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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 100 – General Provisions P a g e | 35
Effective Month: March 2019 ➢ If expedited state hearing is requested, hearing folder must be prepared and forwarded immediately upon receipt of the request to Office of Appeals. ➢ Ensure hearing folder has all required material. o Act on state level hearing decision when received. No additional notices are issued by RO. Hearing decision letter addresses all issues under appeal.
Changes Which Occur During the Hearing Process • A change that becomes known during the hearing process that is not related to issue under appeal is handled as a separate adverse action (requires 15-day notice). • New adverse action can be combined with current issue under appeal if time allows. • A change that becomes known during actual state hearing will result in a recess so that an adverse action notice may be issued by RO. New adverse action may be combined with state hearing when reconvened.
100.05 IMPROPER PAYMENTS When Medicaid benefits are available to recipients improperly, the central and regional office must identify these situations and take corrective action. Improper payments occur when the Medicaid or CHIP coverage authorized by DOM either underpays or overpays a recipient’s fee-for-service or managed care costs. An improper payment may be in the form of an underpayment or an overpayment. Corrective action includes recovering misspent funds directly from a recipient or from the recipient’s state tax refund. Improper payments situations include, but are not limited to, the following: • Begin or end dates of eligibility are incorrect or total ineligibility exists. • A category of eligibility is incorrectly assigned based on incorrect eligibility information entered in the system. • Incorrect Medicaid Income is calculated due to over or under reported income. • Policy is misapplied that impacts eligibility. • A case is not reviewed timely, or a change is not reported timely and the review or change results in benefits that should have been reduced or results in ineligibility. • A transfer of assets is discovered after eligibility has been approved.