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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 101 – Coverage Groups and Processing Applications and Reviews Page 113

Effective Month: March 2018 ACTION POLICY REQUIREMENT PROCEDURAL REQUIREMENTS where facility is located. Timely Processing of Applications (SOP or Standard of Promptness) • 45 days for MAGI and ABD if no DDS decision needed. • Applications filed with FFM have a SOP beginning with date received by DOM; filing date is date filed with FFM. • 90 days for ABD if DDS decision needed. Days are counted from date of filing application to decision date, except those filed with FFM.

Making an Eligibility Decision Verification of eligibility factors comes from data available from electronic data sources and/or the applicant. If data is unavailable from data sources or if applicant provided information is inconsistent, verify independently, which includes obtaining from applicant.

Case documentation is required to support an eligibility decision. Use the Case Narrative or document within the case record. Issuing Requests for Information (RFI) ABD applications utilize a 307 (1st RFI) and 309 (2nd RFI). If additional time is requested, hold to end of allowed processing time period applicable. MAGI applications require direct contact 1st, then utilize a 307 (1st RFI). If additional time is requested, hold to end of 45 days. Refer to “Reasonable Efforts to Assist All Applicants” to avoid multiple denials of eligibility when the applicant is incapable, or rep is unwilling to provide needed information. Compliance After Denial If MAGI or ABD applicant fully complies by providing needed information by the end of the month following the month of denial, use denied application and application date and reinstate the application.