23 Miss. Code. R. 300-2.17 - [Effective until 7/1/2025] State Hearing Requests for Appeals that Must Originate as a State Hearing
A. Disability or
Blindness Denials.
1. An appeal related to a
disability or blindness denial must be resolved through a state hearing.
Procedures for filing a state hearing appeal are detailed in Rules
2.5 through
2.8 of this chapter and should be
followed.
2. After the state
hearing, the hearing officer will forward all medical information to the
Disability Determination Service (DDS) for reconsideration. A review team
consisting of medical staff who were not involved in any way with the original
decision will review the medical information and hearing transcript and give a
decision on the disability or blindness factor.
3. The DDS decision is final and binding on
the Division of Medicaid.
B. Level of Care Denials or Terminations for
a Disabled Child Living at Home (DCLH).
1. An
appeal related to level of care denials or terminations for a Disabled Child
Living at Home must be resolved through a state hearing. Procedures for filing
a state hearing appeal are detailed in Rules
2.5 through
2.8 of this chapter and should be
followed.
2. The final decision of
the hearing officer must be based on oral and written evidence, testimony,
exhibits and other supporting documents that were discussed at the hearing. The
decision cannot be based on any material, oral or written, not available to and
discussed with the beneficiary/applicant or representative.
3. Following the hearing, the hearing officer
will make a written recommendation of the decision to be rendered as a result
of the hearing. The recommendation, which becomes part of the state hearing
record, will cite the appropriate rule that governs the
recommendation.
4. The Executive
Director of the Division of Medicaid, upon review of the recommendation,
proceedings and the record, may:
a) Sustain
the recommendation of the hearing officer,
b) Reject the recommendation,
c) Remand the matter to the hearing officer
for additional testimony and evidence, in which case the hearing officer will
submit a new recommendation to the Executive Director after the additional
action has been taken, or
d) Amend
the recommendation and adopt the remainder.
5. The decision letter will specify any
action to be taken by the agency and any revised eligibility dates. If the
decision is adverse and continuation of benefits is applicable, the
applicant/beneficiary or representative will be notified of the new effective
date of reduction or termination of benefits or services, which will be fifteen
(15) days from the date of the notice of decision.
6. The decision of the Executive Director of
the Division of Medicaid is final and binding. The applicant/beneficiary is
entitled to seek judicial review in a court of appropriate
jurisdiction.
7. Should the
applicant/beneficiary file an appeal of an issue that has already been
adjudicated without a change in circumstances or agency rule, the appeal will
be dismissed as untimely, and the applicant/beneficiary will be notified in
writing by the office to which the appeal was made (be it the Regional Office
or the Central Office) explaining that the appeal cannot be honored. If the
applicant/beneficiary's circumstances or agency rule have changed, the
applicant/beneficiary will be advised to file a new application.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
A. Disability or Blindness Denials.
1. An appeal related to a disability or blindness denial must be resolved through a state hearing. Procedures for filing a state hearing appeal are detailed in Rules 2.5 through 2.8 of this chapter and should be followed.
2. After the state hearing, the hearing officer will forward all medical information to the Disability Determination Service (DDS) for reconsideration. A review team consisting of medical staff who were not involved in any way with the original decision will review the medical information and hearing transcript and give a decision on the disability or blindness factor.
3. The DDS decision is final and binding on the Division of Medicaid.
B. Level of Care Denials or Terminations for a Disabled Child Living at Home (DCLH).
1. An appeal related to level of care denials or terminations for a Disabled Child Living at Home must be resolved through a state hearing. Procedures for filing a state hearing appeal are detailed in Rules 2.5 through 2.8 of this chapter and should be followed.
2. The final decision of the hearing officer must be based on oral and written evidence, testimony, exhibits and other supporting documents that were discussed at the hearing. The decision cannot be based on any material, oral or written, not available to and discussed with the beneficiary/applicant or representative.
3. Following the hearing, the hearing officer will make a written recommendation of the decision to be rendered as a result of the hearing. The recommendation, which becomes part of the state hearing record, will cite the appropriate rule that governs the recommendation.
4. The Executive Director of the Division of Medicaid, upon review of the recommendation, proceedings and the record, may:
a) Sustain the recommendation of the hearing officer,
b) Reject the recommendation,
c) Remand the matter to the hearing officer for additional testimony and evidence, in which case the hearing officer will submit a new recommendation to the Executive Director after the additional action has been taken, or
d) Amend the recommendation and adopt the remainder.
5. The decision letter will specify any action to be taken by the agency and any revised eligibility dates. If the decision is adverse and continuation of benefits is applicable, the applicant/beneficiary or representative will be notified of the new effective date of reduction or termination of benefits or services, which will be fifteen (15) days from the date of the notice of decision.
6. The decision of the Executive Director of the Division of Medicaid is final and binding. The applicant/beneficiary is entitled to seek judicial review in a court of appropriate jurisdiction.
7. Should the applicant/beneficiary file an appeal of an issue that has already been adjudicated without a change in circumstances or agency rule, the appeal will be dismissed as untimely, and the applicant/beneficiary will be notified in writing by the office to which the appeal was made (be it the Regional Office or the Central Office) explaining that the appeal cannot be honored. If the applicant/beneficiary's circumstances or agency rule have changed, the applicant/beneficiary will be advised to file a new application.