(a) Each denial or other deficiency that the Department of Human Services makes against a Medicaid provider shall be prepared in writing and shall specify:(1) The nature of the adverse decision;(2) The statutory provision or specific rule alleged to have been violated; and(3) The facts and grounds that form the basis for the adverse decision.
(1) The nature of the adverse decision;
(2) The statutory provision or specific rule alleged to have been violated; and
(3) The facts and grounds that form the basis for the adverse decision.
(b) A notice of an adverse decision sent to a provider shall contain at a minimum:(1) A clear and detailed explanation of the rationale for the adverse decision; and(2) Citations to all specific protocols, procedures, or policy manual references that were relied upon in making the adverse decision.
(1) A clear and detailed explanation of the rationale for the adverse decision; and
(2) Citations to all specific protocols, procedures, or policy manual references that were relied upon in making the adverse decision.