23 Miss. Code. R. 208-2.11 - Due Process Protection

A. The Division of Medicaid and Mississippi Department of Rehabilitation Services (MDRS) are responsible for operating the dispute mechanism separate from a fair hearing process. The Division of Medicaid has the final authority over any dispute.

1. The types of disputes addressed by an informal dispute resolution process include issues concerning service providers, waiver services, and other issues that directly affect their waiver services.

2. MDRS must inform the person/representative at the initial assessment, of the specific criteria for the dispute, complaint/grievance and hearing processes.

3. MDRS must inform the person/representative of their rights which address disputes, complaints/ grievances and hearings.

B. The Division of Medicaid provides an opportunity to request a Fair Hearing to individuals:

1. Who are not given the choice of home and community-based services as an alternative to the institutional care,

2. Who are denied the service(s) of their choice or the provider(s) of their choice, or

3. Whose services are denied, suspended, reduced, or terminated.

C. MDRS must provide the individual with a Notice of Action (NOA) via certified mail as required in 42 C.F.R. § 431.210.

D. The NOA must include:

1. A description of the action the provider has taken or intends to take,

2. An explanation for the action,

3. Notification that the person/representative has the right to file an appeal,

4. Procedures for filing an appeal,

5. Notification of person/representative's right to request a Fair Hearing,

6. Notice the person/representative has the right to have benefits continued pending the resolution of the appeal, and

7. The specific regulations or the change in Federal or State law that supports or requires the action.

Notes

23 Miss. Code. R. 208-2.11

42 C.F.R. 431, Subpart E; 42 C.F.R. §§ 440.180, 441.301, 441.307; Miss. Code Ann. §§ 37-33-157, 43-13-117, 43-13-121.

Revised - 01/01/2013 Amended 9/1/2019