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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 34
Effective Month: March 2019 Step 2. Determine the type of hearing requested or required. o DDS and Level of Care denials require a state level hearing – handle as state hearing. o If request does not specify type and issue is not DDS or LOC denial, contact client. If no contact within 3 days, assume a standard local hearing is needed and proceed. o If the request indicates medical urgency, evaluate whether an expedited local (or state if DDS or LOC at issue) is needed and handle accordingly.
Step 3. Re-examine action taken to determine if correct. o If correct, proceed to Step 4. o If incorrect, take corrective action and notify client. Step 4. Schedule local hearing, if appropriate. o Local hearings must be scheduled no later than 20 days after receipt of the request. o Schedule local hearing 5 days in advance, in writing. o Expedited hearings must be held, and a decision issued within 7-days of the request. Make telephone contact with individual to schedule hearing then follow up in writing via DOM-351A.
Step 5. Hold a local level hearing, if appropriate. o Must be held by supervisor not directly involved with the eligibility decision. o Expedited local hearing must be held as soon as possible to meet 7-day timeframe. o Prepare a local hearing summary. o Act on local hearing decision – corrective action as needed or uphold original RO decision. o If benefits have been continued pending the local hearing, continue benefits through advance notice period when local decision is adverse. o Client has 15 days from local hearing decision to request a state hearing whether benefits have continued or not. Exception is the original 30-day period for requesting a hearing has not expired which lengthens the time allowed. o Request for expedited state hearing following adverse local hearing must be referred to Office of Appeals on date written request for state hearing is received. Step 6. Prepare for state level hearing if applicable. o Prepare a state level hearing folder within 5 days of request for a state hearing: ➢ 5-days from original hearing request (Step 1), or ➢ 5-days from state hearing request following adverse local hearing.