Advance Action Notice: - State of Michigan - michigan 2025

1. Click ‘Get Form’ to open the Advance Action Notice in the editor.
2. Begin by entering the date at the top of the form. This is crucial for tracking the notice timeline.
3. Fill in the recipient's name, address, city, state, and zip code in the designated fields to ensure proper delivery.
4. In the body of the notice, clearly state whether services will be reduced or suspended. Specify which services are affected.
5. Include a legal basis for this decision referencing 42 CFR 440.230 (d) as required.
6. Provide instructions for requesting a Medicaid Fair Hearing, including necessary details such as deadlines and submission requirements.
7. Finally, sign off with your name and title as a provider representative before saving or sending the document.

Start using our platform today to easily complete your Advance Action Notice for free!