The IDT must provide both oral and written notification when denying a service determination request, and both the oral and the written notification must include the specific reason for the denial. The denial rationale must include why the service is not necessary to maintain or improve the participant’s overall health status, taking into account the participant’s medical, physical, emotional, and social needs. The denial rationale should also include the results of the reassessment in understandable language.
The IDT must provide both oral and written notification when denying a service determination request, and both the oral and the written notification must include the specific reason for the denial. The denial rationale must include why the service is not necessary to maintain or improve the participant’s overall health status, taking into account the participant’s medical, physical, emotional, and social needs. The denial rationale should also include the results of the reassessment in understandable language.
The IDT must provide both oral and written notification when denying a service determination request, and both the oral and the written notification must include the participant’s right to appeal. For written notification this means a full explanation of the participants right to appeal, including information about the expedited appeals process and, for Medicaid participants, information on their right to continue receiving disputed services. For oral notification, the PO must document that appeal rights were explained to the participant during that notification.