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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual

CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |400 Effective Month: December 2016 101.11 NOTIFICATION The recipient and, when applicable, the medical facility must be notified in writing of the action taken on an application or an active case when eligibility or benefit level is affected by a change either at the time of a full review or as a result of a reported change prompting a special review. Notices are generated by the system based on the type of contact and the results of the eligibility determination. NOTE: It is the specialist’s responsibility to review and, if needed, correct notices in the system before they are mailed to the recipient. If a manual notice is required for the recipient, refer to instructions for the DOM-305, Notice of Action, or DOM-306, Notice of Adverse Action. When a manual notice must be issued to a facility, DOM-317, Exchange of Information Between Long Term Care Facility and Medicaid Regional Office, is used. 101.11.01 ADVANCE NOTICE Federal regulations require issuance of a notice of adverse action 10 days before the effective date of an action to reduce or terminate benefits. However, federal regulations also require that for continuation of benefits to apply when requesting a hearing, the 10-day advance notice period includes 5-days mailing time. To simplify this requirement, the adverse action deadline is set for the 15th of each month except in February, which is the 13th of the month, to ensure a minimum of 5-days mailing time. During the advance notice period, the recipient is allowed time to fully comply with unmet requirements, provide information or verification that will alter the decision to terminate or reduce benefits, or request a Fair Hearing with continued benefits. If this occurs, the agency must take prompt and appropriate action to reinstate benefits.