Glossary
Notice of action
In one sentence
The letter that starts your clock. In fee-for-service Medicaid an "action" is defined to include a cut to something already approved, which is why a prior authorization that expires produces a notice with appeal rights on it.
Also written as Notice of adverse benefit determination.
What notice of action actually means
Whatever your state calls the envelope, this is the document your deadline counts from. Keep it, and note the date on its face, because the filing window in most states runs from the mailing date printed there rather than from the day it reached you.
The definition of what triggers one is broader than a refusal of something new. Ending or reducing a benefit you already have is an action, and the regulation says so specifically for benefits under a current approved prior authorization. That sentence is why a state that lets existing GLP-1 authorizations lapse has to send notices, and why those notices carry appeal rights.
The text it comes from
This is the wording the definition rests on. Where it decides anything for you, read the section rather than our summary of it.
The definition reaches benefits you already have. An action includes "a termination, suspension of, or reduction in covered benefits or services, including benefits or services for which there is a current approved prior authorization."
42 CFR §431.201, Electronic Code of Federal Regulations, effective August 2026 · source
Where this comes from
- 42 CFR §431.201, Electronic Code of Federal Regulations, effective August 2026 — www.ecfr.gov/current/title-42/part-431/section-431.201
Where this comes up
American GLP is not a law firm, an insurer, a government office or a clinician, and nothing here is legal or medical advice. This page says what a published rule means by a word. Which rulebook governs you depends on your plan, and your own notice and plan documents govern your case.