Common use of The MassHealth Board of Hearings Clause in Contracts

The MassHealth Board of Hearings. All MassHealth benefits, behavioral health diversionary services, and community-based services may be also appealed to the MassHealth Board of Hearings after the initial plan-level Appeal discussed above. Whenever the Contractor sends notification to an Enrollee or his or her representative (or the representative of a deceased Enrollee’s estate) of its service decision, the Contractor must include information on filing a Board of Hearings Appeal, including notice that the Enrollee, his or her representative, or the representative of a deceased Enrollee’s estate have standing to be a party in the hearing. The form and content of the notification used by the Contractor must be prior approved by EOHHS and CMS. The Enrollee must submit any request for a Board of Hearings Appeal, in writing, no later than 30 calendar days from the date of mailing of the Contractor’s service decision. Whenever an Enrollee submits a written request for a Board of Hearings Appeal within 10 calendar days of the date of mailing of the Contractor‘s internal Appeal decision, the Contractor is responsible for the provision of Continuing Services, if so requested by the Enrollee during the pendency of a Board of Hearings Appeal. If the Board of Hearings decides in the Enrollee’s favor, the Contractor must authorize or provide the service in dispute as expeditiously as the Enrollee’s health condition requires but no later than 72 hours from the date the Contractor receives the notice of the Board of Hearings decision.

The MassHealth Board of Hearings. All MassHealth benefits, behavioral health diversionary services, and community-based services may be also appealed to the MassHealth Board of Hearings after the initial plan-level Appeal discussed above. Whenever the Contractor sends notification to an Enrollee or his or her representative (or the representative of a deceased Enrollee’s estate) of its service decision, the Contractor must include information on filing a Board of Hearings Appeal, including notice that the Enrollee, his or her representative, or the representative of a deceased Enrollee’s estate have standing to be a party in the hearing. The form and content of the notification used by the Contractor must be prior approved by EOHHS and CMS. The Enrollee must submit any request for a Board of Hearings Appeal, in writing, no later than 30 calendar days from the date of mailing of the Contractor’s service internal appeal decision. Whenever an Enrollee submits a written request for a Board of Hearings Appeal within 10 calendar days of the date of mailing of the Contractor‘s internal Appeal decision, the Contractor is responsible for the provision of Continuing Services, if so requested by the Enrollee during the pendency of a Board of Hearings Appeal. If the Board of Hearings decides in the Enrollee’s favor, the Contractor must authorize or provide the service in dispute as expeditiously as the Enrollee’s health condition requires but no later than 72 hours from the date the Contractor receives the notice of the Board of Hearings decision.