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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual

CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |301 Effective Month: December 2016 101.07.03 ABD STANDARDS OF PROMPTNESS Federal rules require that applications be approved or denied, and the applicant notified, within 45 days from the date the application was filed. The processing timeframe is 90 days when a disability determination is required before the eligibility determination can be completed. However, if a separate disability decision is not required, the 45-day standard applies. The applicable standard of promptness, i.e., 45 or 90 days, is applied to an ABD application from the date an application is filed to the date the notice of decision is mailed to the applicant. When there is a delay, the reason must be documented in the record. 101.07.04 MAGI-RELATED STANDARD OF PROMPTNESS MAGI-related programs have a 45-day standard of promptness. No more than 45 days may lapse from the date an application is filed to the date the notice of decision is mailed to the applicant. Any delays in processing MAGI-related applications must be client-caused or requested. When there is a delay, the reason must be documented in the record. NOTE: For MAGI applications filed with the FFM, the date of application is the date it is filed with the FFM; however, the standard of promptness begins when the application is received by DOM.

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Page 50

Official source

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual

CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |301 Effective Month: December 2016 101.07.03 ABD STANDARDS OF PROMPTNESS Federal rules require that applications be approved or denied, and the applicant notified, within 45 days from the date the application was filed. The processing timeframe is 90 days when a disability determination is required before the eligibility determination can be completed. However, if a separate disability decision is not required, the 45-day standard applies. The applicable standard of promptness, i.e., 45 or 90 days, is applied to an ABD application from the date an application is filed to the date the notice of decision is mailed to the applicant. When there is a delay, the reason must be documented in the record. 101.07.04 MAGI-RELATED STANDARD OF PROMPTNESS MAGI-related programs have a 45-day standard of promptness. No more than 45 days may lapse from the date an application is filed to the date the notice of decision is mailed to the applicant. Any delays in processing MAGI-related applications must be client-caused or requested. When there is a delay, the reason must be documented in the record. NOTE: For MAGI applications filed with the FFM, the date of application is the date it is filed with the FFM; however, the standard of promptness begins when the application is received by DOM.