reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 3 - Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) › Rule 23-207-3.12 - Disaster Procedures

Current through June 25, 2024
A. Intermediate care
				facilities for individuals with intellectual disabilities (ICF/IIDs) must
				comply with all federal, state, local, and Mississippi State Department of
				Health (MSDH) emergency preparedness requirements and must establish and
				maintain an emergency preparedness program in accordance with
				42 C.F.R. §
										483.475.
B. ICF/IIDs must develop and maintain an
				emergency preparedness plan that must be reviewed and updated at least annually
				and must:
1. Be based on and include a
				documented, facility-based and community-based risk assessment, utilizing an
				all-hazards approach, including missing residents.
2. Include strategies for addressing
				emergency events identified by the risk assessment.
3. Address the special needs of its ICF/IID
				population, including, but not limited to, persons at-risk; the type of
				services the ICF/IID has the ability to provide in an emergency; and continuity
				of operations, including delegations of authority and succession plans.
4. Include a process for
				cooperation and collaboration with local, tribal, regional, state, and federal
				emergency preparedness officials' efforts to maintain an integrated response
				during a disaster or emergency situation, including documentation of the
				ICF/IID's efforts to contact such officials and, when applicable, of its
				participation in collaborative and cooperative planning efforts.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 3 - Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) › Rule 23-207-3.13 - Facility Initiated Discharges

Current through June 25, 2024
A. An intermediate
				care facility for individuals with intellectual disabilities (ICF/IID) must
				notify the resident and the resident's guardian or legal representative of a
				facility initiated transfer or discharge.
1.
				The notice of transfer or discharge must be given at least thirty (30) calendar
				days prior to the transfer or discharge unless:
a) The safety or health of the individuals in
				the nursing facility would be endangered,
b) The resident no longer requires the level
				of care provided by the nursing facility,
c) An immediate transfer or discharge is
				required by the resident's urgent medical needs, or
d) The resident has not resided in the
				nursing facility for thirty (30) calendar days.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.1 - General

Current through June 25, 2024
A. The purpose of these regulations is to set
				forth the minimum requirements for providers who provide described mental
				health services to Medicaid beneficiaries in a Psychiatric Residential
				Treatment Facility (PRTF).
B. The
				regulations have been prepared for the information and guidance of providers of
				services participating in the Mississippi Medicaid Program.
C. Inpatient psychiatric services for
				beneficiaries under age twenty-one (21) must be provided before the beneficiary
				reaches age twenty-one (21) or, if the beneficiary was receiving the services
				immediately before he/she reached age twenty-one (21), before the earlier of
				the following: the date he/she no longer requires the services or the date
				he/she reaches age twenty-two (22).
D. The goal of PRTF treatment is to help the
				child reach a level of functioning where less restrictive treatment will be
				possible.
E. PRTF providers must
				adhere to applicable state and federal regulations related to their
				license.
F. The facility must have
				a signed transfer agreement with one or more general hospitals to provide
				needed diagnostic and medical services to residents.
G. The facility must have arrangements with
				community physicians to provide specialized medical care to residents when
				needed.
Miss. Code Ann. §
										43-13-121;
				  42 CFR 441.151(a)(2)(ii),
				  (c)(1)(2),
				  441.152(a)(3);
				  OBRA section 4755; 42 CFR 441, Subpart D; 42 CFR
				  483.52
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.2 - Provider Enrollment

Current through June 25, 2024
Enrollment into the Medicaid program requires each provider
				  to comply with the requirements outlined Part 200, Chapter 4, Rule 4.8, in
				  addition to the following provider type specific requirements:
A. National Provider Identifier (NPI),
				verification from National Plan and Provider Enumeration System
				(NPPES).
B. Board of Director's
				(Commissioner's) Resolution form, letter of signature authority, or copy of
				minutes indicating signature authority.
C. Written confirmation from the IRS
				confirming your tax identification number and legal business name.
D. CLIA certificate and completed
				certification form.
E. Joint
				Commission on Accreditation of Health Care Organization (JCAHO) or Council on
				Accreditation (COA) accreditation.
Miss. Code Ann. §
										43-13-121;
				  43-13-117; 43-13-118; 43-13-129; 42 CFR 441, Subpart D;
				  42 CFR
				  441.151
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.3 - Staffing

Current through June 25, 2024
The Division of Medicaid requires Psychiatric Residential
				  Treatment Facilities (PRTF) have the following staff:
A. The governing body of the PRTF must
				appoint an administrator to be responsible for the overall management of the
				facility. The administrator must have appropriate academic credentials and
				administrative experience in child/adolescent psychiatric treatment. The
				administrator must be responsible for the fiscal and administrative support of
				the facility's clinical program.
B.
				The facility must appoint a medical director to be responsible for coordinating
				medical services and directing resident treatment. The medical director must be
				a board-certified child/adolescent psychiatrist or a psychiatrist who has
				successfully completed an approved residency in child/adolescent
				psychiatry.
C. The facility must
				appoint a full-time clinical director to be responsible for coordinating
				clinical services and implementing patient treatment. The clinical director
				must be one of the following:
1. A
				board-certified child/adolescent psychiatrist,
2. A psychiatrist who has successfully
				completed an approved residency in child/adolescent psychiatry,
3. A licensed psychologist who is experienced
				in child/adolescent mental health treatment,
4. A psychiatric mental health nurse
				practitioner (PMHNP) who is experienced in child/adolescent mental health
				treatment, or
5. A licensed
				certified social worker who is experienced in child/adolescent mental health
				treatment.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.4 - Admission

Current through June 25, 2024
The Division of Medicaid covers PRTF services when a child
				  does not require emergency or acute psychiatric care but does require
				  supervision and treatment on a twenty-four (24) hour basis.
A. A board-certified child/adolescent
				psychiatrist or a psychiatrist who has successfully completed an approved
				residency in child/adolescent psychiatry with admitting privileges must approve
				each admission.
B. The goal of PRTF
				treatment is to help the child reach a level of functioning where less
				restrictive treatment will be possible.
C. The need for PRTF admission must be
				supported by documentation that:
1. The child
				has a diagnosable psychiatric disorder.
2. The child can participate and process
				information as evidenced by an appropriate IQ for the program to which they
				have been admitted, unless there is substantial evidence that the IQ score is
				suppressed due to psychiatric illness.
3. The child's psychiatric symptoms are
				severe enough to warrant residential treatment under the direction of a
				psychiatrist.
4. The referring
				psychiatrist or psychologist advises that residential treatment is
				needed.
5. At least one (1) of the
				following:
a) The child has failed to respond
				to less restrictive treatment in the last three (3) months.
b) Adequate less restrictive options are not
				available in the child's community.
c) The child is currently in an acute care
				facility whose professional staff advise that residential treatment is
				needed.
6. The admission
				has been certified by the UM/QIO as medically and psychologically
				necessary.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.5 - Non-Covered Services

Current through June 25, 2024
Division of Medicaid does not cover:
A. Admissions on the weekends. The Division
				of Medicaid defines weekend admissions as admission after 5:00 p.m. on a
				Friday. Covered days will not begin until the following Monday.
B. Non-covered days of stay.
C. Any days of stay not certified by the
				UM/QIO.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.6 - Reimbursement

Current through June 25, 2024
A. Participating Mississippi facilities must
				prepare and submit a Medicaid cost report for reimbursement of long term care
				facilities.
1. All cost reports are due by the
				end of the fifth (5th) calendar month following the reporting period.
2. Failure to file a cost report by the due
				date or the extended due date will result in a penalty of fifty dollars
				($50.00) per day and may result in the termination of the provider
				agreement.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.7 - Active Treatment

Current through June 25, 2024
The use of the term "treatment' refers to the active
				  treatment of the resident. The Division of Medicaid defines active treatment as
				  a process comprising of the following:
A. Multi-disciplinary diagnostic
				assessment,
B. Interdisciplinary
				treatment planning,
C. Therapeutic
				intervention,
D. Treatment
				evaluation/revision, and
E.
				Discharge/aftercare planning.
Miss. Code Ann. §
										43-13-121;
				  142 CFR 441.154
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.8 - Assessment and Evaluation

Current through June 25, 2024
A. The diagnostic
				evaluation must document the need for the PRTF level of care.
B. Diagnostic evaluations must be completed
				within the first fourteen (14) days of admission. The assessment process must
				include, but is not limited to, the following:
1. A psychiatric evaluation.
2. A psychological evaluation signed by a
				licensed psychologist, which must have been completed in the sixty (60) days
				prior to admission. If no psychological evaluation has been conducted within
				the last twelve (12) months, one must be completed within fourteen (14) days
				following PRTF admission.
3. A
				medical history and examination.
4.
				A psychosocial assessment, which includes a psychological profile, a
				developmental profile, a behavioral assessment, and an assessment of the
				potential resources of the resident's family.
5. A Child and Adolescent Needs and Strengths
				(CANS-MH) assessment.
6. An
				educational evaluation.
7. A
				nursing assessment.
8. A
				nutritional assessment, if indicated.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.9 - Treatment Planning

Current through June 25, 2024
A. Treatment
				planning is defined by the Division of Medicaid as a collaborative venture
				which the members of various disciplines jointly develop a comprehensive,
				individualized plan of care for each individual.
1. The treatment plan must be designed to
				achieve the individual's discharge from inpatient status at the earliest
				possible time.
2. An initial
				treatment plan must be in effect within twenty four (24) hours after the
				resident's admission to the psychiatric residential treatment facility
				(PRTF).
3. The interdisciplinary
				treatment team must meet to discuss, approve and implement a more comprehensive
				treatment plan within fourteen (14) days after the individual's admission,
				monthly for the first six (6) months and every ninety (90) days
				thereafter.
4. The treatment plan
				document must contain evidence that the treatment team actively partners with
				the individual and his/her parent or legal guardian and indicate efforts to
				accommodate scheduling conflicts for therapy sessions, meetings and calls to
				ensure active participation by all parties in the treatment
				planning/review/revision process.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.10 - Therapeutic Interventions

Current through June 25, 2024
A. Psychotherapy is
				defined as the intentional, face to face interaction between a mental health
				professional and a client, either an individual, family, or group, in which a
				therapeutic relationship is established to help resolve symptoms of the
				resident's mental and/or emotional disturbance.
B. Individual therapy is defined as
				psychotherapy that takes place between a mental health therapist and a
				resident. Individual Therapy must be provided a minimum of one (1) hour each
				week unless its contraindication is documented in the treatment plan.
				Individual Therapy must be provided by master's level mental health
				therapists.
C. Family therapy is
				defined as psychotherapy that takes place between a mental health therapist and
				a resident's family members or guardians, with or without the presence of the
				resident. If a resident is in the custody of the Department of Human Services
				(DHS), family therapy may also include others, including DHS representatives
				and foster family members, acting in loco parentis. Family Therapy must be at
				least twice a month, unless its contraindication is documented in the treatment
				plan.
1. Each resident's family, guardian, or
				person acting in loco parentis must participate in the family therapy
				sessions.
2. If the resident's
				family is more than a two (2) hour drive from the PRTF, one (1) face-to-face
				family therapy session and one (1) therapeutic conference call is
				acceptable.
3. Family Therapy must
				be therapeutic in nature to include discussing the resident's functioning,
				treatment progress, goals and objectives.
4. Social visits or phone calls are not
				considered family therapy.
5.
				Family Therapy must be provided by master's level mental health
				therapists.
6. Residents who are in
				the custody of the Department of Human Services (DHS) must complete one (1)
				face-to-face family therapy session with the social worker in the county of the
				PRTF, unless the social worker in the home county is available, and complete
				the second (2nd) family therapy session via telephone with the social worker in
				the home county.
7. A
				geographically distant therapist may provide family therapy when there are
				family issues that must be resolved or ameliorated before face-to-face sessions
				that include the resident can be productive and therapeutic.
a) Distance alone is not justification for
				prescribing off-site therapy.
b)
				When off-site therapy is appropriate, the treatment plan must identify the
				off-site therapist, indicate the goals for such therapy, and specify how
				information will be exchanged between the PRTF and the off-site
				therapist.
c) Collaboration between
				therapists is the responsibility of the PRTF and must be documented in the
				clinical record.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.11 - Medical Treatment and Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Requirements

Current through June 25, 2024
A. The Division of
				Medicaid covers medically necessary Early and Periodic Screening, Diagnosis,
				and Treatment (EPSDT) services for EPSDT-eligible beneficiaries in accordance
				with Miss. Admin. Code Part 223, without regard to service limitations and with
				prior authorization.
B. A
				psychiatric residential treatment facility (PRTF) must ensure that every
				individual receives medically necessary EPSDT services regardless of whether
				such services are identified in the individual's plan of care.
C. Each PRTF must have written policies and
				procedures and a designated area for responding to an individual's physical
				and/or medical needs in the PRTF.
D. EPSDT services in a PRTF must be provided
				by:
1. The PRTF,
2. Under arrangement between the PRTF and a
				qualified Mississippi Medicaid enrolled non-facility provider, and/or
3. By a qualified Mississippi Medicaid
				enrolled provider in the community not affiliated with or under arrangement
				with the PRTF.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.12 - Special Procedures

Current through June 25, 2024
A. The Division of
				Medicaid defines special procedures as seclusion and restraint and must be used
				as an immediate response only in emergency safety situations when needed to
				help a resident regain control of his/her behavior. At all times, the least
				restrictive effective intervention must be used. The potential therapeutic
				effects of prevention of self and other injury and reinforcement of behavioral
				boundaries must be weighed against the counter-therapeutic effects.
1. Seclusion is defined as the involuntary
				confinement of a resident in an area from which she/he is physically prevented
				from leaving. It is used to ensure the physical safety of the resident or
				others and to prevent the destruction of property or serious disruption of the
				milieu.
2. Restraint is defined as
				the restriction of a resident's freedom of movement or normal access to his/her
				body through physical, mechanical or pharmacological means, in order from the
				least to the most restrictive method. It is used to ensure the resident's
				physical safety.
a) Personal restraint is
				defined as the restraint of a resident through human physical action using a
				standard technique or method designed and approved for such use. It is used to
				prevent a resident from causing harm to self or others or to prevent
				destruction of property.
b)
				Mechanical restraint is defined as the restraint of a resident through the use
				of any mechanical device, material or equipment attached or adjacent to the
				resident's body that s/he cannot easily remove.
c) Pharmacological restraint is defined as
				the use of a medication, which is not a standard part of the resident's
				treatment regimen, to control or alter the resident's mood or behavior or to
				restrict freedom of movement. Pharmacological restraint is used to insure the
				safety of the resident or others through a period of extreme agitation when
				less restrictive measures have not been effective. Standing PRN orders for
				pharmacological restraints are prohibited.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.13 - Medication

Current through June 25, 2024
A. Documents pertaining to medication must be
				accurate and readily located. When medication is a prescribed intervention for
				a problem identified in the resident's treatment plan, it must be noted as such
				in the treatment plan. Medication changes must be made during treatment
				planning meetings whenever possible. When circumstances preclude this, the
				changes must be reviewed for all team members' update at the next available
				staffing opportunity.
B. When
				medications are prescribed or changed, a member of the professional staff must
				review, with each resident's parent/guardian, the following:
1. The name/class of medication,
2. The method of administration,
3. The symptoms targeted,
4. Possible side effects of the
				medication,
5. Possible long-term
				effects of the medication,
6.
				Treatment alternatives, and
7.
				Likely outcomes of using/not using the medication.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.14 - Discharge Aftercare

Current through June 25, 2024
A. No later than
				seven (7) days prior to the resident's projected discharge date, the treatment
				team must develop a provisional aftercare plan for the resident. The plan's
				content must include, but not be limited to:
1. The planned discharge date,
2. The date of the resident's admission and
				discharge,
3. The name of the
				person/agency expected to assume care and custody of the resident,
4. The physical location/address where the
				resident is expected to reside,
5.
				A list of the resident's psychiatric diagnoses,
6. Behavior management recommendations for
				parents and any other suggestions which might contribute towards the resident's
				successful participation in family life,
7. Educational summary and practical
				recommendations/suggestions for teachers which might contribute towards the
				resident's success at school, and
8. Treatment recommendations or
				observations/comments for follow-up mental health clinicians which may increase
				the likelihood of success in therapeutic aftercare.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.15 - Reporting Requirement

Current through June 25, 2024
A. The PRTF must
				keep the Division of Medicaid informed of serious occurrences involving
				residents of the PRTF.
1. The death of any
				resident or a serious incident involving any resident, regardless of whether or
				not those involved were Medicaid beneficiaries, must be reported to the
				Division of Medicaid.
a) The death of any
				resident must be reported to the Division of Medicaid as soon as possible, but
				no later than close of business the same day.
b) Serious incidents must be reported by fax
				to the Division of Medicaid by close of the next business day.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 4 - Psychiatric Residential Treatment Facility › Rule 23-207-4.16 - Maintenance of Records

Current through June 25, 2024
Refer to Maintenance of Records Part 200, Ch.1, Rule
				  1.3.
Miss. Code Ann. §
										43-13-121;
				  43-21-353
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.1 - General

Current through June 25, 2024
A. The Division of Medicaid covers certain
				home and community-based services as an alternative to institutionalization in
				a nursing facility through the Elderly and Disabled Waiver (E&D).
B. Persons enrolled in the E&D Waiver
				must reside in a private residence which is fully integrated with opportunities
				for full access to the greater community, and meet the requirements of a Home
				and Community-Based (HCB) setting.
C. The Division of Medicaid does not cover
				E&D Waiver services to persons in congregate living facilities,
				institutional settings, on the grounds of or adjacent to institutions, or in
				any other setting that has the effect of isolating persons receiving Medicaid
				Home and Community-Based Services (HCBS).
D. The E&D Waiver is administered and
				operated by the Division of Medicaid.
42 C.F.R. §§
											440.180,
				  441.301;
				  Miss. Code Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.2 - Eligibility

Current through June 25, 2024
A. Eligibility requirements for the Elderly
				& Disabled (E&D) Waiver Program include the following:
1. Persons must be twenty-one (21) years of
				age or older.
2. Persons must
				require nursing facility level of care as determined by a comprehensive
				long-term services and supports (LTSS) assessment.
3. Persons must meet the criteria in one (1)
				of the following Categories of Eligibility (COE):
a) Supplemental Security Income (SSI),
				or
b) An aged, blind or disabled
				individual who meets all factors of institutional eligibility. If income
				exceeds the current institutional limit, the individual must pay the Division
				of Medicaid the portion of their income that is due under the terms of an
				Income Trust in order to qualify.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.3 - Provider Enrollment

Current through June 25, 2024
A. Providers of
				Elderly and Disabled (E&D) Waiver services must satisfy all requirements
				set forth in Title 23 Miss. Admin. Code Part 200, Rule
				4.8 in addition to the listed
				provider-type specific requirements and provide to the Division of Medicaid:
1. A National Provider Identifier (NPI),
				verification from National Plan and Provider Enumeration System
				(NPPES),
2. A copy of the
				provider's current license or permit, if applicable,
3. Verification of a social security number
				using a social security card, driver's license with a social security number,
				military ID or a notarized statement signed by the provider noting the social
				security number. The name noted on verification document must match the name
				noted on the W-9, and
4. Written
				confirmation from the Internal Revenue Service (IRS) confirming the provider's
				tax identification number and legal business name.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.4 - Freedom of Choice

Current through June 25, 2024
A. Persons enrolled
				in a Medicaid Waiver have the right to freedom of choice of Medicaid providers
				for Medicaid covered services. [Refer to Miss. Admin. Code Part 200, Rule
				3.6 ]
B. Each person found eligible for the Elderly
				and Disabled (E&D) Waiver must be given free choice of all qualified
				providers.
C. The person and/or
				guardian or legal representative must be informed of setting options based on
				the person's needs and preferences, including non-disability specific settings.
				The setting options must be selected by the person and identified and
				documented in the plan of services and supports (PSS).
42 U.S.C. §
											1396a; 42 C.F.R. §§ 431.51,
				  440.180; Miss. Code Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.5 - Quality Management

Current through June 25, 2024
A. Waiver providers
				must meet applicable service specifications as referenced in the Elderly and
				Disabled (E&D) Waiver approved by the Centers for Medicare and Medicaid
				Services (CMS).
B. Waiver providers
				must report:
1. Changes in contact
				information, staffing, and licensure within ten (10) calendar days to the
				Division of Medicaid.
2. Critical
				incidences of abuse, neglect, and exploitation (including the unauthorized use
				of restraints, restrictive interventions, and/or seclusion) within twenty (24)
				hours of the occurrence or knowledge of the occurrence to the Division of
				Medicaid and other applicable agencies as required by law.
3. Any complaints not resolved within seven
				(7) days.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.6 - Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid covers the following services through the Elderly and Disabled
				(E&D) Waiver:
1. Case Management (CM) -
				Case Management services include the identification of resources as well as the
				coordination and monitoring of services by case managers to ensure the health
				and social needs, preferences and goals of individuals are met throughout the
				person centered planning process and service provision.
a) The case management team, consisting of a
				registered nurse (RN) and Licensed Social Worker (LSW), must conduct
				face-to-face visits together using the comprehensive long-term services and
				support (LTSS) assessment instrument at the time of admission and
				recertification.
1) Additionally, the RN and
				LSW must visit the person together on a quarterly basis.
2) Case management services may be provided
				at the Adult Day Care Facility at a maximum of one (1) visit per quarter. This
				visit cannot be the initial assessment, recertification assessment or quarterly
				visit.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.7 - Prior Approval

Current through June 25, 2024
A. Prior approval
				must be obtained from the Division of Medicaid before a person can receive
				services through the Elderly and Disabled (E&D) Waiver Program. To obtain
				approval, the waiver case management provider must complete and submit the
				following current Division of Medicaid approved forms as follows:
1. Long-Term Services and Supports (LTSS)
				Assessment,
2. Bill of
				Rights,
3. Plan of Services and
				Supports (PSS),
4. Emergency
				Preparedness Plan, and
5. Informed
				Choice.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.8 - Documentation/Record Maintenance

Current through June 25, 2024
Documentation/record maintenance for reimbursement purposes
				  must, at a minimum, reflect requirements set forth in the Elderly and Disabled
				  (E&D) Waiver. [Refer to Miss. Admin. Code Part 200, Rule
				  1.3.]
42 C.F.R. §§
											440.180,
				  441.303;
				  Miss. Code Ann. §§
										43-13-117;
				  43-13-118; 43-13-121; 43-13-129.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.9 - Person Cost Sharing

Current through June 25, 2024
Persons enrolled in the Elderly and Disabled (E&D)
				  waiver are exempt from cost-sharing for E&D Waiver services.
42 U.S.C.
				  1396(a); 42 C.F.R.
				  §§ 440.180, 447.50 - 447.59; Miss. Code Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.10 - Reimbursement

Current through June 25, 2024
A. Providers must bill for Elderly and
				Disabled (E&D) Waiver services no sooner than the first (1 
				st) day of the month following the month
				in which services were rendered for the following services:
1. Case Management,
2. Adult Day Care (ADC) Services,
3. Institutional Respite, and
4. Home delivered meals.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.11 - Due Process Protection

Current through June 25, 2024
A. The Case Manager
				must provide written notice as specified in the Elderly and Disabled (E&D)
				Waiver to the person when any of the following occur:
1. Services are reduced,
2. Services for requested increases in
				services are denied, or
3. Services
				are terminated.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.12 - Hearings and Appeals

Current through June 25, 2024
A. Decisions made
				by the Division of Medicaid that result in services being denied, terminated,
				or reduced may be appealed. If the person/legal representative chooses to
				appeal, all appeals must be in writing and submitted to the Division of
				Medicaid within thirty (30) days from the date of the notice of the change in
				status.
B. During the appeals
				process, contested services that were already in place must remain in place,
				unless the decision is for immediate termination due to immediate or perceived
				danger, racial discrimination or sexual harassment of the service providers.
				The case manager will maintain responsibility for ensuring that the person
				receives all services that were in place prior to the notice of
				change.
42 C.F.R. 431, Subpart
				  E;
				  42 C.F.R. §§
											440.180,
				  441.308;
				  Miss. Code Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.13 - Person Centered Planning (PCP)

Current through June 25, 2024
A. The Division of
				Medicaid defines Person-Centered Planning (PCP) as an ongoing process used to
				identify a person's desired outcomes based on their personal needs, goals,
				desires, interests, strengths, and abilities. The PCP process helps determine
				the services and supports the person requires in order to achieve these
				outcomes and must:
1. Allow the person to
				lead the process where possible with the person's guardian and/or legal
				representative having a participatory role, as needed and as defined by the
				person and any applicable laws.
2.
				Include people chosen by the person.
3. Provide the necessary information and
				support to ensure that the person directs the process to the maximum extent
				possible, and is enabled to make informed choices and decisions.
4. Be timely and occur at times and locations
				of convenience to the person.
5.
				Reflect cultural considerations of the person and be conducted by providing
				information in plain language and in a manner that is accessible to individuals
				with disabilities and persons who are limited English proficient.
6. Include strategies for solving conflict or
				disagreement within the process, including clear conflict-of-interest
				guidelines for all planning persons.
7. Provide conflict free case management and
				the development of the PSS by a provider who does not provide home and
				community-based services (HCBS) for the person, or those who have an interest
				in or are employed by a provider of HCBS for the person, except when the only
				willing and qualified entity to provide case management and/or develop PSS in a
				geographic area also provides HCBS. In these cases, conflict of interest
				protections including separation of entity and provider functions within
				provider entities, must be approved by the Centers of Medicare and Medicaid
				Services (CMS) and these persons must be provided with a clear and accessible
				alternative dispute resolution process which ensures the individual's rights to
				privacy, dignity, respect, and freedom from coercion and restraint..
8. Offer informed choices to the person
				regarding the services and supports they receive and from whom.
9. Include a method for the person to request
				updates to the PSS as needed.
10.
				Record the alternative HCBSs that were considered by the
				person.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 1 - Home and Community Based Services (HCBS) Elderly and Disabled Waiver › Rule 23-208-1.14 - Monitoring Safeguards

Current through June 25, 2024
A. Case managers
				are required to provide each waiver person with written information regarding
				their rights as a waiver person during the initial assessment.
B. Case managers must provide the persons
				information during the initial assessment regarding the Mississippi Vulnerable
				Person's Act and phone numbers of when and who to call if abuse, neglect or
				exploitation is alleged.
C. All
				E&D providers and their employees must immediately report in writing to the
				Division of Medicaid Office of Long-Term Care, the Mississippi Department of
				Human Services (MDHS), and any other entity required by federal or state law,
				all alleged or reported instances the following:
1. Abuse,
2. Neglect,
3. Exploitation,
4. Suspicious death, or
5. Unauthorized use of restraints, seclusion
				or restrictive interventions.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.1 - General

Current through June 25, 2024
A. The Division of Medicaid covers certain
				Home and Community-Based Services (HCBS) as an alternative to
				institutionalization in a nursing facility through the Independent Living (IL)
				Waiver.
B. Waiver participants
				must reside in a private residence which is fully integrated with opportunities
				for full access to the greater community, and meet the requirements of a Home
				and Community-Based (HCB) setting.
C. The Division of Medicaid does not cover IL
				Waiver services to persons in congregate living facilities, institutional
				settings, on the grounds of or adjacent to institutions, or any other setting
				that has the effect of isolating persons receiving Medicaid Home and
				Community-Based Services (HCBS).
D. The IL Waiver is administered by the
				Division of Medicaid and jointly operated by the Division of Medicaid and
				Mississippi Department of Rehabilitation Services (MDRS).
E. The Division of Medicaid maintains
				responsibility for the administration of the waiver and formulates policies,
				rules, and regulations. Under the direction of the Division of Medicaid, the
				fiscal agent is responsible for processing claims, issuing payments to
				providers, and notifications regarding billing. MDRS is responsible for
				operational functions and maintaining a current Medicaid provider number as
				outlined in an interagency agreement.
F. The average cost for a waiver
				applicant/person must not be above the average estimated cost for nursing
				facility level of care approved by the Centers for Medicare and Medicaid
				Services (CMS) for the current waiver year. The State may refuse entrance to
				the waiver to any otherwise eligible individual when the State reasonably
				expects that the cost of the facility and community-based services furnished to
				that individual would exceed the cost of a level of care specified for the
				waiver up to an amount specified by the State.
42 U.S.C. §
											1396n; 42 C.F.R. §§ 440.180,
				  441.301; Miss. Code Ann. §§
										37-33-157,
				  43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.2 - Eligibility

Current through June 25, 2024
A. Eligibility requirements for the
				Independent Living (IL) Waiver Program include the following:
1. Persons must be age sixteen (16) or older.
2. Persons must require nursing
				facility level of care as determined by a comprehensive long-term services and
				supports (LTSS) assessment.
3.
				Persons must exhibit severe orthopedic and/or neurological impairments that
				render them dependent on others, assistive devices, other types of assistance,
				or a combination of the three (3) to accomplish the activities of daily living.
4. Persons must be able to express
				ideas and wants either verbally or nonverbally with caregivers, personal care
				attendants (PCAs), case managers or others involved in their care.
5. Persons must be certified as medically
				stable by a physician. The Division of Medicaid defines medical stability as
				the absence of all of the following:
a) An
				active, life-threatening condition requiring systematic therapeutic measures,
b) Intravenous drip to control or
				support blood pressure, and
c)
				Intracranial pressure or arterial monitoring.
6. Persons must meet the criteria in one (1)
				of the following Categories of Eligibility (COE):
a) Supplemental Security Income (SSI),
b) Parents and Other Caretaker
				Relatives Program,
c) Disabled
				Child Living at Home,
d) Children
				under age nineteen (19) who meet the applicable income requirements,
e) Disabled Adult Child,
f) Protected Foster Care Adolescents,
g) Child Welfare Services (CWS)
				Foster Children and Adoption Assistance Children,
h) IV-E Foster Children and Adoption
				Assistance Children,
i) An aged,
				blind or disabled individual who meets all factors of institutional
				eligibility. If income exceeds the current institutional limit, the individual
				must pay the Division of Medicaid the portion of their income that is due under
				the terms of an Income Trust in order to qualify, or
j)  Working Disabled.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.3 - Provider Qualifications

Current through June 25, 2024
A. The Mississippi
				Department of Rehabilitation Services (MDRS), as the provider of Independent
				Living (IL) Waiver services, must satisfy all requirements set forth in Title
				23 Miss. Admin. Code Part 200, Rule
				4.8 in addition to the listed
				provider-type specific requirements and provide to the Division of Medicaid:
1. A National Provider Identifier (NPI),
				verification from National Plan and Provider Enumeration System (NPPES),
2. A copy of the provider's
				current license or permit, if applicable,
3. Verification of a social security number
				using a social security card, driver's license with a social security number,
				military ID or a notarized statement signed by the provider noting the social
				security number. The name noted on verification document must match the name
				noted on the W-9, and
4. Written
				confirmation from the Internal Revenue Service (IRS) confirming the provider's
				tax identification number and legal business name
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.4 - Freedom of Choice

Current through June 25, 2024
A. Division of
				Medicaid beneficiaries have the right to freedom of choice of providers for
				Medicaid covered services as outlined in Part 200, Chapter 3, Rule
				3.6.
B. Adherence of Freedom of Choice is required
				of all qualified providers and is monitored by the operating agency and
				Division of Medicaid. The case management team must assist the individual and
				provide them with sufficient information and assistance to make an informed
				choice regarding services and supports, taking into account risks that may be
				involved for that individual.
C.
				Beneficiaries must be:
1. Informed of any
				feasible alternatives under the waiver,
2. Given the choice of either institutional
				or home and community-based services, and
3. Provided a choice among providers or
				settings in which to receive home and community-based services (HCBS) including
				non-disability specific setting options.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.5 - Quality Management

Current through June 25, 2024
A. Waiver providers
				must meet applicable service specifications as referenced in the Independent
				Living Waiver document approved by the Centers for Medicare and Medicaid
				Services (CMS).
B. Waiver
				providers and/or contractors must report changes in contact information,
				staffing, and licensure within ten (10) calendar days to the Mississippi
				Department of Rehabilitative Services (MDRS) and the Division of Medicaid.
C. All reports of abuse, neglect
				or exploitation, as defined below, must be reported by phone and written report
				immediately by the appropriate case manager to their supervisor at MDRS and the
				Department of Human Services (DHS). The potential abuse, neglect, or
				exploitation must be reported to the Division of Medicaid/Long Term Care within
				twenty-four (24) hours.
1. Abuse (A) is
				defined as willful or non-accidental infliction of a single or more incidents
				of physical pain, injury, mental anguish, unreasonable confinement, willful
				deprivation of services necessary to maintain mental and physical health, and
				sexual abuse.
2. Neglect (N)
				includes, but is not limited to, a single incident of the inability of a
				vulnerable person living alone to provide for himself and/or failure of a
				caretaker to provide what a reasonably prudent person would do.
3. Exploitation (E) is the illegal or
				improper use of a vulnerable person or his resources for another's profit or
				advantage with or without the consent of the vulnerable person and includes
				acts committed pursuant to a power of attorney and can include but is not
				limited to a single incident.