When a request for prior authorization for a medical or dental service is denied, the individual and authorized representative shall be provided prompt written notice of the decision. Copies shall also be sent to the provider and to the local agency.

(A)The notice shall contain: a clear and understandable statement of the action taken and the reasons for it, cite the applicable regulations, explain the assistance group's right to and the method of obtaining a state hearing, and contain a telephone number to call about free legal services.

(1)A clear and understandable statement of the action taken and the reasons for it.

(2)Citations of the applicable regulations.

(3)An explanation of the assistance group's right to and the method of obtaining a state hearing.

(4)A telephone number to call about free legal services.

(B)A notice describing the denial of authorization for medical services or its computer-generated equivalent shall be used.

Effective: 3/1/2019

Five Year Review (FYR) Dates: 11/29/2018 and 03/01/2024

Certification: CERTIFIED ELECTRONICALLY

Date: 02/05/2019

Promulgated Under: 119.03

Statutory Authority: 5101.35

Rule Amplifies: 5101.35, 5160.011

Prior Effective Dates: 09/01/1976, 04/01/1980, 10/01/1981, 05/01/1982, 07/01/1982, 04/01/1983, 11/01/1983 (Temp.), 12/01/1983, 01/01/1984, 03/01/1984 (Temp.), 06/01/1984, 10/03/1984 (Emer.), 12/22/1984, 04/01/1986, 04/01/1987, 09/01/1987, 07/01/1988 (Emer.), 09/25/1988, 10/01/1989, 02/01/1990, 04/01/1991, 06/01/1993, 11/01/1994, 06/01/2003, 09/01/2008, 02/28/2014