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(c) Notice of adverse benefit determination. Each contract must provide for the MCO, PIHP, or PAHP to notify the requesting provider, and give the enrollee written notice of any decision by the MCO, PIHP, or PAHP to deny a service authorization request, or to authorize a service in an amount, duration, or scope that is less than requested. For MCOs, PIHPs, and PAHPs, the enrollee's notice must meet the requirements of §438.404. For Medicaid contracts with an applicable integrated plan, as defined in §422.561 of this chapter, in lieu of the provisions in this paragraph governing notices of adverse benefit determinations, the provisions set forth in §§422.629 through 422.634 of this chapter apply to determinations affecting dually eligible individuals who are also enrolled in a dual eligible special needs plan with exclusively aligned enrollment, as defined in §422.2 of this chapter.

(d) *  *  *

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(4) For Medicaid contracts with an applicable integrated plan, as defined in §422.561 of this chapter, timelines for decisions and notices must be compliant with the provisions set forth in §§422.629 through 422.634 of this chapter in lieu of §§438.404 through 438.424.

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(f) Applicability date.

(1) Subject to paragraph (f)(2) of this section, this section applies to the rating period for contracts with MCOs, PIHPs, and PAHPs beginning on or after July 1, 2017. Until that applicability date, States are required to continue to comply with §438.210 contained in the 42 CFR parts 430 to 481, edition revised as of October 1, 2015.

(2) Provisions in this section affecting applicable integrated plans, as defined in §422.561 of this chapter, are applicable no later than January 1, 2021.

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