reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 4 - Provider Enrollment › Rule 23-200-4.4 - Effective Date of Provider Agreement and Provider Agreement Termination

Current through June 25, 2024
A. Each provider or organization furnishing
				services under the Mississippi Medicaid State Plan must enter into a provider
				agreement with the Mississippi Division of Medicaid.
B. The effective date of the provider
				agreement is the earliest day of the following options:
1. The date all required screening has been
				completed by the Division of Medicaid if the Division of Medicaid cannot verify
				all required screenings have been completed by a:
a) Medicare contractor, or
b) Medicaid agency or Children's Health
				Insurance Program (CHIP) of another state,
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 4 - Provider Enrollment › Rule 23-200-4.5 - Licensure, Certification and Permits

Current through June 25, 2024
A. Medicaid
				providers must maintain current information as required by the Division of
				Medicaid such as licensure, permits, and/or certification from their governing
				entity on file with the Division of Medicaid at all times while enrolled as a
				Medicaid provider.
1. The provider is
				ineligible to provide services to Medicaid beneficiaries if the license,
				permit, or certification of the provider is suspended, revoked, surrendered, or
				expired, effective on the date of the suspension, revocation, surrender or
				expiration.
2. The provider is
				ineligible to provide services to Medicaid beneficiaries if the license,
				permit, or certification of an employee of the provider upon which provider
				eligibility results from, is suspended, revoked, surrendered, or expired, or
				the person ceases to be an agent/employee of the provider effective on the date
				of the suspension, revocation, surrender, expiration, or change in
				employment.
3. The provider is
				ineligible to provide services to Medicaid beneficiaries when their license,
				permit, or certification has been limited due to disciplinary action by the
				board or entity that issues the license, permit, or certification effective on
				the date of the limitation.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 4 - Provider Enrollment › Rule 23-200-4.6 - Advertising by Provider

Current through June 25, 2024
A. No person may
				use, in connection with any item constituting an advertisement, solicitation,
				circular, book, pamphlet, or other communication, or a broadcast, telecast, or
				other production, alone or with other words, letters, symbols or emblems, the
				word "Medicaid" or "Division of Medicaid", or "Medicaid program", or
				"Mississippi Medicaid", or "Mississippi Division of Medicaid" in a manner which
				such person knows or should know would convey, or in a manner which reasonably
				could be interpreted or construed as conveying, the false impression that such
				item is approved, endorsed, or authorized by the Mississippi Division of
				Medicaid.
B. Providers may list
				Medicaid as a pay source they will accept, e.g., most third-party insurance,
				Medicare, and Medicaid accepted.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 4 - Provider Enrollment › Rule 23-200-4.7 - Change of Tax ID

Current through June 25, 2024
A. Providers who change tax identification
				numbers under circumstances other than those described in Rule 4.3, Change of
				Ownership and Rule 4.8, Requirements for All Providers must:
1. Request the change and the effective date
				of change in writing,
2. Submit a
				signed original W-9 form,
3. Submit
				verification of the tax identification number on a preprinted document from the
				Internal_Revenue Service (IRS), and
4. Submit verification of the National
				Provider Identifier (NPPES confirmation).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 4 - Provider Enrollment › Rule 23-200-4.8 - Requirements for All Providers

Current through June 25, 2024
A. All providers
				are required to submit the following documentation:
1. Mississippi Medicaid Provider Enrollment
				Application
a) Individuals and Sole Proprietor
				applications must be signed by the individual provider.
b) Business/Entity applications must be
				signed by the Authorized Official.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 4 - Provider Enrollment › Rule 23-200-4.9 - Group Providers

Current through June 25, 2024
A. Business/ Entity
				enrolling as a group of providers so that all monies received shall report to
				the tax identification number of the business. The following criteria must
				apply:
1. The enrolling provider has a tax
				identification number.
2. The
				enrolling provider is not a sole proprietor.
3. The enrolling provider employs and notes
				an active individual servicing provider within their application.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 4 - Provider Enrollment › Rule 23-200-4.10 - 340B Providers

Current through June 25, 2024
A. The Division of
				Medicaid defines a 340B provider as a nonprofit healthcare organization that
				meets the requirements of, and is considered to be, a covered entity under
				Section 340B of the Public Health Service Act which has elected to enroll in
				the 340B program.
B. The Division
				of Medicaid defines 340B purchased drugs as those:
1. Produced by any manufacturer which has
				entered into and complies with an agreement under Section 1927 (a) of the Act
				which are prescribed for a medically acceptable indication,
2. Purchased and administered or dispensed by
				340B covered entities under the rules of the 340B program, and
3. Dispensed and administered to a 340B
				eligible beneficiary as defined in Miss. Admin. Code Part 200, Rule
				4.10.C.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 5 - General › Rule 23-200-5.1 - Medically Necessary

Current through June 25, 2024
A. The Division of
				Medicaid will provide coverage for services when it is determined that the
				medically necessary criteria and guidelines listed below are met.
B. "Medically necessary" or "medical
				necessity" is defined as health care services that a provider, exercising
				prudent clinical judgment, would provide to a patient for the purpose of
				evaluating, diagnosing or treating an illness, injury, disease or its symptoms,
				and that are:
1. Appropriate and consistent
				with the diagnosis of the treating provider and the omission of which could
				adversely affect the patient's medical condition,
2. Compatible with the standards of
				acceptable medical practice in the United States,
3. Provided in a safe, appropriate and
				cost-effective setting given the nature of the diagnosis and the severity of
				the symptoms,
4. Not provided
				solely for the convenience of the beneficiary or family, or the convenience of
				any health care provider,
5. Not
				primarily custodial care
6. There
				is no other effective and more conservative or substantially less costly
				treatment service and setting available, and
7. The service is not experimental,
				investigational or cosmetic in nature.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 5 - General › Rule 23-200-5.2 - Consent for Minors

Current through June 25, 2024
A. Whenever a
				health care practitioner treats a Medicaid beneficiary, it is the
				responsibility of the practitioner to have a clear understanding of the legal
				framework within which care is to be provided to minors.
B. All Mississippi Medicaid providers are
				responsible for following and documenting compliance with their state law,
				federal laws, rules, policies, and/or guidance in the delivery of healthcare
				services to minors.
Miss. Code Ann. §
										43-13-121;
				  §
										41-41-3;
				  41-41-7; 41-41-13, 41-41-14; 41-41-13; §7129-81(h)(Supp.
				  1971)
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 5 - General › Rule 23-200-5.3 - Wellness Program

Current through June 25, 2024
A. Wellness
				Services for Adults
1. Annual Health
				Screening/Physical Examinations for Beneficiaries for Adults (Age 21 and over)
a) The Division of Medicaid covers annual
				physical examinations for adults.
b) The annual physical examination will not
				be counted toward the physician visit limit of twelve (12) per fiscal
				year.
c) Appropriate age-related
				screenings such as those listed below will be reimbursed separately when
				performed as part of the annual physical exam.
1) Cardiovascular Screening - The Division of
				Medicaid will pay for an annual screening of cholesterol, lipids, and
				triglyceride levels.
2) Diabetes
				Screening - An annual screening for diabetes is covered. The screening may
				include appropriate laboratory and urine studies.
3) Cervical and Vaginal Cancer Screening - A
				Pap test and a pelvic exam are covered yearly for women.
4) Screening Mammography - The Division of
				Medicaid covers annual mammography for women beginning at age forty
				(40).
5) Colorectal Cancer
				Screening - A yearly screening for occult blood is covered for individuals
				beginning at age fifty (50), or individuals who are <50 and identified as
				high risk. A flexible sigmoidoscopy or barium enema is covered every five (5)
				years, or a colonoscopy is covered every ten (10) years. High risk individuals
				have one (1) or more of the following colorectal cancer risk factors:
d) A personal history of
				colorectal cancer or adenomatous polyps,
e) A personal history of chronic inflammatory
				bowel disease, either Crohn's disease or ulcerative colitis,
f) A strong family history of colorectal
				cancer or polyps including cancer polyps in a 1st degree relative [parent,
				sibling, or child] younger than sixty (60) or in two (2) or more 1st degree
				relatives of any age, or
g) A known
				family history of hereditary colorectal cancer syndromes such as familial
				adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC).
1) Prostate Cancer Screening - A
				prostate-specific antigen (PSA) blood test and digital rectal examination (DRE)
				are covered annually for men beginning at age fifty (50). Both screenings are
				covered annually beginning at age forty-five (45) for men of African-American
				descent.
2) Bone Density Studies
				are allowed every twenty-four (24) months for women age sixty-five (65) and
				older.
3) Vision and Glaucoma
				Screening eye exams are covered as specified in Part 217 Vision
				Services.
4) Influenza and
				Pneumonia Vaccines are covered services for both children and adults under
				Mississippi Medicaid as outlined in Part 224 Immunizations.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 5 - General › Rule 23-200-5.4 - Tobacco Cessation

Current through June 25, 2024
A. The Division of Medicaid covers up to
				twelve (12) in-person or telehealth tobacco cessation counseling sessions per
				State Fiscal Year, when provided by:
1. A
				physician, or
2. Other licensed
				practitioner that has prescriptive authority, operating within their scope of
				practice.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 5 - General › Rule 23-200-5.5 - Mobile Medical Units Other Than Independent Diagnostic Treatment Facilities

Current through June 25, 2024
A. For Division of Medicaid purposes, a
				mobile medical unit is defined as a self-contained facility or unit that can be
				moved, towed, or transported from one location to another and provides
				prevention, screening, diagnostic, and treatment services. This rule and
				definition excludes services provided in an Independent Diagnostic Treatment
				Facility (IDTF). See Part 219, Rule 1.3.
B. Mobile medical units must satisfy the
				following criteria:
1. Must be owned and
				operated by a current Medicaid provider that has a permanent fixed office
				location where healthcare services are provided during normal business hours on
				a daily basis and the fixed office location is available for contact
				twenty-four (24) hours a day, seven (7) days a week.
2. Must maintain fixed schedule for
				locations.
3. Must have a separate
				Medicaid provider number from the permanent fixed office location
4. Must have a physician, physician
				assistant, dentist, certified audiologist, chiropractor, pharmacist,
				optometrist, ophthalmologist, or nurse practitioner available to furnish direct
				patient care services at all times during business hours.
5. Must have a written procedure that
				includes emergency follow-up care for beneficiaries treated in the mobile
				medical unit and arrangements for treatment in a facility which is permanently
				established in the area.
6. Must
				have communication capabilities which will enable the staff to contact
				necessary emergency personnel in the event of an emergency.
7. Must ensure the driver of the mobile unit
				possesses a valid Mississippi driver's license of the appropriate class, the
				vehicle has a current Mississippi motor vehicle tag, and the vehicle has had a
				current Mississippi motor vehicle inspection.
8. Must comply with all applicable federal,
				state, and local laws, regulations and ordinances governing biohazard waste,
				waste water (black and grey), construction, safety, sanitation, insurance, and
				zoning.
9. Must be accessible in
				accordance with the Americans with Disabilities Act.
10. Must have properly functioning
				sterilization system for sterilizing reusable medical equipment.
11. Must have access to an adequate supply of
				potable (suitable for drinking) and portable water, including hot
				water.
12. Must have access to
				toilets and sanitary hand washing facilities.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 5 - General › Rule 23-200-5.6 - Diabetes Self-Management Training (DSMT)

Current through June 25, 2024
A. The Division
				of Medicaid defines Diabetes Self-Management Training (DSMT) as an interactive
				and collaborative process through which beneficiaries with diabetes gain the
				knowledge and skills needed to modify their behavior and self-manage the
				disease and its related conditions.
B. The Division of Medicaid does not enroll a
				provider for the sole purpose of performing DSMT because DSMT is not a
				separately recognized provider type. The provider seeking reimbursement for
				DSMT must meet all of the required criteria set forth in Miss. Admin. Code Part
				200, Rule 4.8 in addition to being:
1. A
				current Mississippi Medicaid provider,
2. Located in the State of Mississippi, and
3. Accredited by the American
				Diabetes Association (ADA) or the American Association of Diabetes Educators
				(AADE).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 5 - General › Rule 23-200-5.7 - Electronic Health Records

Current through June 25, 2024
A. The Division of
				Medicaid recognizes an electronic health record (EHR) as an electronic version
				of a beneficiary's medical history and key administrative clinical data
				relevant to a beneficiary under the care of a particular provider, that is
				maintained by a provider over time, and may include, but is not limited to:
1. Demographics,
2. Progress notes,
3. Problems,
4. Medications,
5. Vital signs,
6. Past medical history,
7. Immunizations,
8. Laboratory data, and
9. Imaging data.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 6 - Indian Health Services › Rule 23-200-6.1 - Provision of Indian Health Services

Current through June 25, 2024
Governmental responsibility for the provision of health
				  services to the American Indian/Alaskan Native (AI/NI) population evolved
				  through numerous Supreme Court decisions, treaties, Executive Orders, and
				  legislation. Principal legislation authorizing federal funds for health
				  services came through the Snyder Act of 1921. The Transfer Act of 1954
				  transferred the responsibility for Indian health services from the Bureau of
				  Indian Affairs to the Department of Health, Education and Welfare (HEW), now
				  the Department of Health and Human Services (DHHS). The Indian Health Service
				  (IHS), an agency within DHHS, was established as the agency responsible for
				  providing federal health services to the American Indian/Alaskan Native (AI/AN)
				  population. The Indian Self-Determination and Education Assistance Act ( Public
				  Law 93-638, as amended) gave Tribes the option of assuming the operation of
				  health services and community programs from Indian Health Services (IHS) or
				  remaining within the IHS administered system. Subsequently the Indian Health
				  Care Improvement Act ( Public Law 94-437 ) was enacted to provide the quality
				  and quantity of health services needed to elevate the health status of American
				  Indians/Alaska Natives and to encourage maximum participation of tribes in the
				  planning/management of those services.
Miss. Code Ann. §
										43-13-121;
				  Public Law 93-638; Public Law 94-437
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 6 - Indian Health Services › Rule 23-200-6.2 - Beneficiary Enrollment

Current through June 25, 2024
Applicants of American Indian/Alaskan Native descent are
				  subject to the same eligibility criteria as any other applicant. Refer to Part
				  200, Chapter 3, Rule 3.1.
Miss. Code Ann. §
										43-13-121;
				  42 CFR §136.12
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 6 - Indian Health Services › Rule 23-200-6.3 - Provider Enrollment/Participation Requirements

Current through June 25, 2024
A. Indian
				Health Service (IHS) Facilities/Tribal 638 Health Facilities - In accordance
				with Sec. 1911.[
				42 U.S.C.
				1396 j ] (a) (b) the Division of Medicaid
				accepts Indian Health Service Facilities/Tribal 638 Health Facilities as
				Medicaid providers on the same basis as other qualified providers. IHS/Tribal
				638 facilities must meet all applicable standards for state licensure but need
				not obtain a state license. Refer to Part 200 Chapter 4, Rule 4.2 for
				Conditions of Participation.
B. All
				Other Providers - All other providers must complete the enrollment requirements
				for their respective provider type. Refer to Part 200 Chapter 4, Rule
				4.2.
Miss. Code Ann. §
										43-13-121;
				  42 USC
				  1396 j(a)(b)
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 6 - Indian Health Services › Rule 23-200-6.4 - Covered Services

Current through June 25, 2024
American Indians/Alaskan Natives who meet the Division of
				  Medicaid eligibility criteria receive the same benefits as any other
				  beneficiary in the same category of eligibility. All limitations, exclusions,
				  and prior authorization requirements apply.
Miss. Code Ann. §
										43-13-121;
				  42 CFR §136.11
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 6 - Indian Health Services › Rule 23-200-6.5 - Reimbursement

Current through June 25, 2024
A. Indian Health Service (IHS)
				Facilities/Tribal 638 Health Facilities/Providers
1. In accordance with Social Security Act,
				the Division of Medicaid will reimburse Indian Health Service Facilities/Tribal
				638 Health Facilities/Providers as follows:
a) Inpatient Hospital - per diem rate
b) Outpatient Hospital, includes
				physician and clinic services encounter rate
c) Dental Services encounter rate
d) Other approved providers will be
				reimbursed according to the current payment methodology, e.g., fee for service,
				per diem, encounter etc., for the respective provider type.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 200 - General Provider Information › Chapter 6 - Indian Health Services › Rule 23-200-6.6 - Cost-Sharing

Current through June 25, 2024
A. An American Indian/Alaska Native who is
				eligible to receive or has received an item or service by an Indian health care
				provider or through referral under contract health services is exempt from
				Medicaid premiums.
B. American
				Indians/Alaska Natives who are currently receiving or have ever received an
				item or service furnished by an Indian health care provider or through referral
				under contract health services are exempt from all Medicaid
				cost-sharing.
42 C.F.R. §
				  447.56; Miss. Code. Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 1 - Emergency Transportation Services › Rule 23-201-1.1 - Emergency Ambulance Provider Requirements

Current through June 25, 2024
A. All Medicaid
				ambulance service providers whose origin, or site of pickup, is within the
				state of Mississippi must:
1. Provide proof of
				applicable license or permit issued by the Mississippi State Department of
				Health (MSDH), Bureau of Emergency Medical Services (BEMS),
2. Meet the applicable requirements described
				in Miss. Admin. Code Part 200, Chapter 4,
3. Provide a National Provider Identifier
				(NPI), verification from the National Plan and Provider Enumeration System
				(NPPES), and
4. Submit written
				confirmation from the Internal Revenue Service (IRS) of the provider's tax
				identification number and legal business name.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 1 - Emergency Transportation Services › Rule 23-201-1.2 - Definitions

Current through June 25, 2024
A. Basic life support (BLS) services are
				defined as non-invasive emergency procedures and services at the level
				described in the Emergency Medical Technician (EMT) National Standard Training
				Curriculum (NSTC) including, but not limited to:
1. Initiation of basic airway maneuvers and
				procedures,
2. Cardio-pulmonary
				resuscitation (CPR),
3. Automated
				and semi-automated defibrillation,
4. Hemorrhage control, including direct
				pressure and tourniquet,
5. Spinal
				immobilization and extremity stabilization,
6. Assistance with childbirth,
				and/or
7. Obtaining vital
				signs,
8. Other techniques as
				authorized by Bureau of Emergency Medical Services (BEMS).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 1 - Emergency Transportation Services › Rule 23-201-1.3 - Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid covers medically necessary emergency ground ambulance services which
				meet the requirements of the Mississippi Bureau of Emergency Medical Services
				(BEMS) including, but not limited to:
1.
				Basic Life Support (BLS) Ground Ambulance Services which must include, but are
				not limited to:
a) A BLS ambulance vehicle
				with a BEMS permit, staffed with at least one (1) individual certified by BEMS
				to provide services at or above the level of Emergency Medical Technician
				(EMT),
b) A driver with a valid
				Emergency Medical Services Driver Certificate from the state of
				Mississippi,
c) Equipment and
				supplies as required by BEMS,
d)
				Services provided by an EMT within the scope of their practice as determined by
				BEMS, and
e) Transportation from
				the pick-up site to the nearest appropriate facility.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 1 - Emergency Transportation Services › Rule 23-201-1.4 - Non-Covered Emergency Ambulance Services

Current through June 25, 2024
The Division of Medicaid does not cover the following
				  including, but not limited to:
A.
				Emergency ambulance transportation of a beneficiary:
1. To anywhere other than the nearest
				appropriate facility that is able to care for the beneficiary,
2. Pronounced dead prior to the dispatch of
				the ambulance by an individual who is licensed or otherwise authorized under
				state law to pronounce death in the state where such pronouncement is made,
3. To a funeral home,
4. Due to a lack of alternative means,
5. For the convenience of the
				beneficiary and/or beneficiary's family, and/or
6. For which medical necessity criteria has
				not been satisfied.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 1 - Emergency Transportation Services › Rule 23-201-1.5 - Reimbursement

Current through June 25, 2024
A. The Division of Medicaid reimburses
				emergency ground ambulance providers a base rate from a statewide uniform fee
				schedule in effect on July 1, 2021 based on one hundred percent (100%) of the
				rate established under Medicare on January 1, 2020:
1. For only beneficiary loaded
				trips,
2. For medically necessary
				emergency services to the closest appropriate facility for treatment,
				and
3. When provided in an
				appropriate ALS or BLS vehicle that has been licensed by the state that
				actually transports the beneficiary.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 1 - Emergency Transportation Services › Rule 23-201-1.6 - Documentation

Current through June 25, 2024
A. Providers must maintain required
				documentation in accordance with Miss. Admin. Code Part 200, Rule
				1.3, and must maintain auditable
				records to substantiate claims submitted to the Division of Medicaid or
				designated entity.
B. Ambulance
				providers must maintain documentation in the medical record including, but not
				limited to:
1. Time the emergency was
				reported,
2. The person reporting
				the emergency,
3. Nature of illness
				or injury,
4. Documentation of
				medical necessity of emergency ambulance services,
5. Documentation of medical necessity for the
				level of care provided,
6.
				Beneficiary's condition including, but not limited to:
a) Vital signs,
b) Level of consciousness, and
c) Ability to sit, stand, and/or
				walk.
7. Location of
				pick-up, time of pick-up, location of destination, and time of
				arrival,
8. For ground ambulance
				providers, the recording of odometer reading at pick-up and point of
				destination or the mileage as documented by an onboard global positioning
				system (GPS) which can store and retrieve trip data,
9. Detailed record of all services and
				treatments administered to the beneficiary,
10. Documentation that the beneficiary was
				taken to the closest appropriate facility or the reason that nearest
				appropriate facility was unable to accept the beneficiary causing the
				beneficiary to be taken to another appropriate facility, and
11. Trip ticket that indicates the date,
				mileage, crew, origin, destination, and type and level of ambulance service
				provided.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 1 - Emergency Transportation Services › Rule 23-201-1.7 - Ambulance Transport of Nursing Facility Residents by Ambulance

Current through June 25, 2024
[Refer to Miss Admin. Code, Title 23, Part 207 for
				  non-emergency transportation of nursing facility residents. Refer to Miss
				  Admin. Code, Title 23, Part 201, Chapter 1 for emergency transportation of
				  nursing facility residents.]
42 C.F.R. §
											431.53; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 1 - Emergency Transportation Services › Rule 23-201-1.8 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Current through June 25, 2024
The Division of Medicaid pays for all medically necessary
				  services for early and periodic screening, diagnosis, and treatment
				  (EPSDT)-eligible beneficiaries in accordance with Part 223 of this Title,
				  without regard to service limitations and with prior authorization.
Miss. Code Ann.
				  §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 2 - Non-Emergency Transportation (NET) Broker Program › Rule 23-201-2.1 - Non-Emergency Transportation (NET) Broker Program

Current through June 25, 2024
A. The
				Division of Medicaid contracts with a Broker to provide non-emergency
				transportation (NET) through a NET provider to Medicaid beneficiaries in
				appropriate vehicles, depending on the beneficiary's mobility status and
				personal capabilities on the date of service.
1. Other non-Medicaid funded sources for
				non-emergency transportation services must be utilized first with the Medicaid
				NET program being the last resort.
2. Beneficiaries are not allowed to request a
				particular NET provider for transportation.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 2 - Non-Emergency Transportation (NET) Broker Program › Rule 23-201-2.2 - Eligibility

Current through June 25, 2024
A. Non-emergency transportation (NET)
				services are non-covered for beneficiaries enrolled in the following categories
				of eligibility:
1. Family Planning Waiver,
2. Qualified Medicare Beneficiary
				(QMB),
3. Specified Low-Income
				Medicare Beneficiary (SLMB),
4.
				Qualified Working Disabled Individuals (QWDI), and
5. Qualified Individual (QI-1).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 2 - Non-Emergency Transportation (NET) Broker Program › Rule 23-201-2.3 - Non-Emergency Transportation (NET) Services

Current through June 25, 2024
A. Non-emergency
				transportation (NET) services are covered if all the following criteria are
				met:
1. The service for which NET service is
				requested is a covered service provided by a Mississippi Medicaid enrolled
				provider.
2. The beneficiary:
a) Is eligible for NET services,
b) Has a medical need which requires NET
				services, and
c) Does not have
				access to NET from any other source.
3. The transport must be:
a) In a vehicle which meets the medical needs
				of the beneficiary given their mobility status and personal capabilities on the
				date of service,
b) The most
				economical mode of transportation. The NET Broker must document the reason in
				detail if the NET Broker authorizes a mode of transportation that is not the
				most economical,
c) Provided by a
				NET provider closest to the beneficiary. The NET Broker must document the
				reason in detail if a transport is authorized for a NET provider which is not
				the closest to the beneficiary's residence or medical service
				provider,
d) For a single covered
				medical service, and
e) Requested
				at least three (3) business days before the NET service is needed unless the
				NET service is required due to hospital discharge and/or a return trip from an
				emergency service.
4. If
				an adult attendant is necessary the NET Broker must obtain a medical
				certification statement from the beneficiary's physician prior to the
				transport.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 2 - Non-Emergency Transportation (NET) Broker Program › Rule 23-201-2.4 - Non-Emergency Transportation of Long-Term Care (LTC) Facility Residents

Current through June 25, 2024
Refer to Miss. Admin. Code Part 207 for non-emergency
				  transportation of long-term care (LTC) facility residents.
42 C.F.R. §
											431.53; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 2 - Non-Emergency Transportation (NET) Broker Program › Rule 23-201-2.6 - Non-Emergency Transportation (NET) Driver Requirements

Current through June 25, 2024
A.
				The non-emergency transportation (NET) Broker must ensure that all NET drivers
				complete a criminal background check verifying the NET driver is not excluded
				per Miss. Code Ann. §
									43-13-121.
				[Refer to Miss. Admin. Code Part 201, Rule
				2.1.B. 10.]
B. The NET Broker must ensure NET drivers:
1. Abide by federal, state, and local laws.
2. Be at least eighteen (18) years
				of age and have a current valid driver's license to operate the assigned
				vehicle.
3. Be courteous, patient
				and helpful to all passengers and be neat and clean in appearance.
4. Wear a visible, easily read name tag which
				identifies the employee and the employer.
5. Provide an appropriate level of assistance
				to a beneficiary when requested or when necessitated by the beneficiary's
				mobility status or personal condition, including curb-to-curb, door-to-door,
				and hand-to-hand assistance, as required.
a)
				The NET driver must confirm the beneficiary is safely inside the residence or
				facility before departing the drop-off point.
b) The NET driver is responsible for properly
				securing any mobility devices used by the beneficiary.
6. Assist beneficiaries in the process of
				being seated, confirm all seat belts are fastened properly and all passengers
				are safely and properly secured.
7.
				Park the vehicle:
a) In a safe location out
				of traffic if a beneficiary or other passenger's behavior or any other
				condition impedes the safe operation of the vehicle, notify the dispatcher and
				request assistance.
b) To prevent
				the beneficiary from crossing streets to reach the entrance of their
				destination.
8. Must
				provide verbal directions to passengers as appropriate.
9. Notify the NET provider immediately of an
				emergency such as an accident/ incident or vehicle breakdown to arrange for
				alternative transportation for the beneficiaries on board. The NET provider
				must report all accidents/incidents and breakdowns to the NET Broker.
10. Report all no-shows immediately to the
				NET provider and the NET provider must notify the NET Broker so the
				authorization can be cancelled.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 201 - Transportation Services › Chapter 3 - Non-Emergency Transportation (NET) Services Not Covered Under the Broker Program › Rule 23-201-3.1 - Non-Emergency Transportation (NET) Services Not Covered Under the Broker Program

Current through June 25, 2024
A. The Division of
				Medicaid covers the following non-emergency transportation (NET) services
				outside of the Broker program:
1. NET
				ambulance hospital-to-hospital transports when medically necessary to the
				nearest appropriate facility that is able to care for the beneficiary, a
				certificate of medical necessity (CMN) is completed, and all services are
				provided in accordance with the requirements of the Bureau of Emergency Medical
				Services (BEMS), and
2. NET
				services covered as part of another benefit or service including, but not
				limited to, transportation provided:
a) To
				long-term care facility residents [Refer to Miss. Admin. Code Title 23, Part
				207], and
b) By Prescribed
				Pediatric Extended Care (PPEC) centers.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 202 - Hospital Services › Chapter 1 - Inpatient Services › Rule 23-202-1.1 - Definitions

Current through June 25, 2024
A. The Division of Medicaid considers a
				patient an inpatient if formally admitted as an inpatient with the expectation
				that he/she will remain at least overnight and occupy a bed even though it
				later develops that he/she can be discharged or is transferred to another
				hospital and does not actually use a hospital bed overnight.
B. Inpatient services are services that are
				ordinarily furnished by the hospital for the care and treatments of the
				beneficiary, solely during his/her stay in the hospital.
C. The three (3) day payment window rule
				refers to the requirement that all outpatient services provided to a
				beneficiary by the admitting hospital, or by an entity wholly owned or operated
				by the admitting hospital, within the three (3) days prior to an inpatient
				hospital admission that are related to the reason for the inpatient hospital
				stay must be included in the All Patient Refined Diagnosis Related Group
				(APR-DRG) payment for the inpatient stay.
42
				  C.F.R. §§
											440.2,
				  440.10;
				  Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 202 - Hospital Services › Chapter 1 - Inpatient Services › Rule 23-202-1.2 - Provider Enrollment

Current through June 25, 2024
Hospital providers, including psychiatric hospitals and swing
				  bed providers applying for enrollment into the Medicaid program must satisfy
				  all requirements set forth in 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. Written confirmation
				from the IRS confirming your tax identification number and legal business
				name.
C. CLIA certificate and
				completed certification form.
D.
				Licensed freestanding psychiatric hospitals must submit Joint Commission on
				Accreditation of Health Care Organization (JCAHO).
E. Copy of current Medicare certification or
				Tie-In Notice. EOMB is not acceptable.
F. Out of state facility: Copy of outstanding
				claims, if applicable.
G. Copy of
				hospital license
1. Out-of-state facility:
				Copy of license/certification in effect during the claims period for which they
				are billing.
2. In-state facility:
				A copy of letter from the Mississippi State Department of Health is
				acceptable.
3. Hospital undergoing
				a Change of Ownership (CHOW): License in effect for the new owner.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 202 - Hospital Services › Chapter 1 - Inpatient Services › Rule 23-202-1.3 - Prior Authorization of Inpatient Hospital Services

Current through June 25, 2024
A.
				Requirement
1. Prior authorization is
				required from the appropriate Utilization Management/Quality Improvement
				Organization (UM/QIO) for all inpatient hospital admissions except for
				obstetrical deliveries and well newborns with a length of stay under six (6)
				days.
a) Emergent admissions and urgent
				admissions must be authorized on the next working day after
				admission.
b) Failure to obtain the
				prior authorization will result in denial of payment to all providers billing
				for services including, but not limited to, the hospital and the attending
				physician.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 202 - Hospital Services › Chapter 1 - Inpatient Services › Rule 23-202-1.4 - Covered Services

Current through June 25, 2024
A. Covered
				inpatient services include:
1. Ancillary
				services.
2. Drugs, excluding take
				home drugs.
3. Supplies.
4. Oxygen.
5. Durable Medical Equipment.
6. The cost of implantable programmable
				baclofen drug pumps used to treat spasticity which are implanted in an
				inpatient hospital setting are reimbursed through the Mississippi Medicaid
				APR-DRG payment.
7. Newborn Hearing
				Screens - refer to Part 218.
8.
				Therapy Services
a) Therapeutic services
				ordinarily furnished to inpatients by the hospital, or by others under
				arrangements made by the hospital, are covered.
b) Inpatient services rendered by a
				psychologist or a therapist who is employed by the hospital, and whose services
				are normally included in the billing of the hospital, are covered in the same
				manner as the services of other non-physician hospital employees.
9. Inpatient Psychiatric Services
				are covered in the following settings as outlined:
a) Acute Freestanding Psychiatric Facility
1) Services available for children up to age
				twenty-one (21).
2) Certification
				by the UM/QIO is required for the admission and for a continued stay after
				nineteen (19) days.
b)
				Psychiatric Unit at a Medical Surgical Facility
1) Services available to children or
				adults.
2) Certification by the
				UM/QIO is required for the admission and for a continued stay after nineteen
				(19) days.
10. Inpatient or outpatient hospital services
				rendered to a beneficiary who leaves the hospital against medical
				advice.
11. Canceled or incomplete
				procedures related to the beneficiary's medical condition. Services performed
				before the surgical or other procedure is canceled or terminated before
				completion due to a change in the beneficiary's condition.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 202 - Hospital Services › Chapter 1 - Inpatient Services › Rule 23-202-1.5 - Non-Covered Services

Current through June 25, 2024
A. Services
				provided in a geriatric psychiatric unit of a hospital.
B. Services rendered to a Medicaid
				beneficiary and billed by a physician employed by or contracted with the
				hospital.
C. Elective cancellation
				of procedures not related to the beneficiary's medical condition.
1. Surgical or other procedures canceled due
				to scheduling conflicts of the operating suite or physicians, beneficiary
				request, or other reasons not related to medical necessity.
2. Additional room and board days required
				due to rescheduling.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 202 - Hospital Services › Chapter 1 - Inpatient Services › Rule 23-202-1.11 - Documentation Requirements

Current through June 25, 2024
The hospital must maintain legible and auditable records that
				  will substantiate the claim submitted to Medicaid. At a minimum, the records
				  must contain the following on each patient:
A. Date of service.
B. A comprehensive history and physical
				assessment/report, including the patient's presenting complaint.
C. Diagnosis(es) to substantiate the
				hospitalization and all treatments/procedures rendered during the
				hospitalization.
D. The specific
				name/type of all diagnostic studies, including lab, x-ray, and the like, and
				the medical indication and results/finding of the studies.
E. Documentation and consult reports to
				substantiate treatment/procedures rendered, the patient's response to the
				treatment/procedure; and the signature or initials of the appropriate health
				care worker providing the treatment/procedure, including but not limited to the
				physician, nurse, therapist, dietitian.
F. The name, strength, dosage, route, either
				IM, IV, PO, topical, enteral, intracatheter, date and time, indication for, and
				the administration of all medications administered to the patient.
G. Discharge planning and instructions,
				including the signature or initials of the health care worker performing the
				instruction; the name of the person being instructed; date and time of
				instruction; whether the instructions are given in writing, verbally, by
				telephone or other means; and how much instruction was comprehended by the
				beneficiary, including level of proficiency on return demonstration when a
				procedure is being taught.
H.
				Discharge orders for medications, treatments and procedures that indicate
				whether the orders/prescriptions are issued in writing, verbally, or by
				telephone, and to whom the orders are issued.
I. Signed physician orders for all
				medications, treatments, and procedures rendered to the patient.
J. All x-ray images, including films and
				digital images, films, and digital images must be of such quality that they can
				be clearly interpreted.
Miss. Code Ann. §
										43-13-121;
				  42 CFR §424.13
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 202 - Hospital Services › Chapter 1 - Inpatient Services › Rule 23-202-1.12 - Disproportionate Share Hospital

Current through June 25, 2024
The Disproportionate Share Hospital (DSH) program and the
				  qualifications for participation in the DSH program are defined in Attachment
				  4.19-A of the Medicaid State Plan.
Miss. Code Ann. §
										43-13-121;
				  42 CFR §447.298
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 202 - Hospital Services › Chapter 1 - Inpatient Services › Rule 23-202-1.13 - Out-of-State Facilities

Current through June 25, 2024
A. Out-of-state
				hospitals are reimbursed under the APR-DRG payment methodology. The inpatient
				cost-to-charge ratios (CCRs) used to pay cost outlier payments for each
				out-of-state hospital are set using the Federal Register in effect as of July
				1, 2021, that applies to the federal fiscal year beginning October 1, 2020,
				issued prior to the reimbursement period. The inpatient CCR is calculated using
				the sum of the statewide average operating urban CCR plus the statewide average
				capital CCR for each state.
B. For
				transplants not available in Mississippi, payment for transplant services
				performed outside of Mississippi is made under the MS APR-DRG payment
				methodology including a policy adjustor. If access to quality services is
				unavailable under the MS APR-DRG payment methodology, a case rate may be set as
				described in Part 202, Chapter 4, Rule
				4.7.
C. For specialized services not available in
				Mississippi, the Division of Medicaid will make payment using the MS APR-DRG
				payment methodology. If MS APR-DRG payment limits access to care, the Division
				will reimburse what the domicile state pays for the service or a comparable
				payment other states reimburse under APR-DRG.
42 CFR §
											431.52; 42 USC § 1395f, also known as,
				  Social Security Act § 1814; Miss. Code Ann. §§
										43-13-117,
				  43-13-121.