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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page |517 Effective Month: December 2016 101.15.11 DISPOSITION OF A REGULAR REVIEW – ABD AND MAGI
ABD and MAGI redeterminations are completed administratively, if possible, or by use of a pre-populated review form that is issued either systematically or manually, as discussed above. When the form is returned and all information subject to change has been evaluated and a decision is reached regarding continuing eligibility, the following actions will be authorized:
101.15.11A APPROVAL OF A REGULAR REVIEW When the ABD recipient/representative or MAGI head of household has complied with all redetermination requirements and provides required verifications, the specialist will review the eligibility criteria; ensure appropriate documentation is filed in the case record and input the data into the system for an eligibility decision. All redeterminations are submitted for supervisory review and authorization. When eligibility will continue at the same level, a new review due date is established and an approval notice issued to the recipient or head of household when benefits are authorized.
101.15.11B REDUCTION OR TERMINATION OF BENEFITS Advance notice of adverse action is required, if the eligibility decision results in termination of benefits for all or some members of the case. During the adverse action period, the recipient or head of household is allowed time to fully comply with unmet redetermination requirements, provide information or verification that will alter the adverse action decision or request a fair hearing with continued benefits.
For MAGI-related cases, adverse action is required to terminate benefits for one or all members of the household.
For ABD cases, adverse action is required in all of the following situations:
• Termination of benefits; • Conversion to a reduced services coverage group; • Termination of a nursing facility per diem payment.