23 Miss. Code. R. 300-2.21 - Continuation of Benefits
When an applicant/beneficiary or representative requests a hearing within the Advance Notice Period, benefits must be continued or reinstated to the benefit level in effect prior to the planned adverse action, if a timely request is filed.
A. Timely
Request for Continuation of Benefits.
1. To
determine if the request for continuation of benefits is timely, the request
must be received by the regional office within ten (10) days from the notice
date of the adverse action.
2. Any
hearing requested or dated after this period will not be accepted as a timely
request for continuation of benefits.
B. Continuation of Benefits When Local
Decision is Adverse.
1. The
applicant/beneficiary may request a state hearing if the local hearing is
adverse.
2. If benefits have been
continued pending the local hearing, then benefits will continue pending a
state hearing decision as long as the request for the state hearing is made
within fifteen (15) days of the date on the Notice of Local Hearing
Decision.
C. Agency
Action Upheld in Final Hearing Decision.
1.
When the final hearing decision is adverse to the applicant or beneficiary, the
Medicaid specialist will terminate or reduce the continued benefits using the
original reason for the adverse action.
2. A second (2nd) Notice of Adverse Action is
not required.
D. When an
adverse action is ultimately upheld, the Division of Medicaid has the right to
initiate recovery procedures against the applicant or beneficiary to recoup the
cost of any medical services furnished the applicant or beneficiary, to the
extent they were furnished solely based on the provision for continuation of
benefits.
Notes
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No prior version found.