reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-15.4 - PERSONAL CARE ATTENDANT (PCA) TRAINING

Current through June 25, 2024
RESPONSIBILITIES OF THE REGISTERED NURSE AND THE OSDP COUNSELOR
Training shall be conducted by the client (or caregiver), the OSDP Counselor and Registered Nurse. Training shall also include disability awareness, employee employer relationships, and the need of respect for the client's privacy and property.
The Counselor must provide orientation regarding the Academic Requirements, and the RN/Counselor should provide orientation to the functional requirements for a PCA in the client's home, on or before the service initiation date for PCA Services, in order to:
* Provide them necessary training to deliver the personal care tasks and document that the orientation/training was provided or initiated;
* Determine if the individual is competent to deliver the authorized personal care tasks and document competency on the Provider Competency Form
The Counselor/RN will provide information to the PCA on the following:
* Information about the client's condition and how it may affect the performance of tasks;
* Tasks to be performed, work schedule, safety and procedures;
* Changes in the client's condition in which they should contact the Counselor to report the problem
If more than one attendant is needed to provide the service, the individuals identified as attendants should be certified at the same time.
The Counselor will provide information to the PCA on the following:
* The maximum number of PCA hours per day and the number of days per week the client is certified/approved to receive.
* Discuss with the PCA on how to complete the daily time logs.
* Inform the PCA of the pay periods and the amount to be paid.
* Inform the PCA that services cannot be rendered while the client is in the hospital.
The PCA will be instructed to provide information to the Counselor on the following:
* To provide at least 5 days notice if they decide to no longer work for the client.
* If the condition of the client changes (improves/clients condition declines).
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-15.5 - FLEXIBILITY TO CHANGE PERSONAL CARE ASSISTANCE TASKS ASSIGNED

Current through June 25, 2024
The consumer and the Counselor can modify the initial schedule and change the personal assistance tasks assigned that are included on the PCA Task Assignment Sheet to a mutually agreeable schedule that will meet the client's needs. This does not change the number of hours that have been approved as needed. Only PCA tasks that are allowed on the IL Waiver or TBI/SCI Waiver can be provided and PCA paid for. If additional hours are needed, the procedures outlined in 12.2 must be utilized. The schedule modification can be ongoing; for example, the client scheduled tub bathe daily can be changed to 4 times per week; or tasks assigned Monday, Wednesday and Friday can be changed to Monday, Tuesday and Wednesday. Flexibility allows the client tasks to meet the particular needs of the client considering changes in their condition and wants. Hours are based solely on hours assumed to be provided within the home environment. Flexibility is not intended to be for convenience or to be applied to justify the absence of an attendant or break in services.
OSDP has a backup system to assure the provision of all PCA services on the schedule agreed and approved without service break; even if there are unexpected changes in personnel.
If the client notifies the Counselor that the PCA has not provided services as mutually agreed, the Counselor must contact the PCA to find out the problem of which endangered the health and safety of the client.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-15.6 - APPROVING ATTENDANT'S TIMESHEET

Current through June 25, 2024
The attendant is responsible for completing their timesheet and should be instructed to send in timesheets based on the designated payroll dates. The attendant should be cautioned about holding time logs for months prior to sending them for payment. Failure to submit time logs in a timely manner could result in non-payment.
The OSDP Counselor must review the attendant's timesheet to verify that the tasks assigned are being provided and the number of hours approved are not exceeded. The attendant will only be paid for the hours they are approved by MDRS to work.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-16.0 - DURABLE MEDICAL/SPECIALIZED MEDICAL EQUIPMENT AND SUPPLIES

Current through June 25, 2024
Specialized medical equipment and supplies are devices, controls, or appliances that enable individuals to increase their abilities to perform ADL's, or to perceive, control, or communicate with the environment in which they live. These services also include items necessary to the proper functioning of such items and durable and non-durable medical equipment not available under the Medicaid State Plan.
Specialized medical supplies are supplies that are medically necessary to meet the needs of the consumer. The Counselor must document the necessity of the requested medical supply based on:
*
Consumer's disability or medical condition; and
*
Evaluation of the medical supply to adequately support the consumer living in the most integrated setting possible in the community.
*
Medical supplies are only covered after the consumer has exhausted any insurance, including Medicaid and Medicare, the consumer is eligible to receive.
Covered Medical supplies include:
*
Briefs
*
Blue pads
*
Underpads
*
Catheters
*
Gloves
*
Drainage Bags
*
Leg Bags
*
Skin Barrier Products (medically prescribed)
*
Ostomy Supplies (medically prescribed)
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-16.1 - SPECIALIZED MEDICAL EQUIPMENT AND ADAPTIVE AIDS

Current through June 25, 2024
Specialized medical equipment/adaptive aids are devices, controls, or appliances that increase a consumer's ability to:
*
Perform Activities of Daily Living;
*
Perceive, control, or communicate with the environment in which they live;
*
Ensure safety, security, and accessibility.
Medical equipment/adaptive aids may:
*
Assist with mobility and communication;
*
Compensate for conditions resulting in disability or loss of function.
*
Medical equipment/adaptive aids are only covered after the consumer has exhausted any insurance, including Medicaid and Medicare, the consumer is eligible to receive.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-16.2 - MEDICAL EQUIPMENT/ADAPTIVE AIDS COVERED

Current through June 25, 2024
Medical equipment/adaptive aids consist of the following services:
Lifts:
*
Wheelchair lifts
*
Porch lifts
*
Hydraulic, manual, or other electronic lifts
*
Bathtub seat lifts
*
Transfer bench
Mobility Aids:
*
Manual/electric wheelchairs and necessary accessories
*
Scooters
*
Braces, crutches, walkers, canes
*
Prescribed prosthetic devices
*
Prescribed orthotic devices, orthopedic shoes and other prescribed footwear
*
Portable ramps and
*
Batteries and chargers
Positioning Devices:
*
Customized seating systems
*
Electric or manual hospital beds, tilt-frame bed, and necessary accessories
*
Trapeze bars
*
Egg crate mattresses, sheepskin, and other medically related padding
Communication Aids (including repair, maintenance and batteries
)
:
*
Augmentative communication devices
*
Speech amplifies, aids and assistive devices
*
Hearing aids
Control Switches/Pneumatic Switches and Devices:
*
Sip and puff controls and
*
Adaptive switches/devices
Environmental Control Units:
*
Locks
*
Electronic devices
*
Voice activated, light-activated, oral motion-activated devices
Adaptive equipment for activities of daily living:
*
Assistive devices:
*
Reachers
*
Holders
*
Shower chairs
*
Overbed tray tables
*
Medically Necessary Durable Medical Equipment not covered in the State plan for the Mississippi Medicaid Program
*
Temporary rental of medically necessary durable medical equipment to allow for repair, purchase, replacement of essential equipment, or temporary usage of the equipment.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-16.3 - MAKING REQUESTS FOR NON-COVERED ITEMS

Current through June 25, 2024
The request must include:
*
A copy of the Rationale for Adaptive Aids, Medical Equipment
*
The cost estimate/price quote
*
Adaptive Aid Form indicating the item is not covered by Medicare, Medicaid or other private insurance and
*
Assistive Technology Report (if applicable) and
*
Medical Prescription (if applicable)
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-16.4 - REQUESTING ITEMS THAT ARE NOT ON THE LIST OF COVERED MEDICAL EQUIPMENT/ADAPTIVE AIDS

Current through June 25, 2024
The Counselor must submit a request to the District Manager for approval of an adaptive aid or medical equipment that is not on the current list. The Counselor must forward the request to the District Manager. The District Manager will staff the case with the Registered Nurse and Program Director based on:
*
How the request is related to the consumer's disability, and
*
If the Medical equipment is:
* Medically necessary
* Cost effective and
* Necessary to prevent institutionalization
Federal Regulations and State Purchasing laws require a Fee Schedule be established for all purchases. However, some items do not have a fee listed in the fee schedule and must be manually priced.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-16.5 - UTILIZING COMPARABLE BENEFITS, THIRD PARTY PROVIDERS, BEFORE PURCHASING ADAPTIVE AID/MEDICAL EQUIPMENT

Current through June 25, 2024
All comparable benefits/third party providers the consumer is eligible for must be accessed before using the waiver or any other funding program to pay for adaptive aids or medical equipment. The Counselor must work with the vendor to ensure that, if the consumer is eligible for Medicare, Medicaid, Home Health Services, or any other comparable benefit, the resources are used to meet the consumer's need for services. If the Counselor determines the consumer qualifies for services provided by another resource, they must obtain documentation to support their eligibility for the resource.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-16.6 - REQUESTING AN ADAPTIVE AID/MEDICAL EQUIPMENT THAT THE COUNSELOR THINKS MAY NOT BE PAID

Current through June 25, 2024
The Counselor must submit a request with supporting documentation to the District Manager for a decision. It is outside of the Counselor's role to make decisions about the adaptive aids for which will or will not be covered. Decisions regarding such request must be made by the Counselor and must be made under OSDP procedures to ensure the consumer's due process rights are observed.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-16.7 - DOCUMENTATION REQUIRED JUSTIFYING COST-EFFECTIVE PURCHASE OF ADAPTIVE AID/MEDICAL EQUIPMENT

Current through June 25, 2024
A price quote from at a minimum of two (2) vendors is required to purchase medical equipment/adaptive aid.
The quote must contain:
*
Name of the adaptive aid/medical equipment
*
A price quote
*
Date of the quote
*
Name of agency
DME exempt from obtaining two (2) quotes are:
*
Prosthesis
*
Orthotics
*
Wheelchairs and accessories
*
Hospital Beds and accessories
*
Motorized Scooters
*
Patient Lifts and
*
Other medically prescribed, medically necessary DME
Regardless of whether the vendor is also the manufacturer, or the vendor is purchasing from a manufacturer or from a distributor/supplier, it is the responsibility of the vendor to clearly note whether a charge is the MSRP or cost. Vendors are entirely responsible for submitting correct documentation for DME at MSRP or cost. Vendors should be able to produce documentation to show the charges can be substantiated if audited. The Counselor will provide information on vendors of specialized medical equipment and supplies so that the consumer can make and
informed choice regarding vendor for services.
Specialized medical equipment, supplies, and adaptive aids and any other Medically Prescribed DME items not elsewhere listed in the printed OVR Fee Schedule may be manually priced and purchased from any authorized Durable Medical Equipment dealer/vendor.
Quotes are not acceptable as an invoice.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-16.8 - DURABLE MEDICAL EQUIPMENT PRIOR TO TRANSITION

Current through June 25, 2024
Recommended/Medically Prescribed Durable Medical Equipment can be purchased within 60 days of a scheduled transition date if the item is an approved waiver service.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-17.0 - RESPITE CARE SERVICES

Current through June 25, 2024
Respite Care Services are a service component of the TBI/SCI Trust fund and the TBI/SCI Waiver. Respite care services gives short-term, temporary relief to the usual caregiver because of the absence or need for relief of the caregiver. Respite provides all the necessary care that the usual caregiver would provide during that time period to the client. Respite care enables the client to remain in their current living situations and provides services to the family member. Respite care services and PCA services are not the same.
Goals of Respite:
*
Reduce stress and help maintain family relations
*
Assist and strengthen the family as a unit
*
Contribute to good physical and emotional health
*
Provide the caregiver time to rest, relax, and re-create
Respite care may be provided in the individual's home or place of residence, Foster Home or Institution - Medicaid certified Hospital, Medicaid certified Nursing Facility, Group Home and Licensed respite care facility.
An in-home companion, Nurse Aide/Assistant, Licensed Practical Nurse or Registered Nurse, may provide respite care services. The primary care physician determines the level of respite care that the client requires. This is documented by his/her physician by completion of the Respite Tier-Determination Form. (See Resource Guide)
Tier 1 -
Companion - $7.25
Tier 2 -
Nurse Aide - $9.00
Tier 3 -
Licensed Practical Nurse - $12.00
Tier 4 -
Registered Nurse - $18.00
All respite care providers must be certified as meeting the skill level determined to be required by the physician, by the OSDP Counselor and the Registered Nurse (Case Management).
When respite care is provided, payment for other duplicative services is precluded.
The Tier determination level should also be reflected on the authorization for services so that the appropriate pay level (Tier) is verified.
Limitation: An individual is allowed a maximum of 288 respite hours per year which is scheduled at the discretion of the individual and regular caregiver. However, the OSDP Counselor must be notified when it becomes necessary for the individual to use respite services that have been planned on the Plan of Care for waiver cases and ILP for all IL cases.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-18.0 - TRANSITION ASSISTANCE SERVICES

Current through June 25, 2024
Transition Assistance Services are services provided to a Mississippi Medicaid eligible nursing facility resident to assist in transitioning from the nursing facility into the Independent Living or the Traumatic Brain Injury/Spinal Cord Injury Waiver Program.
Transition Assistance is one-time initial expense required for setting up a household. The expenses must be included in approved Plan of Care.
**Transition Assistance Services are capped at $800.00
one-time initial expense per lifetime.
Transition Assistance Services include
:
1.
				Security Deposits that are required to obtain a lease on an apartment or
				home.
2. Essential furnishings and
				moving expense required to occupy and use a community domicile.
3. Set up fees or deposits for utility or
				service access (e.g. telephone, electricity, heating).
4. Health and safety assurances, such as pest
				eradication, allergen control, or one-time cleaning prior to occupancy.
(Essential items for an individual to establish his/her basic
				  living arrangement includes such items as a bed, table, chairs, window blinds,
				  eating utensils, and food preparation items). Diversional or recreational items
				  such as televisions, cable TV access or VCR's are not considered
				  furnishings.
Need for this service
: All items and services covered must be essential to:
1. Ensure that the individual is able to
				transition from the current nursing facility.
2. Remove an identified barrier or risk to
				the success of the transition to a more independent living situation.
To be eligible
:
1. Individual must be a current nursing
				facility resident whose NF services are being paid by Medicaid and want to
				transition on the Independent Living or Traumatic Brain Injury/Spinal Cord
				Injury Waiver.
In order to provide sufficient time to coordinate and plan
				  appropriate transition services, the transition service must occur within 90
				  days of discharge but must be completed by the day the individual relocates
				  from the institution. Persons whose NF stay is temporary or rehabilitative, or
				  whose services are covered by Medicare or other insurance, wholly or partially,
				  are not eligible for this service. Transition services will be considered
				  provided once the individual has transitioned from the nursing facility to the
				  waiver.
Exclusions: Transition Assistance is not available to
				  residents whose stay in a nursing facility is ninety (90) days or
				  less.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-18.1 - DESCRIPTION OF TRANSITION ASSISTANCE SERVICES

Current through June 25, 2024
Deposits
Deposits include security deposits for rental and utilities including basic telephone service. Security deposits or utility deposits must be in the applicant's name.
Security deposits may be paid as long as the payment is specifically called a security deposit and not rent, the payment is for a one-time expense, and the amount of the payment is no more than the equivalent of two months rent. Transition assistance services cannot pay for rent.
Transition assistance services can be used to pay for arrears on previous utilities if the account is in the client's name and the client will not be able to get the utilities unless the previous balance is paid. Transition assistance services cannot pay the first month's payment on utilities.
Transition assistance services can be used to pay for a telephone since it is a basic need but minutes or services on the telephone cannot be paid for.
Transition assistance services cannot pay for any charges for upgraded services beyond the basic service.
Transition assistance services funds can be used to pay for initial setup or reconnection fees to propane or butane service including the minimal supply of fuel if the utility company has a policy that requires a minimal supply of fuel to be delivered during the initial or reconnection service call. Transition assistance services funds cannot be used to top off a tank with fuel when the individual's home is connected and has a supply of butane or propane.
Transition assistance services can pay for pet deposits only if the pet is a service animal essential to the client.
Household Needs
Household needs include basic furniture/appliances. This includes bedroom furniture, living room furniture, kitchen furniture, refrigerator, stove, washer, dryer, etc.
An applicant may request a specific brand or type of appliance, furniture or other Transition assistance services item as long as the applicant's needs are met within the cost limit.
Transition assistance services items may be placed in someone's home other than the applicant only when furnishings are not available and are necessary for the applicant to transition to the community. Transition assistance services cannot pay for items that would only be used by the other person.
If existing items are not usable and the lack of a usable basic/essential item creates a barrier keeping the individual from transitioning to the home and community, the item is considered a need.
House wares
House wares can include pots, pans, dishes, silverware, cooking utensils, linens, towels, clock and other small items required for the household.
Small Appliances
Small appliances include a microwave oven, electric can opener, coffee pot, toaster, etc.
Cleaning Supplies
Cleaning supplies include a mop, broom, vacuum, brushes, soaps and cleaning agents.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-18.2 - SERVICES AND ITEMS NOT INCLUDED IN TRANSITION ASSISTANCE SERVICES

Current through June 25, 2024
Transition assistance services does not include any items or services that will be included under waiver services such as adaptive aids, minor home modifications, and medical supplies/equipment.
Transition assistance services does not include any recreational items including television, VCR or DVD player, games, computers, cable TV, satellite TV, exercise equipment, vehicles or other modes of transportation.
Transition assistance services will not cover the cost of repairs on the client's dwelling.
Transition assistance services funds cannot be used for food. The OSDP Counselor may refer the client to the Department of Human Services for food stamp assistance and any local food pantry resources.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-18.3 - PREPARING THE HOME FOR TRANSITION

Current through June 25, 2024
Preparing the home for transition can include the following services:
*
Moving expenses which include the cost of moving the applicant's items from another location or delivery charges on large purchased items.
*
Pest eradication, if the applicant's place of residence has been unattended and some type of extermination is needed.
*
Allergen control, if the applicant's place of residence has been unattended or the applicant is moving into a place that poses a respiratory health problem or
*
One time cleaning, if the applicant's place of residence has been unattended or the applicant is moving into a private home or apartment where pre-move-in cleaning should not be expected, e.g., a family friend has an empty house available but cannot provide the cleaning.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-18.4 - TRANSITIONING ASSISTANCE SERVICES FORM - ESTIMATED COST OF ITEMS AND SERVICES

Current through June 25, 2024
The OSDP Counselor may use the Transition Assistance Services Form (See Resource Guide) to assist with planning and determining the services needed and estimated cost. The amounts must be reasonable estimates of the cost of basic items and services. The list may be used to assist the applicant in identifying specific needs, but the Counselor will enter a description and amount only for the items and services identified by the applicant.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-18.6 - FIVE DAY MONITORING REQUIRED BY COUNSELOR AFTER TRANSITION

Current through June 25, 2024
The Counselor must monitor the clients within (5) five work days of the discharge date to be sure that all services and items authorized were received and the client has transitioned successfully. If the client reports that any items have not been provided, the Counselor must follow-up to resolve the issue.
Once the Counselor confirms that all items/services have been delivered, the Counselor pays the Authorization in AACE and submits the authorization and all documentation to OSDP Madison for Medicaid Reimbursement.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-18.7 - FAILURE TO TRANSITION FROM THE NURSING FACILITY

Current through June 25, 2024
While the Counselor makes every effort to confirm that the client has definite plans to leave the nursing facility, there may be situations in which the client changes his mind or has a change in his health making it impossible for him to relocate to the community as planned. In this situation, the Counselor must contact any vendor that has provided a service and stop the delivery of the services. No additional service should be provided/purchased.
MDRS via the Counselor must attempt to return any item(s) purchased on behalf of the individual and collect a refund for the amount of the purchase. MDRS must also attempt to recoup security, utility and other deposits paid on behalf of the individual.
*
If the Counselor is unsuccessful in returning the item(s) for the amount or the deposits paid on behalf of the individual cannot be recouped, MDRS is responsible for paying for the item(s) or deposits paid. The Counselor must attach to the authorization when submitting to Madison case note documentation stating that the item(s) could not be returned, or the deposits could not be recouped. Any items obtained from the client may be used to serve individuals whose needs are similar to those of the individual for whom the items were purchased or must be dedicated to assisting other individuals to establish a home.
*
If the Counselor is able to return the item(s) or receives the deposits back, the refund for money must be made payable to: Mississippi Department of Rehabilitation Services. A claim will not be billed to Division of Medicaid.
*
If the individual is only in the home for a few days and returns to the nursing facility, the individual can keep the item(s) purchased or donate them to other individuals to help establish a home. The Counselor must work with the client to determine what item(s) they should keep and what items should be used for other clients.
The Counselor must explain the purpose and limitations of transition assistance services to the individual when determining their need for the service(s).
The applicant may appeal a decision regarding a needed item or service, but transition services should not be delayed due to the appeal.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-19.0 - PROSTHETIC AND ORTHOTIC & APPLIANCES

Current through June 25, 2024
The provision of Prosthetic and Orthotic Devices in an appropriate Independent Living Service.
OSDP staff will follow the same guidelines and procedures set forth in the OVR/OVRB Resource Guide and the Fee Schedule Amputee Clinic Section and fees for Orthotic Procedures L0000-L4999, that specify guidelines regarding Prescriptions, Authorizations, Physical Therapy, Checkout Sessions, Appointments and Fees.
The IL Counselor should provide the client receiving a prosthetic or orthotic device with sufficient information so the client can make
Informed Choices
regarding the provision of this service. In some instances, a physician or prosthetist may refer the client. A client who was originally referred to OSDP by a prosthetist should have the new appliance purchased from that company unless there are documented reasons to the contrary, ex. The client chooses to use another prosthetic company.
If the individual has experienced any recent physical problems or changes, a current evaluation and medical records should be obtained from the primary treating physician that indicates their current physical condition.
Any client with amputations resulting from diabetes should be evaluated prior to a prosthetic fitting by an internist or their primary treating physician, to determine that there have been no exacerbations of the physical condition that would affect the successful fitting of a new appliance. The Counselor may obtain current medical information from their primary treating physician that may reflect that there have been no exacerbations of their physical condition.
When determining if a prosthetic or orthotic appliance will benefit an individual in terms of improving their ability to function more independently in the family or community, the following should be considered:
1. Is the person medically ready to wear a prosthesis?
2. Will a prosthetic or orthotic fitting be beneficial in terms of functioning more independently in the home and community?
3. Prescription for the prosthetic or orthotic device
4. Recommendations for appropriate training in the use of the prosthesis or orthotic device.
(
See fee schedule for L codes when purchasing orthotic and/or prosthetics)
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-19.1 - DETERMINING ELIGIBILITY FOR INDIVIDUALS WITH HEARING IMPAIRMENTS

Current through June 25, 2024
In order to determine eligibility, the Counselor must obtain a valid ENT report signed by a licensed Otolaryngologist. This report can be furnished by the client, or the Counselor can authorize for a comprehensive ENT examination.
A. If the hearing loss is
				between 40-50 dB in the better ear and the speech discrimination scores are
				between 75% and 85%, this case would normally be served by the cross-over
				Counselor.
B. If the hearing loss
				is 55dB or greater in the better ear speech discrimination score is between 50%
				and 75%, this case would normally be served by the RCD.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-19.2 - DEGREES OF HEARING LOSS

Current through June 25, 2024
0 dB to 25 dB
Normal limits
26 dB to 40 dB
Mild loss
41 dB to 55 dB
Moderate loss
56 dB to 70 dB
Moderately severe loss
71 dB to 90 dB
Severe loss
91+
Profound loss
Difficulty in Speech Discrimination
90 to 100%
Normal limits
75 to 90%
Slight difficulty, comparable to listening over a telephone
60 to 75%
Moderate difficulty
50 to 60%
Poor discrimination, marked by difficulty in following conversation
Below 50%
Unable to follow running a speech
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-19.3 - COMPLETING YOUR ENT REPORT FORM

Current through June 25, 2024
1.
Page
				one
- Background information (should be completed by the Counselor
				prior to the examination).
2.
Page two
- Audiogram and pure tones scores.
(O) represents right ear
(X) represents left ear
[ ] represents bone conduction (sound introduced in the
				  temporal lobe).
MDRS uses the pure tone scores at [500hz, 1000hz, 2000 hz],
				  which are referred to as the
Speech Range
, to determine if the
				  client's loss causes serious limitation in their ability to function or move
				  toward functioning on the home or community.
Pure Tone Averages
are determined by adding
				  the scores of these ranges and dividing by three. This is called a
				  three-frequency average. If there is a presence of loss
in at least
				  one of the frequencies in the speech range
that drops sharply at
				  4000 hrtz, the Counselor should do a four-frequency average.
Several terms are used in the section:
- Air
refers to the result of the test for
				  air conduction using pure one averages.
-
Bone
refers to the results of the test for
				  bone conduction.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-19.4 - AUTHORIZING FOR ENT EVALUATION

Current through June 25, 2024
ENT Evaluations: Which CPT Codes To Use
For comprehensive Otological and Audiological visit for a
new patient *
to the same office, authorize:
* 99203
Otological evaluation
* 92557
Audiological evaluation
*
92507 Speech Therapy sessions
*
92508 Auditory Training
If the Otolaryngologist and the Audiologist are in different offices, the Counselor would authorize for the CPT procedures on separate authorizations.
If the client is returning to the same Otolaryngologist they are now considered to be an established patient, authorized:
* 99213
(office visit/outpatient visit/typically 15 mins).
*The fees listed in the fee schedule should always be used unless the vendor's usual and customary fee is less than that listed in the fee schedule
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-19.5 - AUTHORIZATIONS FOR HEARING AIDS AND OPTIONS

Current through June 25, 2024
MDRS prices for recommended hearing aids should be established according to the following guidelines:
Markup
Monaural Fitting
Vendor's invoice cost from the manufacturer plus .......................
....$375.00
Binaural Fitting
Vendor's invoice cost from the manufacturer .................................
....$575.00
Additional for Digital Aids
...........................................................................................
....$200.00
The MDRS markup includes cost of impressions, postage, insurance, batteries, and a One-year warranty.
In keeping with the established policy for purchasing hearing aids and options, MDRS will pay the vendor's invoice cost for the hearing aid and options which are recommended and agreed upon by the Counselor plus the appropriate markup for monaural or binaural aide.
Counselors should obtain the factory cost (invoice) from the hearing aid dealer and authorize for the aid/aids.
The following statement should be on the authorization:
"INVOICE TO ACCOMPANY STATEMENT OF ACCOUNT"
Counselors should receive an actual copy of the invoice with the Statement of Account from the hearing aid dealer and attach it to the Statement of Account when submitting for payment. A copy of the invoice should also be placed in the case file.
The following is a partial list of other optional and assistive devices with prices:
Ear-mold (When authorized separately)
$40.00
Telephone switch (When auth. Separately)
$25.00
Bi-Cros ( invoice price plus monaural markup)
Hearing aid repairs . . factory invoice cost plus
$30.00
*Note that ear-mold(s) would not be authorized for in-the-ear aids.
If an option is listed as being more than these prices, the actual manufacturer's invoice cost for the option may be paid.
All Authorizations for hearing aids MUST include the make and model of the aid, monaural or binaural markup, and cost of the aid. Example authorizations are given below:
Siemens BTE analog aid
$380.00
Monaural markup
$375.00
TOTAL
$755.00
Resound digital aid (x2)
$1,380.00
Binaural markup
$ 575.00
Additional markup
$ 200.00
TOTAL
$2,155.00
Digital/Programmable Hearing Aids
Digital/Programmable hearing aids may be more appropriate for some types of hearing loss configurations; however, they are not
required
for the majority of clients with hearing loss. These aids are more expensive and require much more time to adjust properly after the initial fitting. For these reasons, an additional markup of $200 has been allowed to compensate the vendor for up to 4 additional office visits to cover services rendered after the initial fitting.
Any Digital/Programmable hearing aids in excess of $2,300.00, including markups must be staffed with the State Coordinator of Deaf Services (SCD) before an authorization is issued.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-19.6 - FOUR (4) REASONS FOR REPLACING HEARING AIDS

Current through June 25, 2024
a. If
				the aid is at least four years old
b. If the aid has been repaired at least once
				at the cost of the user*
c. If the
				aid now being worn is no longer appropriate for the client's hearing loss d. If
				technology has improved to the point that a new aid is significantly better.
*If the client purchases an extended warranty, his/her
				  out-of-pocket expenses are automatically considered to meet the requirements
				  "for part b".
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-19.7 - CLIENT PARTICIPATION

Current through June 25, 2024
Client participation can be an appropriate way to utilize case service funds if the client can afford to participate in the payment of his/her hearing aids. If you do receive some amount of client participation by the client, MDRS is still ultimately responsible for the hearing aid payment.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-19.8 - WEEK FOLLOW-UPS/THIRTY DAY FOLLOW-UP

Current through June 25, 2024
The purpose of the two week follow-up is to show that the vendor has successfully fitted the client with the prescribed hearing aid and has met with the client within two weeks to confirm his/her satisfaction with the fitting. The form should be included along with the initial authorization and sent directly to the vendor. Two weeks after the fitting, the form should be completed by the client in the hearing aid dealer's office, not sent to the client in the mail. Again, the two week follow-up form is your confirmation that the client has received the proper services for which you are paying. If the client is not satisfied with his hearing aid or the services of the vendor, the two week follow- up serves as the client's mechanism to express his feelings in writing.
The thirty day follow-up is conducted by the Counselor with the client, thirty days after the initial fitting, to confirm that the client is still satisfied after thirty days. Because it serves as one of the required counseling contacts prior to moving a client to employed status, the thirty day follow-up should be conducted in a one-on-one counseling session not over the phone. Most often, during a thirty day follow-up session, the client will have questions and concerns about his new aids that only the Counselor is qualified to answer.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-20.0 - CASE FILE FOLDER

Current through June 25, 2024
Each client's folder will have a label affixed to the tab on the folder. The label will include: the client's name, address, county, and district number. The following will be stamped on the outside of the client's file folder and the appropriate information recorded beside the headings:
*
Client's Social Security Number
*
Client's Telephone Number
*
SSI/SSDI Status
*
Case Status Dates (updates as status changes are made)
*
Medicaid Number (if applicable)
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-20.1 - CASE NOTES

Current through June 25, 2024
Entries made are to include a record of all Counselor contacts with and/or behalf of the client. Case notes should include the counseling sessions, monthly contacts, telephone conversations, and reports of progress. Case notes will be filed on top of all other records on the left side of the folder. All case notes must be entered into the electronic case file (AACE), printed, and placed in the hard copy case file. All entries will be dated and the place of contact recorded (Category). The nature of the Case notes will be recorded in the Summary Section. AACE records the author of the Case notes as the person logged in the system. If another staff is entering the Case note on the Counselor's behalf, the Case notes will be signed by the Counselor. Record the first initial and last name.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-20.2 - CASE SERVICE RECORD ORGANIZATION

Current through June 25, 2024
The case record should be organized in such a way as to allow for easy access of information. All materials should be filed in reverse chronological order (most recent on top) based on the date information was received.
The Client Case File maintained by the OSDP Counselor should contain all assessment and eligibility information.
The case file is considered to be deficient if it does not contain the following information, at a minimum
:
* Running Record - Case notes
- Documentation of Quarterly Reviews
- Recertification Notes
- Monthly Contacts
*Some clients correspond with their Counselor via e-mail. If this occurs the e-mail shall become a part of Case notes and filed accordingly.
PAGE 1 - Application
- Referral Form
- Envision Sheet
- Application for Services
- Statement of Understanding
- Consent to Disclose Form
- HIPPA
- Insurance Declaration Form
- Appendix D/Medicaid Payment Authorization Sheet
- Medical Records
- Emergency Preparedness Form
PAGE 2 - Case Notes
- Case Notes
- AT Reports, Project Start, etc.
- Notice of Action Letter
PAGE 3 - Pre-Admission Screening (PAS)
- PAS Application
- Informed Choice
PAGE 4 - Physician's Form
- Physician's Summary
- TBI/SCI Verification Form
- Respite Tier Form
PAGE 5 - Plan of Care (POC)
- POC (Handwritten)
- POC (Electronic)
- Added Services
PAGE 6 Personal Care Attendant (PCA) Certification
- PCA Cert (not application)
- Change of Address
- PCA Task Assignment Sheet
PAGE 7 - Time Logs
- PCA Time Logs/payment sheets
- Respite Time Logs/payment sheets
PAGE 8 - Financial Documents
- Authorizations
- EOB
- FIN
- AT Reports
- Quotes/Bids
- Prescription
PAGE 9 Medicaid Correspondence
- NOD
- 105
- Two-Way Communication
PAGE 10 Independent Living Plan (ILP)
- ILP
- Certificate of Eligibility
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-21.1 - TIME LIMIT FOR FILING CLAIMS

Current through June 25, 2024
Claims for covered services will be paid by DOM only when received within twelve (12) months of the through date of service.
The following are the only reasons allowed consideration for overriding the timely filing:
* Claims filed within twelve (12) months from the date of service but denied can be resubmitted with the internal control number (ICN) from the original denied claim recorded on the face of the resubmitted claim.
* Claims over twelve (12) months can be processed if the consumer's Medicaid eligibility has been approved retroactively by the Division of Medicaid. Proof of retroactive determination should accompany the claim and be filed within twelve (12) months from the date of retroactive letter.
Claims submitted two (2) years from the date of service are not reimbursable unless the consumer's Medicaid eligibility is retroactive.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-21.2 - MDRS/OSDP FILING CLAIMS TO MEDICAID

Current through June 25, 2024
After receiving payment or denial from all third party sources, MDRS is required to file a claim with DOM. The amount of the third party payment must be indicated in the appropriate claim field. The claim is processed, and Medicaid either pays the balance due on the claim (the total Medicaid payment amount less the third party payment amount) or makes no additional payment if the third party payment is equal to or greater than the total amount due to Medicaid. In either situation, the consumer's history of services is updated.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-22.0 - CASE RECORD CLOSURES FOR INDEPENDENT LIVING SERVICES

Current through June 25, 2024
A client's case shall be closed when it has been determined by the Counselor that planned services are completed, as appropriate, or that additional services are either unnecessary or inappropriate.
Cases may be closed at different stages in the rehabilitation process:
*
From Applicant Status
*
After Eligibility From Pre-Service Listing
*
After Eligibility but prior to ILP development
*
After ILP development but prior to ILP services being initiated
*
After Initiation of ILP services
There are two types of closure statuses:
*
Closed Goals Met
*
Closed Other Than Rehabilitated - Goals Not Met
There must be adequate documentation in the case record regarding the case closure. Documentation may be on AACE forms and case notes.
Required documentation generated from AACE includes the following:
*
AACE Closure Report
*
Notification of Closure Letter
*
Closing Statement for Goals Met
*
Certificate of Ineligibility
*
Certificate of Ineligibility/ILP closing amendment
*
AACE Case Summary Report at closure
*
AACE Case History Report
All documentation regarding case closure must be clearly
stated
and
written
in a manner that presents a thorough explanation of the reasons or situations regarding the closure. All closure documentation must be based on the contents of the case record.
Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-22.1 - CLOSURE-GOALS MET

Current through June 25, 2024
Cases closed, as Goals Met must meet the minimum criteria listed below:
*
The individual has been determined eligible.
*
The individual was provided an evaluation/ assessment for services.
*
The individual was provided counseling and guidance/case management as an essential IL service.
There must be documented evidence that the Counselor personally addressed the following issues with the consumer or, as appropriate, the consumer's representative:
*
The client's ability to function independently in the home or community or continue in employment has improved.
*
Consumer indication of agreement/disagreement with the decision to close their case.
The consumer must be informed in writing of the case closure decision in a letter labeled
"Closing Statement."
The closing statement must be
dated
and
signed
by the Counselor and must include:
*
Indication that the consumer agreed/disagreed with the decision.
*
Indication that the provision of services contributed significantly to improving their ability to function or continuing functioning in the home and community.
*
Information regarding benefits/insurance.