23 Miss. Code. R. 300-2.3 - Appeal Rights of Applicants and Beneficiaries

A. The Division of Medicaid provides an opportunity to contest any adverse decisions through an appeal and fair hearing process, and notifies applicants, beneficiaries and/or their legal representatives of their Medicaid appeal rights. The following categories have appeal processes through the Division of Medicaid:

1. Fee-for-service (FFS) beneficiaries,

2. Beneficiaries enrolled in a coordinated care organization (CCO),

3. Beneficiaries enrolled in a Medicaid waiver,

4. Beneficiaries who are subject to a proposed transfer or discharge from a long-term care facility or nursing facility,

5. Individuals who are adversely affected by the pre-admission screening or the annual resident review, and

6. Any other Medicaid applicants or beneficiaries not enumerated herein.

B. The Division of Medicaid's informal dispute and appeal process has four (4) levels:

1. Grievance,

2. Local Hearing,

3. State Hearing, also referred to as Fair Hearing, and

4. Judicial Review.

C. A hearing request made prior to any adverse action being taken will not be accepted.

D. The Division of Medicaid is not required to grant a hearing if the sole issue is a federal or state law requiring an automatic change adversely affecting some or all beneficiaries.

E. At the time of any action affecting an applicant or beneficiary's claim for assistance, the applicant or beneficiary must be:

1. Informed of the right to a hearing,

2. Notified of the method by which to obtain a hearing, and

3. Informed of the right to self-representation at the hearing or to be represented by an authorized person such as an attorney, relative, friend, or other spokesperson.

Notes

23 Miss. Code. R. 300-2.3

42 C.F.R. Part 431 Subpart E; Miss. Code Ann. §§ 43-13-116, 43-13-117, 43-13-121

Adopted 8/1/2020 Amended 3/1/2023