23 Miss. Code. R. 300-1.2 - Categories of Appeals
A. The Division of
Medicaid provides an appeal process for applicants, beneficiaries, and
providers.
B. Appeals for
Fee-for-Service (FFS) Applicants, Beneficiaries, and Providers
1. An applicant or beneficiary, or an
applicant/beneficiary's representative wishing to appeal a Reconsideration
decision originating from FFS Medicaid must file the appeal directly with the
Division of Medicaid, following rules and procedures stated in Part 300,
Chapter 2.
2. A provider wishing to
appeal a Final Agency Action originating from FFS Medicaid must file the appeal
directly with the Division of Medicaid, following rules and procedures stated
in Part 300, Chapter 3.
C. Appeals for MississippiCAN (MSCAN)
Beneficiaries and Providers
Beneficiaries and providers must exhaust all appeals with the coordinated care organizations (CCOs) prior to requesting a fair and/or administrative hearing with the Division of Medicaid.
D. Appeals for Waiver Beneficiaries Receiving
Medicaid Services Through Other State Agencies.
1. Appeal Procedure for Waivers Administered
by the Mississippi Department of Rehabilitative Services (MDRS) are covered
under Part 300, Chapter 2, Rule
2.22.A. MDRS administers benefits
for the following waivers:
a) Independent
Living (IL) Waiver, and
b)
Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver.
2. Appeal Procedures for Waivers
Administered by the Mississippi Department of Mental Health (DMH) are covered
under Part 300, Chapter 2, Rule
2.22.B. DMH administers the
Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver.
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