Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 300 - Appeals
Chapter 2 - Fee-for-Service Applicant and Beneficiary Appeals
Rule 23-300-2.22 - Appeals for Waiver Beneficiaries Receiving Medicaid Services
Universal Citation: MS Code of Rules 23-300-2.22
Current through September 24, 2024
A. Appeal Procedure for Waivers Administered by the Mississippi Department of Rehabilitative Services (MDRS).
1. MDRS administers benefits for the
following waivers:
a) Independent Living (IL)
Waiver, and
b) Traumatic Brain
Injury/Spinal Cord Injury (TBI/SCI) Waiver,
2. A Case Manager sends a Notice of Action
(NOA) to a beneficiary via certified mail informing the beneficiary that
benefits have been denied.
a) The
beneficiary/beneficiary's representative may request to present an appeal
within thirty (30) days. This appeal request may ask for a local hearing, state
hearing, or both.
b) The
beneficiary/beneficiary's representative may choose to represent themselves or
designate another representative in writing.
3. Local Hearing
a) For the IL and TBI/SCI, local hearings
will be conducted by MDRS. MDRS will issue a determination within thirty (30)
days of the initial request.
b) If
the beneficiary/beneficiary's representative is dissatisfied with the of the
local level determination for any of the waivers listed, the
beneficiary/beneficiary's representative may request a state hearing with the
Division of Medicaid through the methods described in Part 300, Chapter 2, Rule
2.16: State Hearing Requests After
Adverse Local Decision. Requests must be made within fifteen (15) days of the
adverse decision.
4.
State Hearing
a) State hearings are conducted
by the Division of Medicaid.
b) The
beneficiary/beneficiary's representative may either:
1) Request a state hearing at the beginning
of the appeal process, or
2)
Request a state hearing within fifteen (15) days after receiving a local level
determination with which the beneficiary/beneficiary's representative is
dissatisfied.
(a) For beneficiaries receiving
services through the Traumatic Brain Injury/Spinal Cord Injury Waiver, the
request must be made within fifteen (15) days from the date the determination
letter was mailed.
(b) For
beneficiaries receiving services through the Independent Living Waiver, the
request must be made within fifteen (15) days from the date the letter was
received.
c)
State hearings for wavier beneficiaries will be conducted in the same manner as
state hearings for all Division of Medicaid beneficiaries who request a state
hearing, as described in Part 300, Chapter 2, Rule
2.18 of this Title.
d) The Division will issue a determination
within ninety (90) days of the hearing request. Both the Division and MDRS will
inform the beneficiary/beneficiary's representative of the decision in writing.
This decision is final and not appealable to MDRS or the Division of
Medicaid.
B. Appeal Procedures for Waivers Administered by the Mississippi Department of Mental Health (DMH).
1. DMH administers the
Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver.
2. At any point in the DMH appeal process,
the beneficiary/beneficiary's representative may request a state hearing
through the Division of Medicaid.
3. Beneficiaries are notified of level of
care (LOC) or eligibility denials within ten (10) days of the denial of
eligibility for the LOC. The beneficiary has thirty (30) days from the date of
the notice to submit an appeal to the Director of the Bureau of Intellectual
Disabilities/Disabilities (BIDD). Appeals must be submitted in
writing.
4. During the appeal
process, contested services that were already in place must remain in place,
unless the decision is for immediate termination due to possible adverse
circumstances to the beneficiary.
5. The BIDD Director will respond in writing
within thirty (30) days of receipt of the appeal. If more information is
needed, the BIDD Director may request additional information before making a
decision and extend the thirty (30) day timeline.
6. If the beneficiary/beneficiary's
representative is dissatisfied with the BIDD Director's decision, the
beneficiary/beneficiary's representative may appeal to the Executive Director
of DMH in writing by the date noted in the decision letter. Appeals must be
submitted in writing.
7. The
Executive Director of DMH will respond in writing within thirty (30) days of
receipt of the appeal. If more information is needed, the Executive Director of
DMH may request additional information before making a decision and extend the
thirty (30) day timeline.
8. If the
beneficiary/beneficiary's representative is dissatisfied with the Executive
Director of DMH's decision, the beneficiary/beneficiary's representative may
appeal to the Executive Director of Medicaid for a state hearing in writing
within thirty (30) days of receiving notification of the decision.
9. State Hearing
a) State hearings are conducted by the
Division of Medicaid.
b) The
beneficiary/beneficiary's representative may either:
1) Request a state hearing at any point in
the appeal process, or
2) Request a
state hearing within thirty (30) days after receiving a local level
determination with which the beneficiary/beneficiary's representative is
dissatisfied.
c) State
hearings for waiver beneficiaries will be conducted in the same manner as state
hearings for all Division of Medicaid beneficiaries who request a state
hearing, as described in Part 300, Chapter 2, Rule
2.18 of this Title.
d) The Division will issue a determination
within ninety (90) days of the hearing request and inform the
beneficiary/beneficiary's representative and DMH of the decision in
writing.
e) If the
beneficiary/beneficiary's representative is dissatisfied with Division of
Medicaid's decision, the beneficiary/beneficiary's representative may seek
relief in a court of proper jurisdiction.
C. Appeal Procedures for Waivers Administered by the Mississippi Division of Medicaid.
1.
The Division of Medicaid administers the following waivers:
a) Elderly and Disabled (ED) Waiver,
and
b) Assisted Living (AL)
Waiver.
2. A Case
Manager sends a Notice of Action (NOA) to a beneficiary via certified mail
informing the beneficiary that benefits have been denied.
a) The beneficiary/beneficiary's
representative may request to present an appeal within thirty (30) days of the
date of the denial notice. This appeal request may ask for a state
hearing.
b) The
beneficiary/beneficiary's representative may choose to represent themselves or
designate another representative in writing.
3. State Hearing
a) State hearings are conducted by the
Division of Medicaid, Office of Appeals.
b) State hearings for waiver beneficiaries
will be conducted in the same manner as state hearings for all Division of
Medicaid beneficiaries who request a state hearing, as described in Part 300,
Chapter 2, Rule 2.18 of this
Title.
c) The Division will issue a
determination within ninety (90) days of the hearing request. The Division will
inform the beneficiary/beneficiary's representative of the decision in writing.
If the person/legal guarding determines the need for further redress, he/she
may seek relief in a court of appropriate jurisdiction.
42 C.F.R. Part 431 Subpart E; 42 C.F.R. Part 438 Subpart F; 42 C.F.R. Part 431 Subpart E; Miss. Code Ann. §§ 43-13-116, 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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
