(1) The department or its designee must notify the youth or the youth's designated representative in writing of a decision denying eligibility or a request for services. The requirements of ARM 37.5.505 do not apply to the notice. The notice will state:

(a) the youth's name and identifying information;

(b) a statement of the decision, including the specific services, dates, and other information necessary to identify the matter at issue;

(c) a concise statement of the reasons for the decision; and

(d) an explanation of how to request a grievance or reconsideration regarding the determination.

(2) If the department fails to provide notice or fails to timely provide notice or if a notice required by (1) fails to comply substantially with the requirements of (1), the remedy is the provision of a new notice which does comply substantially with (1) and a new opportunity to request a reconsideration regarding the decision specified in the notice. A failure to give adequate or timely notice under (1) does not entitle the member to an authorization for the services that were denied.

(3) A youth has the right to any applicable grievance processes provided in ARM 37.5.318 regarding a denial or termination of plan eligibility.

(4) The department or its designee may request additional supporting information or documentation from the youth or the provider for purposes of a grievance or informal reconsideration.

(a) The department will consider the written materials submitted and the rationale for the decision. In its discretion, if the department finds that resolution of the issues would be aided, the department may contact persons involved in the case, interested agencies, or mental health professionals and may request that the youth, youth's representative, a mental health professional, a provider representative, or other appropriate persons to appear in person or by telephone conference to discuss the case.

(b) The department must make a decision on the informal reconsideration and notify the youth or the youth's representative in writing of the decision.

(5) A youth must request a grievance according to the requirements specified by the department's designee.

(6) A youth must request an informal reconsideration within 30 days after receiving notice of the grievance decision. A youth that does not timely request an informal reconsideration is deemed to have accepted the determination and is not entitled to any further notice or review opportunity.

(7) A youth is not entitled to continuation of benefits under these rules, ARM 37.5.316, or 42 CFR, part 431, subpart E.

(8) A youth is entitled only to the processes specifically provided in this rule to contest an adverse decision by the department or its designee.

(9) A youth is not entitled to any grievance, reconsideration, review, hearing, or other appeal process with respect to changes in eligibility coverage or other plan benefits which result from generally applicable changes in eligibility requirements, coverage provisions, rates, imposition of limitations, or other changes.