Categories of Appeals

Categories of Appeals A. The Division of Medicaid provides an appeal process for applicants, beneficiaries, and providers. B. Appeals for Fee-for-Service (FFS) Applicants, Beneficiaries, and Providers 1. An applicant or beneficiary, or an applicant/beneficiary’s representative wishing to appeal a Reconsideration decision originating from FFS Medicaid must file the appeal directly with the Division of Medicaid, following rules and procedures stated in Part 300, Chapter 2. 2. A provider wishing to appeal a Final Agency Action originating from FFS Medicaid must file the appeal directly with the Division of Medicaid, following rules and procedures stated in Part 300, Chapter 3. C. Appeals for MississippiCAN (MSCAN) Beneficiaries and Providers Beneficiaries and providers must exhaust all appeals with the coordinated care organizations (CCOs) prior to requesting a fair and/or administrative hearing with the Division of Medicaid. D. Appeals for Waiver Beneficiaries Receiving Medicaid Services Through Other State Agencies. 1. Appeal Procedure for Waivers Administered by the Mississippi Department of Rehabilitative Services (MDRS) are covered under Part 300, Chapter 2, Rule 2.22.A. MDRS administers benefits for the following waivers: a) Independent Living (IL) Waiver, and b) Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver. 2. Appeal Procedures for Waivers Administered by the Mississippi Department of Mental Health (DMH) are covered under Part 300, Chapter 2, Rule 2.22.B. DMH administers the Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver.