Decision Letters Clause Samples

Decision Letters. The Hospital is responsible for providing the applicant with a decision letter notifying the applicant of the HPE eligibility determination at the time of the determination. 9.6.1 The letter must be on Hospital letterhead. 9.6.2 For each applicant who applies for HPE, the letter must contain the name, DOB, and HEAplus Person Identification Number (PID), the eligibility decision, the begin date and end dates of the HPE period, the date a full Medicaid/AHCCCS application was submitted if it was submitted at the same time the HPE application was approved. 9.6.3 If a full Medicaid/AHCCCS application was not submitted at the same time the HPE application was approved, the letter must explain to the applicant the need to submit a full Medicaid/AHCCCS application, and the deadline date for submission of this application. The letter must also contain a date, time and location of a follow-up appointment for the applicant to complete the full Medicaid/AHCCCS application. 9.6.4 When the eligibility decision is a denial, the letter must indicate that the applicant does not have appeal rights. 9.6.5 The decision letter must comply with the AZ HPE Policy and the HPE Decision Notice Template.