Page 49

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual

CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |300 Effective Month: December 2016 101.07 STANDARDS OF PROMPTNESS Eligibility must be determined within the appropriate timeframes for the program type as discussed below. If there is a delay in processing, the reason must be clearly documented in the record. 101.07.01 REGIONAL OFFICE RESPONSIBILITIES Each regional office must have controls in place which ensure timely application processing at all staff levels, including sufficient time for supervisory review and corrections. Applications should generally be processed in the order in which received, taking into consideration promptness and delay in receipt of verifications, and in some cases, urgent need. Under no circumstances should an application be approved without the proper verifications and documented eligibility for each applicant. 101.07.02 EXCEPTIONS TO TIMELY PROCESSING The agency must determine eligibility within established standards, except in unusual circumstances when a decision cannot be reached because of: • Failure or delay on the part of the applicant; • A disability decision has not been returned by DDS; or • Administrative or other emergency delay that could not be controlled by the agency. Time standards may not be used by the agency as a waiting period before determining eligibility or as a reason to deny eligibility because the agency has not determined eligibility within the time standards.

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Page 49

Official source

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual

CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |300 Effective Month: December 2016 101.07 STANDARDS OF PROMPTNESS Eligibility must be determined within the appropriate timeframes for the program type as discussed below. If there is a delay in processing, the reason must be clearly documented in the record. 101.07.01 REGIONAL OFFICE RESPONSIBILITIES Each regional office must have controls in place which ensure timely application processing at all staff levels, including sufficient time for supervisory review and corrections. Applications should generally be processed in the order in which received, taking into consideration promptness and delay in receipt of verifications, and in some cases, urgent need. Under no circumstances should an application be approved without the proper verifications and documented eligibility for each applicant. 101.07.02 EXCEPTIONS TO TIMELY PROCESSING The agency must determine eligibility within established standards, except in unusual circumstances when a decision cannot be reached because of: • Failure or delay on the part of the applicant; • A disability decision has not been returned by DDS; or • Administrative or other emergency delay that could not be controlled by the agency. Time standards may not be used by the agency as a waiting period before determining eligibility or as a reason to deny eligibility because the agency has not determined eligibility within the time standards.