1. (a) The Notice of Action, issued pursuant to Section 1850.210(a)-(e) shall contain the following information:

   1. (1) The action taken by the MHP.
   2. (2) The reason for the action taken.
   3. (3) A citation of the specific regulations or MHP payment authorization procedures supporting the action.
   4. (4) The beneficiary's right to file an appeal or expedited appeal with the MHP.

   5. (5) The beneficiary's right to a fair hearing or to request an expedited fair hearing, including:

      1. (A) The method by which a hearing may be obtained.

      2. (B) That the beneficiary may be either:

         1. 1. Self-represented.
         2. 2. Represented by an authorized third party such as legal counsel, relative, friend or any other person.
      3. (C) An explanation of the circumstances under which a specialty mental health service will be continued if a fair hearing is requested.
      4. (D) The time limits for requesting a fair hearing or an expedited fair hearing.

2. (b) A Notice of Action, issued pursuant to Section 1850.210(g), shall specify the following:

   1. (1) The reason that the medical necessity criteria were not met, including a citation of the applicable regulation.
   2. (2) The beneficiary's options for obtaining care outside the MHP, if applicable.
   3. (3) The beneficiary's right to request a second opinion on the determination.
   4. (4) The beneficiary's right to file an appeal or expedited appeal with the MHP.

   5. (5) The beneficiary's right to a fair hearing or to request an expedited fair hearing, including:

      1. (A) The method by which a hearing may be obtained.

      2. (B) That the beneficiary may be either:

         1. 1. Self-represented.
         2. 2. Represented by an authorized third party such as legal counsel, relative, friend or any other person.
      3. (C) The time limits for requesting a fair hearing or an expedited fair hearing.

Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Section 14684, Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Section 431.244 and Part 438, Subpart F.

History

1. New section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).