Section 403.429 - Denial of Services and Administrative Review(A) A failure or refusal by a home health agency to provide services that have been ordered by the member's attending physician and that are within the range of payable services is not an action by the MassHealth agency or its designee that a member may appeal; but such failure or refusal constitutes a violation of these regulations for which administrative sanctions may be imposed, with the exception of instances where the home health agency does not reasonably have staffing availability or cannot reasonably procure staffing to provide services. The MassHealth agency receives and acts upon complaints from physicians and ordering non-physician practitioners, continuing-care coordinators, and other social-services agencies, as well as from members and their families. A failure or refusal by a physician or ordering non-physician practitioner to order services or to certify their medical necessity is not an action by the MassHealth agency or its designee that a member may appeal.(B) When a home health agency believes that services ordered by the physician or ordering non-physician practitioner are not payable under 130 CMR 403.000, the agency must refer the matter to the MassHealth agency for a payment decision. If and to the extent the MassHealth agency determines that the ordered services are payable, the agency must provide those services.Amended by Mass Register Issue 1319, eff. 8/12/2016.Amended by Mass Register Issue 1343, eff. 7/14/2017.Amended by Mass Register Issue 1472, eff. 7/1/2022.