32 Miss. Code. R. 1-10.6
Decisions that result in services being denied, terminated, or reduced may be appealed. The consumer/legal representative has thirty (30) days from the date on the notice to appeal the decision. The consumer/legal representative can elect either a local or state hearing. All appeals must be in writing.
The consumer/legal representative is entitled to an initial appeal at the local level with the MDRS/OSDP Counselor and the immediate supervisor. The action will be explained at that time. The local hearing will be documented and become a permanent part of the consumer file.
If the consumer/legal representative does not agree with the decision made following the local hearing, he/she may appeal that decision by requesting a State level hearing within 15 days of the notice of the local hearing decision. The consumer/legal representative must submit this request in writing to the Division of Medicaid. Upon receiving the notification from the Division of Medicaid that the consumer has requested a State level hearing, the OSDP Counselor/District Manager assigned will prepare a copy of the pertinent case file documentation used to reach the decision and send the copy to OSDP in the State Office. The copy of the documentation must be forwarded to the Division of Medicaid no later than five (5) days after MDRS has been notified that the consumer has requested a State level hearing.
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.
NOTE:Refer to Resource Guide for appropriate notice of action forms.
32 Miss. Code. R. 1-10.6