Page 20

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 20

Effective Month: March 2019 100.04.02 EXPEDITED HEARINGS An expedited hearing, either local or state, must be granted if the agency determines that the 90-day timeframe described in “Timeframe for the Entire Hearing Process (Local and/or State Hearings)” could jeopardize the individual’s life, health or ability to attain, maintain or regain maximum function, i.e., the medical urgency of the individual’s situation must be taken into consideration. An expedited hearing must be granted if the individual attests to an immediate need for a health service or services that, if delayed, could jeopardize the individual’s life or health. Take the following into consideration in making the decision to approve or deny a request for a local expedited hearing. • Does the individual currently have health insurance. If the individual has current coverage, Medicaid and Medicare included, that provides major medical coverage that would cover the cost of an urgent medical procedure or treatment then an expedited hearing would not be granted. • If the individual is a terminated recipient who requested continuation of benefits within 15 days of the adverse action notice and benefits are continued, an expedited hearing would not be granted. • Does the individual have an urgent medical procedure or treatment scheduled, or an urgent procedure/treatment that needs to be scheduled that may indicate a need for an expedited hearing. For example, an uninsured high risk pregnant woman attesting to the need for urgent pre-natal care may qualify for an expedited hearing. • If there is no medical urgency attested to in the request, an expedited hearing will not be granted. The hearing request will be handled as a standard hearing. • Expedited hearings apply to both MAGI and ABD denied or terminated individuals. However, for ABD purposes, if disability or level of care for a disabled child is the issue under appeal, it must be handled as an expedited state hearing. Expedited appeal requests may be submitted in person, by mail, by electronic submission or orally, as described below. A request for an expedited local hearing will be granted or denied by the regional office. A request for an expedited state hearing will be granted or denied by the Office of Appeals. If the regional office receives the request for an expedited state