Due Process Protection

Due Process Protection A. The Division of Medicaid and Mississippi Department of Rehabilitation Services (MDRS) are responsible for operating a dispute resolution process separate from a fair hearing process. The Division of Medicaid has the final authority over any dispute. 1. The types of disputes addressed by an informal dispute resolution process include issues concerning service providers, waiver services, and other issues that directly affect their waiver services. 2. MDRS must inform the beneficiary/representative at the initial assessment of the specific criteria for the dispute, complaint/grievance and hearing processes. 3. MDRS must inform the beneficiary/representative of their rights which address disputes, complaints/ grievances and hearings. 4. A beneficiary participating in the TBI/SCI waiver or their representative may engage the dispute resolution process by notifying MDRS or DOM of their concern either by phone or in writing. 5. The Division of Medicaid has the final authority over any dispute. B. The Division of Medicaid provides an opportunity to request a Fair Hearing to beneficiaries: 1. Who are not given the choice of home and community-based services as an alternative to the institutional care, 2. Who are denied the service(s) of their choice or the provider(s) of their choice, or 3. Whose services are denied, suspended, reduced, or terminated. C. Notice of Action (NOA) 1. MDRS must provide the beneficiary with a Notice of Action via certified mail as required in C.F. R. §431.210. 2. The NOA must include: a) A description of the action the provider has taken or intends to take, b) An explanation for the action, c) Notification that the beneficiary/representative has the right to file an appeal, d) Procedures for filing an appeal, e) Notification of beneficiary/representative’s right to request a Fair Hearing, f) Notice that the beneficiary/representative has the right to have benefits continued pending the resolution of the appeal, and g) The specific regulations or the change in federal or state law that supports or requires the action. D. A person applying for or participating in the TBI/SCI waiver has any additional rights to an appeal and/or hearing which are provided for in Title 23, Mississippi Administrative Code, Part 300.