reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 205 - Hospice Services › Chapter 1 - Program Overview › Rule 23-205-1.8 - Reimbursement

Current through June 25, 2024
A. A hospice provider must obtain written
				certification/recertification of terminal illness before billing for hospice
				services.
B. The Division of
				Medicaid reimburses hospice providers at one (1) of the four (4) following
				predetermined rates for each day that the beneficiary is under the care of the
				hospice based on the level of care required to meet the beneficiary's and
				family's needs:
1. Routine Home Care (RHC):
a) Is reimbursed for each day the beneficiary
				is under the care of the hospice provider and not receiving one of the other
				categories of hospice care. This rate is reimbursed without regard to the
				volume or intensity of routine home care services provided on any given day,
				and is also reimbursed when the beneficiary is receiving outpatient hospital
				care for a condition unrelated to the terminal condition.
b) Beginning January 1, 2016 is reimbursed:
1) At a higher payment rate for the first
				sixty (60) days of hospice care, and
2) At a reduced payment rate for hospice care
				for sixty-one (61) days and over, and
c) Includes a service intensity add-on (SAI)
				payment in addition to the perdiem RHC rate for the actual direct patient care
				hours provided by a registered nurse (RN) or social worker, up to four (4)
				hours total per day, during the last seven (7) days of a beneficiary's life
				when discharged due to death. The SAI payment is equal to the continuous home
				care hourly payment rate multiplied by the amount of direct care actually
				provided by an RN and/or social worker.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 205 - Hospice Services › Chapter 1 - Program Overview › Rule 23-205-1.9 - Documentation Requirements

Current through June 25, 2024
A. The hospice
				provider must maintain medical records for each beneficiary at the hospice site
				which corresponds to the address associated with the provider license and
				Division of Medicaid provider number and must include, but not limited to, the
				following:
1. The Division of Medicaid's
				specific hospice related forms which must be complete and accurate:
a) Terminal illness
				certification/recertification form with supporting documentation,
b) Hospice notice of election form,
c) Hospice discharge/Hospice
				revocation form, if applicable,
d)
				Hospice transfer form, if applicable,
e) Hospice discharge/Hospice revocation form
				including the discharge summary for a hospice beneficiary which must include
				the following:
1) A summary of the
				beneficiary's stay including treatments, symptoms, and pain management,
2) The beneficiary's current plan
				of care (POC),
3) The beneficiary's
				current physician orders, and
4)
				Any other documentation that will assist in post-discharge continuity of care
				or that is requested by the attending physician or receiving facility.
(a) The hospice must forward to the receiving
				facility for any beneficiary transferred to another hospice provider, the
				following:
(1) The hospice discharge summary,
				and
(2) The beneficiary's clinical
				record, if requested.
(b)
				The hospice must forward to the beneficiary's attending physician for any
				beneficiary that revokes hospice election or is discharged the following:
(1) The hospice discharge summary,
				and
(2) The beneficiary's clinical
				record, if requested.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 205 - Hospice Services › Chapter 1 - Program Overview › Rule 23-205-1.10 - Dual Eligibles

Current through June 25, 2024
A. The hospice
				benefit must be used simultaneously under Medicare and Medicaid with Medicare
				providing primary coverage for dual eligible beneficiaries.
B. The Division of Medicaid requires the
				hospice provider to submit the Notice of Hospice Election or Discharge for Dual
				Eligible Beneficiaries (Form DOM 1166C) to the Division of Medicaid's
				Utilization Management/Quality Improvement Organization (UM/QIO) within five
				(5) calendar days of the beneficiary's hospice election or discharge date.
1. If the hospice provider fails to submit
				Form DOM 1166C to the UM/QIO within five (5) calendar days of the election
				period, the effective date will be the date when the completed Form DOM 1166C
				is received.
a) The Division of Medicaid will
				not reimburse the hospice or nursing facility providers for days prior to the
				effective date of the election statement.
b) The hospice and/or nursing facility cannot
				seek payment from the beneficiary.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 205 - Hospice Services › Chapter 1 - Program Overview › Rule 23-205-1.11 - Prior Authorization

Current through June 25, 2024
A. Prior
				authorization is required for the initial and all subsequent hospice election
				periods.
B. All prior authorization
				requests must be submitted within ten (10) calendar days of the effective date
				of the election period and must include the following:
1. For the initial ninety (90) day election
				period:
a) Signed notice of election form,
b) Signed
				certification/recertification of terminal illness form,
c) Clinical/medical information supporting
				terminal prognosis,
d) Physician
				orders,
e) Current medication list,
				and
f) Hospice provider plan of
				care.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 206 - Mental Health Services › Chapter 1 - Community Mental Health Services › Rule 23-206-1.1 - Provider Requirements

Current through June 25, 2024
A. All providers of
				community mental health services must:
1.
				Provide proof of certification by the Mississippi Department of Mental Health
				(MDMH), professional license, or certification and/or license from the
				appropriate agency as required by the Division of Medicaid,
2. Provide proof that the services they
				provide have been certified by the appropriate agency when
				applicable,
3. Meet the applicable
				requirements described in Miss. Admin Code Part 200, Chapter 4,
4. Provide a National Provider Identifier
				(NPI), verification from the National Plan and Provider Enumeration System
				(NPPES), and
5. 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 206 - Mental Health Services › Chapter 1 - Community Mental Health Services › Rule 23-206-1.3 - Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid covers four (4) medically necessary mental health assessments by a
				non-physician per fiscal year when:
1.
				Completed during the intake process and/or when there is a need for
				reassessment.
2. Provided by a
				staff member who holds a master's degree and professional license or is one (1)
				of the following as appropriate:
a) A
				Department of Mental Health (DMH) Certified Mental Health Therapist
				(CMHT),
b) DMH Certified
				Intellectual and Developmental Disabilities Therapist (CIDDT), or
c) A DMH Certified Addiction Therapist
				(CAT).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 206 - Mental Health Services › Chapter 1 - Community Mental Health Services › Rule 23-206-1.4 - Non-Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid does not cover community mental health services that:
1. Are not medically necessary,
2. Are not prior authorized by the Division
				of Medicaid, Utilization Management/Quality Improvement Organization (UM/QIO)
				or designee, if required, and
3.
				Are not part of a plan of care or treatment plan approved by a team member
				qualified to approve the service being provided.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 206 - Mental Health Services › Chapter 1 - Community Mental Health Services › Rule 23-206-1.5 - Reimbursement

Current through June 25, 2024
A. The Division of Medicaid reimburses for
				covered mental health services according to a statewide uniform fee
				schedule.
B. Reimbursement for
				physician services provided outside of a Community or Private Mental health
				center are subject to the limits described in Miss. Admin. Code Title 23, Part
				203.
42 C.F.R.
				  §§ 440.130; Miss. Code Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 206 - Mental Health Services › Chapter 1 - Community Mental Health Services › Rule 23-206-1.6 - Documentation

Current through June 25, 2024
A. All services must be documented on a
				treatment plan and approved, signed and dated by a licensed practitioner
				operating within their scope of practice.
B. The following must be documented in the
				beneficiary's case record for each service provided:
1. Type of service provided,
2. Date of service,
3. Length of time spent providing the
				service,
4. Start and end times of
				sessions,
5. Names of all
				individuals receiving or participating in the service,
6. Summary of session,
7. Explanation of how the service relates to
				the goals and objectives established in the treatment plan,
8. Name and title of servicing provider,
				and
9. Signature and credentials of
				servicing provider/practitioner.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 1 - Long-Term Care Pre-Admission Screening and Resident Review (PASRR) Level I › Rule 23-207-1.1 - Clinical Eligibility Determination

Current through June 25, 2024
A. A Pre-Admission
				Screening and Resident Review (PASRR) Level I must be performed prior to
				admission to a Medicaid certified nursing facility (NF), except for the
				exclusions listed under Miss. Admin. Code Part 207, Rule 1.2., to:
1. Assess the person's clinical eligibility
				and need for NF services.
a) A person must
				meet the Division of Medicaid's specific numerical threshold for clinical
				eligibility, or be approved based on a secondary review, in order to be
				considered clinically eligible.
b)
				Clinical eligibility determinations, which are unable to be determined by the
				Division of Medicaid, will be submitted to a Mississippi licensed physician for
				the determination.
c) A person
				must also have signed physician's orders upon admission to the NF.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 1 - Long-Term Care Pre-Admission Screening and Resident Review (PASRR) Level I › Rule 23-207-1.2 - Exclusions

Current through June 25, 2024
A. A Pre-Admission Screening and Resident
				Review (PASRR) Level I is not required when a person is:
1. Admitted to a nursing facility (NF) when
				the person was discharged from an acute care hospitalization directly into a NF
				for continued treatment of a condition for a period of less than thirty (30)
				days.
a) The person must be admitted to a NF
				short stay covered under Medicare Part A, Medicare Part C Plan, or other payor,
				as a skilled NF resident, and
b)
				The attending physician must certify before admission to the NF that the person
				is likely to require less than thirty (30) days of NF services.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 1 - Long-Term Care Pre-Admission Screening and Resident Review (PASRR) Level I › Rule 23-207-1.3 - Qualification Requirements for Pre-Admission Screening and Resident Review (PASRR) Level I Evaluators

Current through June 25, 2024
The Pre-Admission Screening Resident Review (PASRR) Level I
				  must be completed by the following qualified individuals:
A. Physician,
B. Nurse Practitioner or Registered Nurse,
C. Licensed Social Worker,
D. Rehabilitation Counselor,
E. Designee by facility/setting,
				or
F. Certified
				Assessor.
Miss. Code Ann.
				  §§ 43-13-117, 43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 1 - Long-Term Care Pre-Admission Screening and Resident Review (PASRR) Level I › Rule 23-207-1.4 - Documentation of Informed Choice

Current through June 25, 2024
A. A person must be
				advised of all identified placement options funded by the Division of Medicaid
				as part of ensuring that an informed choice is made regardless of where a
				person applies for services. Medicaid beneficiaries have the right to freedom
				of choice of providers for Medicaid covered services. [Refer to Miss. Code Part
				200, Rule 3.6]
B. The PASRR Level
				I Informed Choice section must be signed by the person and/or their legal
				and/or designated representative.
C. The PASRR Level I will not be processed
				without the Informed Choice section having being completed and signed.
Miss. Code Ann.
				  §§ 43-13-117, 43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 1 - Long-Term Care Pre-Admission Screening and Resident Review (PASRR) Level I › Rule 23-207-1.6 - Appeals

Current through June 25, 2024
Persons have the right to appeal long-term care eligibility
				  denials. [Refer to Miss. Admin. Code Part 300]
Miss. Code Ann.
				  §§ 43-13-116, 43-13-117, 43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.1 - General

Current through June 25, 2024
A. The Division of Medicaid will execute a
				provider agreement with a nursing facility (NF) only when the Mississippi
				Department of Health (MSDH) or Centers for Medicare and Medicaid Services (CMS)
				has certified the NF has met all participation requirements in accordance with
				federal and state law.
B. The
				Division of Medicaid does not make payments to any NF prior to the date of
				certification and execution of a valid Medicaid provider agreement.
C. If the Division of Medicaid has adequate
				documentation showing good cause, it may refuse to execute an agreement, or may
				cancel an agreement, with a certified facility. A provider agreement is not
				valid, even though certified by the State survey agency, if the facility fails
				to meet the civil rights requirements set forth in 45 C.F.R. Parts 80, 84 and
				90.
45 C.F.R. Parts 80, 84,
				  90;
				  42 C.F.R. §§
											442.10,
				  442.12,
				  483.1; Miss. Code
				  Ann. §§ 43-11-1, 43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.2 - Provider Enrollment Requirements

Current through June 25, 2024
Nursing facility providers 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 the tax identification number and
				legal name.
C. Copy of license or
				current certification letter and from the state of servicing
				location.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.3 - Remedies and Termination of Agreements

Current through June 25, 2024
A. The Division of
				Medicaid will use one (1) or more of the following remedies when deemed
				appropriate by the Centers for Medicare and Medicaid Services (CMS) or the
				Division of Medicaid based on results of surveys conducted by the Mississippi
				State Department of Health, Bureau of Health Facilities Licensure and
				Certification (MSDH HFLC):
1. Temporary
				Management,
2. Denial of payment
				for new admissions,
3. Civil money
				penalties,
4. Transfer of
				residents,
5. Closure of the
				facility and transfer of residents, and/or
6. State monitoring.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.4 - Dual Eligibles

Current through June 25, 2024
A state is not required to pay for any expenses related to
				  payment for deductibles, coinsurance, or co-payments for Medicare cost sharing
				  for dually eligibles that exceed what the state's Medicaid program would have
				  paid for such service for a beneficiary who is not a dually eligible. When a
				  state's payment for Medicare cost-sharing for a dually eligible is reduced or
				  eliminated, the Medicare payment plus the state's Medicaid payment is
				  considered payment in full; and the dually eligible cannot be billed the
				  difference between the provider's charge and the Medicare and Medicaid payment.
				  Medicare is the primary payor for dually eligible recipients, and providers are
				  obligated to comply with the requirements covering the coordination between the
				  two programs. Persons eligible for Medicare and Medicaid are entitled to all
				  covered services available under both programs, but a claim must be filed with
				  Medicare, if Medicare covers the service.
Miss. Code Ann. §
										43-13-121;
				  42 U.S.C.
				  1396 u3; 42 CFR §447.15; Balanced Budget
				  Act of 1997, Social Security Act 1902 (a)
				  (10)(E)
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.5 - Reimbursement

Current through June 25, 2024
A. Participating Mississippi nursing
				facilities must prepare and submit a Medicaid cost report for reimbursement.
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 2 - Nursing Facility › Rule 23-207-2.7 - Admission Requirements

Current through June 25, 2024
A. A Pre-Admission
				Screening and Resident Review (PASRR) Level I must be completed to determine
				clinical eligibility for persons seeking admission to a Division of Medicaid
				certified nursing facility (NF) regardless of payment source except for the
				exclusions listed in Miss. Admin. Code Part 207, Rule 1.2.
1. The PASRR Level I must be submitted to the
				Division of Medicaid's Envision web portal upon completion. The completed PASRR
				Level I must be faxed to the Division of Medicaid if the provider is not a
				Mississippi Medicaid provider.
2.
				A person must receive a PASRR Level I numerical threshold score of fifty (50)
				or greater to be clinically eligible for NF placement, or be determined
				clinically eligible through a secondary review or physician's determination.
3. Persons with mental illness
				(MI), an intellectual disability/developmental disability (ID/DD) and/or a
				related condition (RC) determined to require a NF level of care must receive a
				PASRR Level II to ensure appropriate placement and the provision of necessary
				specialized rehabilitative services or supplemental services and supports
				regardless of payment source.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.8 - Temporary Leave

Current through June 25, 2024
A. The Division of
				Medicaid defines temporary leave as a temporary absence for one (1) or more
				calendar days the resident is out of the nursing facility for:
1. A home/therapeutic temporary leave.
a) The temporary leave is defined as:
1) Eight (8) consecutive hours or more during
				the day excluding:
(a) Dialysis,
(b) Chemotherapy,
(c) Physical therapy,
(d) Speech therapy,
(e) Occupational therapy, or
(f) Medical treatments that occur two (2) or
				more days per week.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.9 - Resident Assessment Instrument (RAI)

Current through June 25, 2024
A. Nursing
				facilities must complete the Minimum Data Set (MDS) 3.0, including Section S,
				which is the Resident Assessment Instrument (RAI) specified by the Division of
				Medicaid and approved by the Centers of Medicare and Medicaid Services (CMS),
				on all residents regardless of source of payment.
B. Section S identifies beneficiaries
				residing in an Alzheimer's/dementia care unit of a nursing facility which must
				be completed on all residents during the specified time period of each of the
				following MDS assessments including, but not limited to:
1. Comprehensive (NC) which includes:
a) Admission,
b) Annual,
c) Significant Change in Status Assessment
				(SCSA), and
d) Significant
				Correction to Prior Comprehensive Assessment (SCPA),
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.10 - Case Mix Reimbursement and Case Mix Review

Current through June 25, 2024
A. The Division
				of Medicaid utilizes a resource utilization grouper-version 4 (RUG-IV)
				fortyeight (48) group model for case mix calculation for reimbursement.
1. Each of the forty-eight (48) resident
				classifications as well as the default classification is assigned case mix
				weights.
2. The classifications are
				calculated electronically using the minimum data set (MDS) assessment data and
				the RUG-IV calculation program.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.11 - Resident Funds

Current through June 25, 2024
A. Basic
				Requirements
1. The facility must, upon
				written authorization by the resident, accept responsibility for holding,
				safeguarding and accounting for the resident's personal funds. The facility may
				make arrangements with a federally or state insured banking institution to
				provide these services, but the responsibility for the quality and accuracy of
				compliance with the requirements of this section remains with the facility. The
				facility may not charge the resident for these services, but must include any
				charges in the facility's basic daily rate.
2. Resident fund accounts are reviewed to
				assist facilities in developing acceptable systems of accounting for resident
				funds.
3. Penalties may be assessed
				on any licensed nursing facility that fails to maintain an auditable system of
				accounting for residents' funds or has had repeated instances of noncompliance
				with the provisions of federal law and of the requirements contained in this
				section.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.12 - Nurse Aide Training

Current through June 25, 2024
A. Nurse Aide
				Training and Testing Reimbursement
1. The
				Division of Medicaid uses the direct reimbursement method for nurse aide
				training and testing expenses incurred by nursing facilities.
2. Reasonable cost of training and competency
				testing of nurse aides in order to meet the requirements necessary for the
				nurse aide to be certified are to be billed directly to Medicaid
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.13 - Release of Information

Current through June 25, 2024
A. Public access to
				records maintained by the Medicaid agency is mandated. The exceptions to public
				access are those records which are exempt as confidential or
				privileged.
B. Beneficiary-Specific
				Information will only be released by the Medicaid agency when the requirements
				of federal regulation are met.
C.
				Provider-Specific Information, including, but not limited to, cost reports,
				reimbursement rates, reimbursement amounts and reports not
				beneficiary-specific, will be available to the public when:
1. A written request for the information is
				made to the Executive Director of the Medicaid agency,
2. The information is available in existing
				agency files or reports, and
3. The
				requestor reimburses the Medicaid agency for the costs associated with the
				compilation of the requested material, as permitted by law.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.14 - Pharmacy

Current through June 25, 2024
A. Beneficiaries in nursing facilities may
				obtain medications from pharmacies holding retail, closed door or institutional
				permits. Nursing facility (NF) residents may receive unlimited prescriptions
				per month if the medication orders, signed by the prescribing provider, are
				documented in the individual patient record and maintained at the nursing
				facility.
B. Beneficiaries maintain
				the ability to obtain Medicaid services from any institution, agency, pharmacy,
				person or organization that is qualified to furnish the services and willing to
				furnish them to that beneficiary. Participation in any package plan for medical
				care, such as those furnished by nursing facilities, must be strictly
				voluntary.
C. A resident of a
				long-term care facility is allowed freedom of choice of pharmacy providers for
				drugs covered by the Medicaid drug program. The freedom of choice is limited to
				pharmacies that meet labeling and packaging requirements established by the
				Mississippi State Board of Pharmacy.
D. Consequently, once a beneficiary chooses a
				particular provider or NF, he or she has clearly exercised freedom of choice
				with the respect to all items of medical care included within the scope of that
				nursing facility, including all services provided or arranged for by the NF
				which are reimbursed through the NF rates.
Miss. Code Ann. §
										43-13-121;
				  Social Security Act 1902 (a)(23)
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.15 - Ventilator Dependent Care

Current through June 25, 2024
A. The Division of
				Medicaid defines ventilator dependent care (VDC) as mechanical ventilation for
				life support designed to replace and/or support normal ventilatory lung
				function.
B. Effective January 1,
				2015, the Division of Medicaid provides an established reimbursement per diem
				rate in addition to the standard per diem rate to Mississippi nursing
				facilities, excluding out-of-state nursing facilities and Nursing Facilities
				for the Severely Disabled (NF-SD), for residents requiring VDC services.
				Effective January 1, 2015, Mississippi nursing facilities will receive the
				following reimbursement for a ventilator dependent resident:
1. A standard per diem, and
2. A ventilator per diem.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.16 - Therapy Services

Current through June 25, 2024
A. All nursing
				facilities are required to provide rehabilitation services for residents.
				Requirements include physical, occupational and speech-language pathology
				therapies. Medicaid, consistent with third party liability rules, is obligated
				to cover these services.
B. Prior
				authorization/pre-certification of certain physical, occupation, and
				speech-language pathology services is required by the Division of Medicaid.
				Therapy providers must prior authorize services through the Utilization
				Management and Quality Improvement Organization (UM/QIO) for Medicaid. Failure
				to obtain prior authorization will result in denial of payment to billing
				providers.
C. The UM/QIO will
				determine medical necessity, the types of therapy services, and the number of
				visits/treatments reasonably necessary to treat the beneficiary's condition. A
				complete list of procedure codes that require prior authorization may be
				obtained through the UM/QIO. All procedures and criteria set forth by the
				UM/QIO are applicable and are approved by Medicaid.
D. Providers must also adhere to all Medicaid
				outpatient therapy rules.
E.
				Nursing Facility for the Severely Disabled - Miss. Admin. Code Part 207, Rule
				2.16 is not applicable to a Nursing Facility for the Severely Disabled (NFSD).
				Therapy services for this provider type are inclusive in the per diem rate and
				cannot be billed separately.
F.
				Medicaid-Only Residents - Therapy services for Medicaid-only residents may be
				provided by state-licensed therapists who have a current Medicaid provider
				number. Nursing facilities may apply for a group therapy provider number for
				billing purposes.
G. Dually
				Eligible Residents - Mississippi law requires providers participating in the
				Medicaid program to determine if a beneficiary is covered by a third party
				source, and to file and collect all third party coverage prior to billing
				Medicaid. This includes beneficiaries who are Medicare/Medicaid dual eligibles.
				Therapists providing services to dually eligible beneficiaries must bill
				Medicare as the primary coverage. All therapy providers must meet state and
				federal requirements.
Miss. Code
				  Ann. §§
										43-13-117,
				  43-13-121, SPA
				  15-004.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.17 - Feeding Assistant Program

Current through June 25, 2024
A. Feeding
				Assistant Reimbursement
1. The Division of
				Medicaid uses the direct reimbursement method for feeding assistant training
				expenses incurred by nursing facilities. Reasonable costs of training of
				feeding assistants in order to meet the requirements necessary for the feeding
				assistant to be certified and are to be billed directly to Medicaid. The
				nursing facility will be directly reimbursed by Medicaid for covered services
				and items as defined on the agency website. In order to receive Medicaid
				reimbursement, the training program must have approval from the Mississippi
				State Department of Health (MSDH), Division of Health Facilities Licensure and
				Certification.
2. Services and
				supplies approved for payment will be subject to application of the nursing
				facility's percentage of Medicaid utilization. The Medicaid utilization
				percentages of every facility are redetermined annually and are applicable for
				one (1) state fiscal year. The Medicaid utilization percentages are taken from
				the most recent cost report at the time of redetermination. Nursing facilities
				and training centers are notified in writing of their Medicaid utilization
				percent. In cases where no cost report data is available, eighty (80) percent
				will be applied to approved billings until such time that the correct Medicaid
				utilization percent can be determined. Training centers' Medicaid utilization
				percentage will be redetermined annually and will be calculated based on the
				weighted average of Medicaid utilization percentages of associated facilities
				weighted by bed size.
3. The
				Division of Medicaid will reimburse the nursing facilities or related training
				centers for the minimum required services and supplies. A facility or training
				center will be reimbursed for no more than four (4) training sessions per year.
				No costs actually incurred by the facility or the training center will be
				considered for reimbursement, like for electricity, gas, or water. No
				reimbursements will be made for estimated cost. The cost of manuals approved
				for use by MSDH will be reimbursed.
4. Training programs refer to the training
				area set up within a nursing facility or training center. Training programs
				include, but are not limited to, training areas set up by a nursing facility in
				a remote location due to space restrictions and training centers where an area
				has been set up for training that serves more than one (1) facility and is
				located in an area remote from any of the associated facilities.
5. No reimbursement is available for training
				costs incurred by individuals or for tuition to outside entities.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.18 - Individualized, Resident Specific Custom Manual and/or Custom Motorized/Power Wheelchairs Uniquely Constructed or Substantially Modified for a Specific Resident

Current through June 25, 2024
A. The Division of
				Medicaid defines a wheelchair as a seating system that is designed to increase
				the mobility of residents who would otherwise be restricted by inability to
				ambulate or transfer from one place to another.
B. The Division of Medicaid defines an
				individualized, resident specific custom manual and/or custom motorized/power
				wheelchair as one that has been uniquely constructed or substantially modified
				for a specific resident referred to in this Rule as "custom manual wheelchair"
				and/or "custom motorized/power wheelchair".
C. The Division of Medicaid does not classify
				the following wheelchairs as custom manual and/or custom motorized/power
				wheelchairs:
1. Standard manual
				wheelchairs,
2. Standard manual
				wheelchairs with added accessories,
3. Standard motorized/power wheelchairs,
				and/or
4. Standard motorized/power
				wheelchairs with added accessories.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.19 - Disaster Procedures

Current through June 25, 2024
A. Nursing
				facilities 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. §
										483.73.
B. Nursing facilities 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 resident population, including,
				but not limited to, persons at-risk; the type of services the nursing facility
				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, or federal emergency
				preparedness officials' efforts to maintain an integrated response during a
				disaster or emergency situation, including documentation of the nursing
				facility'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 2 - Nursing Facility › Rule 23-207-2.20 - Facility Initiated Discharges

Current through June 25, 2024
A. A nursing
				facility 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 3 - Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) › Rule 23-207-3.1 - General

Current through June 25, 2024
A. The Division of Medicaid may not execute a
				provider agreement with an intermediate care facility for individuals with
				intellectual disabilities (ICF/IID) for services unless the State survey agency
				or the Centers for Medicare and Medicaid Services (CMS) has certified the
				ICF/IID as having met all of the participation requirements. The Mississippi
				State Department of Health (MSDH), Division of Health Facilities Licensure and
				Certification, pursuant to federal law and regulation, certifies ICF/IIDs for
				participation in the Medicaid program.
B. The Division of Medicaid does not
				reimburse an ICF/IID prior to the date of certification and execution of a
				valid Medicaid provider agreement.
C. If the Division of Medicaid has adequate
				documentation showing good cause, it may refuse to execute an agreement, or may
				cancel an agreement, with a certified ICF/IID. A provider agreement is not
				valid, even though certified by the State survey agency, if the ICF/IID fails
				to meet civil rights requirements.
42 U.S.C. §
											1396r; 42 C.F.R. § 442.12; 45 C.F.R.
				  Parts 80, 84 and 90; Miss. Code Ann. §
										43-13-121.
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 23-207-3.2 - Provider Enrollment Requirements

Current through June 25, 2024
Intermediate care facility for individuals with intellectual
				  disabilities (ICF/IID) providers must satisfy all requirements set forth in
				  Part 200, 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
				Internal Revenue Service (IRS) confirming the tax identification number and
				legal name.
C. Copy of license or
				current certification letter and from the state of servicing
				location.
Miss. Code Ann. §
										43-13-121.
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 23-207-3.3 - Duration and Termination of Provider Agreements

Current through June 25, 2024
A. The duration
				of an intermediate care facility for individuals with intellectual
				disabilities' (ICF/IID's) Medicaid provider agreement is for the same period of
				time as an ICF/IID's certification or recertification for participation by the
				Mississippi State Department of Health (MSDH).
B. The certification or recertification for
				an ICF/IID remains in effect until it is determined that the ICF/IID is no
				longer in compliance with the Conditions of Participation as determined by MSDH
				and/or the Centers for Medicare and Medicaid Services (CMS).
1. ICF/IIDs must be surveyed by MSDH
				licensure and certification:
a) No later than
				fifteen (15) months after the last day of the previous survey to determine
				compliance with the Conditions of Participation, and
b) At a state-wide average interval of twelve
				(12) months or less which is computed at the end of each federal fiscal year by
				comparing the last day of the most recent survey for each participating ICF/IID
				to the last day of each ICF/IID's previous survey.
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 23-207-3.4 - Admission Review

Current through June 25, 2024
A. The Mississippi
				Department of Mental Health (DMH) is responsible for conducting reviews of each
				beneficiary's need for admission to an intermediate care facility for
				individuals with intellectual disabilities (ICF/IID).
B. An ICF/IID pre-admission form must be
				completed no more than thirty (30) days prior to the admission of the
				beneficiary to an ICF/IID and submitted with a copy of the current physical
				examination, medical and social history, and the preliminary evaluation.
C. A physician must certify that
				each applicant's or beneficiary's ICF/IID level of care criteria were met at
				the time of admission. Recertification must be made at least every twelve (12)
				months thereafter.
D. The
				interdisciplinary team must prepare for each resident, within thirty (30) days
				after admission, an individual program plan (IPP) that states the specific
				objectives necessary to meet the beneficiary's needs. At least annually, the
				comprehensive functional assessment of each beneficiary must be reviewed by the
				interdisciplinary team for relevancy and must be updated and the IPP is revised
				as needed.
42 C.F.R.
				  §§
											456.350-
				  456.381,
				  456.400,
				  456.431;
				  Miss. Code Ann. §
										43-13-121.
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 23-207-3.6 - Reimbursement

Current through June 25, 2024
A. Participating Mississippi intermediate
				care facilities for individuals with intellectual disabilities (ICF/IIDs) must
				prepare and submit a Long-term Care Medicaid cost report for reimbursement.
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 3 - Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) › Rule 23-207-3.7 - Temporary Leave Payment

Current through June 25, 2024
A. The Division of
				Medicaid defines temporary leave as a temporary absence for one (1) or more
				calendar days the resident is out of the intermediate care facility for
				individuals with intellectual disabilities (ICF/IID) for:
1. A home/therapeutic temporary leave.
a) The temporary leave is defined as:
1) Eight (8) consecutive hours or more during
				the day excluding dialysis, chemotherapy or medical treatments that occur two
				(2) or more days per week,
2) An
				absence at twelve midnight (12 a.m.), or
3) A hospital observation stay.
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 23-207-3.8 - Resident Personal Funds

Current through June 25, 2024
A. The intermediate
				care facility for individuals with intellectual disabilities (ICF/IID) must,
				upon written authorization by the resident, and/or guardian or legal
				representative accept responsibility for holding, safeguarding and accounting
				for the resident's personal funds.
1. The
				ICF/IID may make arrangements with a federally or state insured banking
				institution to provide these services, but the responsibility for the quality
				and accuracy of compliance with the requirements of this rule remains with the
				ICF/IID.
2. The ICF/IID must
				include any charges for this service in the ICF/IID's basic daily rate and
				cannot charge the resident.
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 23-207-3.9 - Utilization Review

Current through June 25, 2024
The Division of Medicaid's Utilization Management/Quality
				  Improvement Organization (UM/QIO) is the organization designated to conduct
				  utilization reviews (UR) in intermediate care facilities for individuals with
				  intellectual disabilities (ICF/IIDs), as required by the Division of
				  Medicaid.
42 C.F.R. Part 456, 42
				  C.F.R. Part 483, Subpart I; Miss. Code Ann. §
										43-13-121.
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 23-207-3.10 - Release of Information

Current through June 25, 2024
A. Public access to
				records maintained by the Division of Medicaid is mandated. The exception to
				public access is those records which are exempt as confidential or privileged.
B. Beneficiary-specific
				information will only be released by the Division of Medicaid when the
				requirements of federal regulations are met.
C. Provider-specific information, including,
				but not limited to, cost reports, reimbursement rates, reimbursement amounts
				and reports not beneficiary-specific, will be available to the public when:
1. A written request for the information is
				made to the Executive Director of the Division of Medicaid,
2. The information is available in existing
				agency files and reports, and
3.
				The requestor reimburses the Division of Medicaid for the costs associated with
				the compilation of the requested material, as permitted by law.
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 23-207-3.11 - Individualized, Resident Specific Custom Manual and/or Custom Motorized/Power Wheelchairs Uniquely Constructed or Substantially Modified for a Specific Resident

Current through June 25, 2024
A. The Division of
				Medicaid defines a wheelchair as a seating system that is designed to increase
				the mobility of residents who would otherwise be restricted by inability to
				ambulate or transfer from one place to another.
B. The Division of Medicaid defines an
				individualized, resident specific custom manual and/or custom motorized/power
				wheelchair as one that has been uniquely constructed or substantially modified
				for a specific resident referred to in this Rule as "custom manual wheelchair"
				and/or "custom motorized/power wheelchair."
C. The Division of Medicaid does not classify
				the following wheelchairs as custom manual and/or custom motorized/power
				wheelchairs:
1. Standard manual wheelchairs,
2. Standard manual wheelchairs
				with added accessories,
3.
				Standard motorized/power wheelchairs, and/or
4. Standard motorized/power wheelchairs with
				added accessories.