32 Miss. Code. R. 1-10.4
Secondary clinical reviews will be performed in the following circumstances:
* Individual scores below the clinical eligibility numerical threshold but falls into a DOM defined "automatic secondary review" range (score of 45-49)
* Individual is under the age of twelve (12) on the date of the screening
* Individual appeals the denial in accordance with Medicaid's appeal procedures
Secondary reviews will be performed by DOM Registered Nurses, Nurse Practitioners, Licensed Social Workers and/or physicians as deemed by DOM to be clinically appropriate. DOM reviewers may request additional supporting documentation from the OSDP Counselor before making a determination. The OSDP Counselor also may submit additional supporting documentation, in a format specified by DOM, for consideration during the secondary review.
In conducting the secondary review, the reviewer may consider all available information from the PAS as well as any additional documentation provided by the OSDP Counselor or applicant/client. The reviewer also may consult with the OSDP Counselor and/or the certifying physician.
Once the secondary review is completed DOM will notify the applicant/client and MDRS of its determination. If the secondary review upholds the finding of clinical ineligibility, the applicant/client retains the right to appeal.
32 Miss. Code. R. 1-10.4