32 Miss. Code. R. 1-10.5
The completed PAS will be adjudicated through application of an eligibility algorithm that generates a numerical score. The numerical score will be compared to a DOM defined threshold score of fifty (50) or greater. If an individual's score is equal to or greater than the threshold of fifty (50), the applicant/client will be determined clinically eligible for Medicaid long term care.
Individuals seeking applicable HCBS waiver programs that meet the threshold of fifty (50) or greater, or approved based on a secondary review will be referred to the requested HCBS waiver program. Each request will be considered individually and the applicant/client shall be admitted to the waiver as soon as possible. DOM/LTC will submit the required documentation to Eligibility prior to admission as required for each HCBS waiver program. Financial eligibility requirements must be met at that time.
The Division of Medicaid will assign a hearing officer. The consumer/legal representative will be given advance notice of the hearing date, time, and place. The hearing may be conducted with all parties involved present, or it may be conducted as a conference call (telephone) hearing. The hearing will be recorded.
The hearing officer will make a recommendation, based on all evidence presented at the hearing, to the Executive Director of the Division of Medicaid. The Executive Director will make the final determination of the case, and the consumer/legal representative will receive written notification of the decision. The final administrative action including state or local will be made within ninety (90) days of the date of the initial request for a hearing. OSDP will be notified by the Division of Medicaid to either initiate/continue or terminate/reduce services.
During the appeals process, contested services that were already in place must remain in place unless the decision is one of immediate termination due to possible danger or racial or sexual harassment of the service providers. The OSDP Counselor/registered nurse is responsible for ensuring that the consumer receives all services that were in place prior to their receipt of the notice that informed them that an action will occur regarding services.
32 Miss. Code. R. 1-10.5