Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 208 - Home and Community Based Services (HCBS) Long Term Care
Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver
Rule 23-208-2.11 - Due Process Protection
Universal Citation: MS Code of Rules 23-208-2.11
Current through September 24, 2024
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.
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.
Disclaimer: These regulations may not be the most recent version. Mississippi may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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