnation loss or any casualty loss which affects a material portion of the Property or which affects any Lot on which there is a first Mortgage held, insured or guaranteed by such Eligible Holder;
C. Any lapse, cancellation, or material modification of any insurance policy maintained by the Association;
D. Any proposed action which, pursuant to the terms of this Declaration, the Articles, the Bylaws, or under applicable law, would require the consent of a specified percentage of Eligible Holders; or
E. If the U.S. Department of Housing and Urban Development is insuring or the U.S. Department of Veterans Affairs is guaranteeing the Mortgage on any Lot, material amendment to any of this Declaration, the Articles, or the Bylaws, or extraordinary action of the Association, as defined under VA Pamphlet 26-7, {36205737;1) 58 A failure by Declarant or the Association to furnish notice to any Eligible Holder shall not result in liability of Declarant or the Association because such notice is given as a courtesy to a Eligible Holder and the furnishing of such notice is not an obligation of the Association to Eligible Holder.
Notices of Action a. The MCO or its subcontractor (as duly authorized by the MCO) shall mail a notice of action to a Member when the MCO denies or partially denies coverage of goods or services prescribed by the Member's treating PCP, or other treating provider, functioning within his or her scope of practice as defined under state law; or the MCO reduces, suspends, or terminates ongoing goods or services being provided to a Member. The notice requirements shall apply to all categories of covered services including transportation to medically necessary appointments.
b. The MCO may request additional information from a provider if additional information is needed for the MCO's consideration of a request for approval of coverage of goods or services. If the provider does not respond to the request for additional information within twenty (20) business days and the MCO still does not have adequate information to approve the request, a notice of action must be sent. The notice of action shall state that the lack of sufficient information from the provider is the reason for the denial.
c. The MCO shall issue a notice of action if the MCO approves a good or service that is not the same type, amount, duration, frequency or intensity as that requested by the provider, consistent with current DSS policy.
d. The MCO shall identify if the Member reads only a language other than English. In that case, the notice of action shall be in the Member's native language, if possible.
e. Except as provided in (h) below the MCO shall mail an advance notice of action to a Member at least ten (10) days before the date of any action described in (a) above, consistent with current DSS policy.
Notices of Action. 1) No later than August 31, 2021, Defendant shall implement a standardized system of written notification in English and Spanish, including the child-care placement agreement. Eligibility notice shall meet the following requirements:
a. State the Department’s eligibility decision as to hours of care, share of costs a family must pay, and duration of assistance; and
b. Provide the reason for a decision, if the individual is denied or not approved for full assistance; and
c. Provide information about the individual’s right to appeal, including the timeframe and method for doing so; and
d. Provide the contact information for free legal services.
2) Defendant will continue to post posters in the Early Childhood offices that describe child-care application rights with the same information available and distributed as a flyer to applicants.
3) After completing the requirements in Sections 1 and 2, Defendant will train staff of the Early Childhood Education and Care Department on the changes made to regulations under this order by March 31, 2022 and on changes made to notices of action under this order by March 31, 2022. Defendant will provide training materials and recordings of trainings to Plaintiffs’ Counsel. To the extent practicable, Defendant will provide training materials to Plaintiffs’ Counsel in advance of the actual training.
Notices of Action. DCFS will continue to use the standard Notice of Action (NOA) for termination of payments to the licensed residential substance abuse treatment facility. Substitutions of the form will be permitted as approved by California Department of Social Services (CDSS). Any county decision to grant, deny, change, or terminate payments must be communicated by providing adequate written notice to the provider.
Notices of Action. If delegated to subcontractors, the Contractor must ensure that the subcontractor appropriately notifies Enrollees when an Action has been taken. The Contractor must monitor to ensure that the content of Notices of Action include the required elements and is written in understandable language.
Notices of Action. An institutional holder, insurer, or guarantor of a first Mortgage who provides written request to the Association (such request to state the name and address of such holder, insurer, or guarantor and the Unit Number, therefore becoming an “eligible holder”), will be entitled to timely written notice of:
(a) any condemnation loss or any casualty loss which affects a material portion of the Properties or which affects any Unit on which there is a first Mortgage held, insured, or guaranteed by such eligible holder;
(b) any delinquency in the payment of assessments or charges owed by an Owner of a Unit subject to the Mortgage of such eligible holder, where such delinquency has continued for a period of sixty (60) days; provided, however, notwithstanding this provision, any holder of a first Mortgage, upon request, is entitled to written notice from the Association of any default in the performance by an Owner of a Unit of any obligation under the Declaration or By-Laws of the Association which is not cured within sixty (60) days;
(c) any lapse, cancellation, or material modification of any insurance policy maintained by the Association; or
(d) any proposed action which would require the consent of a specified percentage of eligible holders.
Notices of Action. An institutional holder, insurer, or guarantor of a First Mortgage, who provides written request to the Association (which request shall state the name and address of the holder, insurer or guarantor and the Lot address), (said holder, insurer, or guarantor then becoming an "Eligible Holder"), will be entitled to timely written notice of:
(a) any proposed termination of the Association;
(b) any condemnation loss or any casualty loss which affects a material portion of the Properties or which affects any Lot on which there is a First Mortgage held, insured or guaranteed by the Eligible Holder;
(c) any delinquency in the payment of assessments or charges owed by an Owner of a Lot subject to the First Mortgage of the Eligible Holder, where such delinquency has continued for a period of sixty (60) days or any default in the performance by the Owner of any obligation under the Declaration or the Bylaws which is not cured within sixty (60) days;
(d) any lapse, cancellation or material modification of any insurance policy or fidelity bond maintained by the Association.
Notices of Action. Notwithstanding the foregoing, neither a judicial foreclosure action nor a suit at law for a monetary judgment shall be commenced, nor shall any notice of foreclosure by advertisement be published, until the expiration of 10 days after mailing by first class mail, postage prepaid, addressed to the delinquent Co-owner(s) at his or their last known address, of a written notice that 1 or more installments of the annual assessment levied against the pertinent Unit is or are delinquent and that the Association may invoke any of its remedies hereunder if the default is not cured within 10 days after the date of mailing. Such written notice shall be accompanied by a written affidavit of an authorized representative of the Association that sets forth (i) the affiant’s capacity to make the affidavit, (ii) the statutory and other authority for the lien, (iii) the amount outstanding (exclusive of interest, costs, attorney fees, and future assessments), (iv) the legal description of the subject Unit(s), and (v) the name(s) of the Co- owner(s) of record. Such affidavit shall be recorded in the office of the Register of Deeds in the county in which the Project is located prior to commencement of any foreclosure proceeding, but it need not have been recorded as of the date of mailing as aforesaid. If the delinquency is not cured within the 10-day period, the Association may take such remedial action as may be available to it hereunder or under Michigan law. In the event the Association elects to foreclose the lien by advertisement, the Association shall so notify the delinquent Co-owner and shall inform him that he may request a judicial hearing by bringing suit against the Association.
