Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 300 - Appeals
Chapter 2 - Fee-for-Service Applicant and Beneficiary Appeals
Rule 23-300-2.2 - Definitions

A. Case Record as all documents relevant to the administration of an appeal, including but not limited to all correspondence, applications, medical records and decisions, and past appeals.

B. Course of Treatment as a planned program of one or more services or supplies.

C. Grievance as an expression of dissatisfaction submitted orally or in writing about any matter, including but not limited to the quality of services provided, rudeness from a Division of Medicaid employee, unfair treatment, or failure to respect the applicant or beneficiary's rights.

D. Local Hearing or Reconsideration as a hearing held at the Division of Medicaid Regional Office from which the decision the applicant or beneficiary wishes to appeal was generated.

E. State Hearing or Fair Hearing as an orderly, but informal meeting in which an applicant or beneficiary or his/her representative is afforded an opportunity to address an impartial hearing officer for the purpose of presenting oral testimony and/or evidence of the individual's entitlement to medical assistance and services.

F. Hearing Officer as the presiding officer appointed by the Executive Director or the Executive Director's designee to conduct administrative hearings within the guidelines stated in this chapter. The Hearing Officer may:

G. A legal representative or representative as the applicant or beneficiary's authorized representative, an attorney retained to represent the applicant or beneficiary, a paralegal representative with a legal aid service, the parent of a minor child if the beneficiary or appellant is a child, a legal guardian or conservator or an individual with power of attorney for the applicant or beneficiary.

H. Final Decision as the decision rendered by the Executive Director at the end of the hearing process, subject to appeal only through judicial review.

I. Judicial Review as the relief available to an applicant or beneficiary after the Division of Medicaid has rendered its final decision. Final decisions by the Division of Medicaid may be appealed to the court of proper jurisdiction for Judicial Review.

J. Advance Notice Period as the time in which the Division of Medicaid must send a notice before the date of an action, except when advance notice is impossible, or in cases of probable fraud.

K. Adverse Action as a decision rendered by the Division of Medicaid denying or reducing an applicant or beneficiary's coverage or desired treatment. An applicant or beneficiary will receive written notice of an adverse action and be able to file for an appeal after receipt of this notice.