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Revision 22-1; Effective September 1, 2022
1810 Program Support Unit Notification Requirements
Revision 23-3; Effective July 21, 2023
Program Support Unit (PSU) staff are responsible for preparing and sending notifications to the applicant, member or legally authorized representative (LAR) advising of actions taken regarding program eligibility and the right to a fair hearing. Form H2065-D, Notification of Managed Care Program Services, is the legal notice sent to an applicant, member or LAR of the actions taken regarding the Medically Dependent Children Program (MDCP). The form must be completed in plain language that can be understood by the applicant, member or LAR. The language preference of the member must be considered.
The applicant, member or LAR must be notified on Form H2065-D within two business days of the date a case is certified. The form also includes information on the member’s room and board charges and copayment, if applicable.
Form H2065-D is also used to notify an applicant or LAR when services are denied or program eligibility is terminated. PSU staff must notify the applicant or LAR on Form H2065-D of the denial of application within two business days of the decision. See also Section 6000, Denials and Terminations.
Depending on when the notification is generated, it will either be uploaded to the MCO's STAR Kids folder in MCOHub or generated in the Long-Term Care (LTC) Online Portal on the case action date.
1820 MCO Notification Requirements
Revision 22-2; Effective September 1, 2022
The managed care organization (MCO) is responsible for notifying the member or legally authorized representative (LAR) when a service is either denied or reduced. This is considered an adverse action and the member or LAR has a right to appeal. Appeal rights of STAR Kids members are in the STAR Kids Managed Care Contract.