reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 221 - Family Planning and Family Planning Related Services › Chapter 2 - 1115(a) Family Planning and Family Planning Related Waiver Services › Rule 23-221-2.3 - Freedom of Choice

Current through June 25, 2024
A. Participants
				have the right to freedom of choice of providers for Family Planning Waiver
				(FPW) services in accordance with Miss. Admin. Code Part 200, Rule
				3.6.
B. Participants have freedom
				of choice to:
1. Receive or reject FPW
				services,
2. Choose FPW providers,
				and
3. Choose any method of birth
				control, including sterilization.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 221 - Family Planning and Family Planning Related Services › Chapter 2 - 1115(a) Family Planning and Family Planning Related Waiver Services › Rule 23-221-2.4 - Covered Services

Current through June 25, 2024
A. Family Planning
				Waiver (FPW) services are available for eligible participants who voluntarily
				choose to:
1. Prevent pregnancy,
2. Plan the number of pregnancies,
				or
3. Plan the spacing between
				pregnancies.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 221 - Family Planning and Family Planning Related Services › Chapter 2 - 1115(a) Family Planning and Family Planning Related Waiver Services › Rule 23-221-2.5 - Non-Covered Services and Item

Current through June 25, 2024
Services and items not considered Family Planning Waiver
				  (FPW) services and not reimbursable under the waiver program include, but are
				  not limited to, the following:
A.
				Facilitating services including, but not limited to, transportation, parking,
				and child care while FPW services are being obtained,
B. Indirect services, including, but not
				limited to, telephone contacts/consultations,
C. Drugs used to promote fertility,
D. Over-the-counter emergency contraceptives
				and related services,
E.
				Over-the-counter drugs and supplies including, but not limited to, pregnancy
				tests, spermicides, and condoms.
F. Infertility studies and procedures to
				enhance fertility including, but not limited to, reversal of sterilization,
				artificial or intrauterine insemination or in-vitro fertilization,
G. Abortions and related services,
H. Hysterectomy and related services for
				sterilization purposes,
I.
				Menopausal or post-menopausal treatment and related services,
J. Removal of an implanted device for a
				non-FPW eligible individual,
K.
				Natural family planning services,
L. Cancer screening services, except for Pap
				smears,
M. Mammograms,
N. Services to a participant whose age or
				physical condition precludes reproduction,
O. Services to a participant known to be
				pregnant,
P. Reversal of voluntary
				sterilization,
Q. Services outside
				the scope and/or authority of the provider's specialty and/or area of
				practice,
R. Inpatient hospital
				visit,
S. All services provided for
				the treatment of a medical condition not considered family planning or family
				planning related,
T. Services for
				participants who have received a sterilization procedure and have completed all
				necessary follow-up procedures, and
U. Prescriptions other than contraceptives
				and medications to treat STI/STD, vaginal infections or disorders, other lower
				genital tract and genital skin infections or disorders, and urinary tract
				infections.
42 U.S.C. §§
											1315,
				  1396;
				  Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 221 - Family Planning and Family Planning Related Services › Chapter 2 - 1115(a) Family Planning and Family Planning Related Waiver Services › Rule 23-221-2.6 - Quality Assurance

Current through June 25, 2024
A. The Quality
				Assurance Plan:
1. Ensures the provision of
				comprehensive, accessible, quality and appropriate Family Planning Waiver (FPW)
				services,
2. Provides a system for
				accountability and measuring performance, and
3. Improves care outcomes and quality of
				life.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 221 - Family Planning and Family Planning Related Services › Chapter 2 - 1115(a) Family Planning and Family Planning Related Waiver Services › Rule 23-221-2.7 - Participant Cost Sharing

Current through June 25, 2024
Family Planning Waiver (FPW) services are exempt from cost
				  sharing (co-pay) requirements in accordance with Miss. Admin. Code Part 200,
				  Rule 3.7.
42 U.S.C. §
											1396a; 42 C.F.R. §§ 447.50-447.57;
				  Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 221 - Family Planning and Family Planning Related Services › Chapter 2 - 1115(a) Family Planning and Family Planning Related Waiver Services › Rule 23-221-2.8 - Primary Care Referrals

Current through June 25, 2024
A. Health concerns
				identified during a Family Planning Waiver (FPW) visit but not covered by the
				FPW must be followed up by a primary care provider with an appropriate clinical
				referral.
B. Providers should refer
				participants to other social service and healthcare providers as medically
				indicated including, but not limited to, a Federally Qualified Health Center
				(FQHC) or Rural Health Clinic (RHC).
C. As a component of the medical record
				audit, the primary care referral must be documented in the participant's
				medical record.
Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 221 - Family Planning and Family Planning Related Services › Chapter 2 - 1115(a) Family Planning and Family Planning Related Waiver Services › Rule 23-221-2.9 - Documentation/Record Maintenance

Current through June 25, 2024
A. Providers of
				Family Planning Waiver (FPW) services must comply with the requirements for
				maintenance of records outlined in Miss. Admin. Code Part 200, Rule
				1.3.
B. FPW services documentation must include,
				but is not limited to:
1. Date of
				service,
2. Reason for
				visit,
3. Physical findings
				including vital signs, and weight,
4. Documentation of a physical exam, clinical
				breast exam and cervical cancer screenings conducted at the initial and annual
				visits,
5. Treatments/procedures
				rendered,
6. Demographic
				information, including name, address, Medicaid number, date of birth, sex, and
				marital status,
7. Allergies
				including type, reaction and treatment,
8. Comprehensive health history, updated at
				least annually including, but not limited to:
a) Health risk factors,
b) Personal medical, sexual and contraceptive
				history,
c) Plans for having
				children, and
d) Obstetrical and
				gynecological history.
9.
				Complete family history, updated at least annually,
10. Specific name/type of all diagnostic
				studies including, but not limited to, laboratory and the result/finding of the
				studies,
11. Documentation of all
				medications including contraceptives, whether administered by the provider,
				prescribed, or issued via samples and must include the:
a) Name,
b) Strength,
c) Dose,
d) Route of administration,
e) Site for all injectables, and
f) Manner in which prescription was issued
				including, but not limited to, in writing, by telephone, electronically or via
				facsimile.
12.
				Contraceptive supplies whether administered by the provider, prescribed, or
				issued via samples,
13.
				Contraceptive devices,
14.
				Documentation of education and counseling on contraception management, sexually
				transmitted infections (STI)/sexually transmitted disease (STD), human
				immunodeficiency virus infection (HIV) and acquired immune deficiency syndrome
				(AIDS),
15. Date, time, and
				signature for all entries in the participant's record,
16. Provider's order, which must include the
				time, date, and signature for all medications, treatments and procedures
				rendered,
17. Signed and dated
				consent for treatment, as applicable,
18. Primary care referrals, if
				applicable,
19. OB/GYN referral if
				beneficiary is determined to be pregnant, and
20. Signed and dated consent for
				sterilization, if applicable, as outlined in Miss. Admin. Code Part 202, Rule
				5.3.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 221 - Family Planning and Family Planning Related Services › Chapter 2 - 1115(a) Family Planning and Family Planning Related Waiver Services › Rule 23-221-2.10 - Reimbursement

Current through June 25, 2024
A. The Division of Medicaid reimburses for
				only the provider's whole acquisition cost (WAC) for physician administered
				drugs or implantable drug system devices.
B. The Division of Medicaid does not
				reimburse for provider/prescriber drug samples.
Miss. Code
				  Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 1 - General › Rule 23-222-1.1 - Maternity Services

Current through June 25, 2024
A. The Division of Medicaid covers maternity
				services which include:
1. Antepartum
				services defined by the Division of Medicaid as the care of a pregnant woman
				during the time in the maternity cycle that begins with conception and ends
				with labor.
2. Delivery services
				defined by the Division of Medicaid as the care involved in labor and
				delivery.
3. Postpartum services
				defined by the Division of Medicaid as the care of the mother inclusive of both
				hospital and office visits following delivery for twelve (12) months including
				any remaining days in the month in which the twelfth
				(12th) month occurs.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 1 - General › Rule 23-222-1.3 - Maternal Fetal Ultrasound

Current through June 25, 2024
A. For a fetal
				biophysical profile, the physician may bill one (1) unit for each fetus being
				evaluated in cases of multiple gestations.
B. For an ultrasound during hospitalization,
				Medicaid reimburses the physician submitting a claim for a visit and a review
				of an ultrasound on the same date of service for the visit only. A physician's
				interpretation of the results of an ultrasound will be reimbursed as a separate
				service when prepared with a separate distinctly identifiable signed written
				report using the appropriate procedure code with the appropriate modifier which
				indicates professional component only.
C. Medicaid does not cover routine sonography
				during pregnancy.
D. Medicaid
				covers medically necessary ultrasounds when all of the following criteria are
				met:
1. The ultrasound is consistent with the
				beneficiary's signs, symptoms, and/or condition,
2. Diagnosis cannot be made through clinical
				evaluation of the beneficiary's signs and symptoms, and
3. The results of the ultrasound can
				reasonably be expected to influence the beneficiary's treatment plan.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 1 - General › Rule 23-222-1.4 - Maternity Epidurals

Current through June 25, 2024
A. Medicaid covers
				a maternity epidural for all pregnant Medicaid beneficiaries. Medicaid
				considers maternity epidurals as a medically necessary service for treatment of
				labor pain and does not consider it an elective procedure.
B. A physician who is participating in the
				Medicaid program must take all reasonable measures to ensure that maternity
				patients are instructed and offered an epidural as an available and covered
				service under Medicaid as part of the patient's prenatal counseling. The
				patient's options for pain relief medication during childbirth must be
				explained to her.
C.
				Anesthesiologists/CRNAs cannot refuse to provide a maternity epidural to a
				Medicaid beneficiary except when medically contraindicated.
1. An anesthesiologist/CRNA who is
				participating in the Medicaid program must make available and offer maternity
				epidural services to pregnant Medicaid beneficiaries and cannot require a
				pregnant Medicaid beneficiary to pay for an epidural.
2. He/she must accept the Medicaid payment as
				payment in full and cannot require a co-payment for his/her services. Under
				federal Medicaid law, deductions, cost sharing, or similar charges are not
				permitted for Medicaid services furnished to pregnant women. Thus, a
				participating provider's demand for these additional payments would be in
				violation of the law.
3. The
				decision to have an epidural is to be decided between the beneficiary and her
				anesthesiologist/CRNA in consultation with the obstetrician. No means of
				coercion, dissuasion, or refusal by an anesthesiologist/CRNA to provide an
				epidural to a beneficiary in labor shall be utilized in determining this
				decision.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 1 - General › Rule 23-222-1.6 - Reimbursement for Delivery and Tubal Ligation

Current through June 25, 2024
A delivery, cesarean section or vaginal, and a tubal ligation
				  performed at the same setting will be reimbursed at one hundred percent
				  (100¢) of the fee schedule for each procedure.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 1 - General › Rule 23-222-1.7 - Sterilization

Current through June 25, 2024
Medicaid reimburses covered sterilization procedures when the
				  criteria for covered sterilization are satisfied in accordance with Part 202,
				  Chapter 1, Rule 1.8.
Miss. Code Ann. §
										43-13-121;
				  42 CFR 441, Subpart F
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 1 - General › Rule 23-222-1.8 - Terbutaline Therapy

Current through June 25, 2024
Terbutaline pump therapy with uterine activity monitoring for
				  beneficiaries who are at risk for preterm labor is not covered by
				  Medicaid.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 1 - General › Rule 23-222-1.10 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Current through June 25, 2024
The Division of Medicaid pays for all medically necessary
				  services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title
				  23, without regard to service limitations and with prior
				  authorization.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 1 - General › Rule 23-222-1.11 - Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services

Current through June 25, 2024
A. The Division of Medicaid defines
				Screening, Brief Intervention, and Referral to Treatment (SBIRT) as an early
				intervention approach that targets pregnant women with nondependent substance
				use to provide effective strategies for intervention prior to the need for more
				extensive or specialized treatment.
B. SBIRT services must include:
1. Screening of a pregnant woman for risky
				substance use behaviors using evidence based standardized assessments or
				validated screening tools,
2.
				Brief intervention of a pregnant woman showing risky substance use behaviors in
				a short conversation, providing feedback and advice, and
3. Referral to treatment for brief therapy or
				additional treatment to a pregnant woman whose assessments or screenings
				indicate a need for additional services.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 1 - General › Rule 23-222-1.12 - Tobacco Cessation Counseling Services

Current through June 25, 2024
A. The Division of
				Medicaid covers one (1) face-to-face counseling session per quit attempt with
				mandatory referral to the Mississippi (MS) Tobacco Quit Line for pregnant women
				who use tobacco.
B. Face-to-Face
				sessions must be provided by:
1. Or under
				supervision of a physician,
2. Any
				other health professional who is legally authorized to furnish such services
				under State Law and who is authorized to provide Medicaid coverable services
				other than tobacco cessation services, or
3. Any other health professional legally
				authorized to provide tobacco cessation services under State Law and who is
				specifically designated by the Secretary in regulations.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.1 - Provider Participation

Current through June 25, 2024
A. The Division of
				Medicaid covers the multidisciplinary case management program known as the
				Perinatal High Risk Management/Infant Services System (PHRM/ISS) program,
				administered by the State Department of Health, for certain Medicaid eligible
				pregnant/postpartum women and infants.
B. Any physician or clinic licensed to
				practice in the State of Mississippi or other approved practitioner actively
				enrolled as a Mississippi Medicaid provider may provide PHRM/ISS services as a
				High Risk Case Management Agency.
C. Providers must meet all the following
				qualifications:
1. Meet applicable state and
				federal laws governing the participation of providers in the
Medicaid program.
2. Meet the criteria established by the
				Division of Medicaid as a provider of high risk case management agency
				services.
3. Be enrolled by the
				Division of Medicaid as an EPSDT provider to provide high risk infant
				services
4. Must have qualified
				case managers who meet the qualifications applicable to their specific
				disciplines.
a) Medical Discipline: Case
				manager must be one (1) of the following:
1)
				Physician licensed in Mississippi.
2) Physician assistant licensed in
				Mississippi.
3) Nurse practitioner
				licensed in Mississippi.
4)
				Nurse-midwife certified in Mississippi.
5) Registered nurse licensed in Mississippi
				with a minimum of one (1) year of experience in community nursing.
b) Psychosocial Discipline: Social
				worker with a minimum of one (1) year of experience in health and/or human
				services, and one (1) of the following:
1)
				Masters in Social Work (MSW) social worker licensed in Mississippi.
2) Bachelor in Social Work (BSW) social
				worker licensed in Mississippi in consultation with an MSW.
3) Other Mississippi licensed social worker
				supervised by an MSW.
c)
				Nutritional Discipline: Nutritionist licensed in Mississippi or a registered
				dietitian, with a minimum of one (1) year of experience in providing
				nutritional services to pregnant women and infants. The nutritionist/dietitian
				may only serve as a case manager for enrollees for whom nutritional problems
				are their primary risk.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.1 - Provider Participation

Current through June 25, 2024
A. The provider,
				agency, or entity of Targeted Case Management (TCM) services for high-risk
				women who are pregnant and up to sixty (60) days postpartum or high-risk
				infants through one (1) year of age must comply with the requirements to enroll
				as a Mississippi Medicaid Early and Periodic Screening, Diagnosis, and
				Treatment (EPSDT) Provider and meet the following requirements:
1. Have a minimum of two (2) years'
				experience providing comprehensive case management services to the target
				population,
2. Have an established
				system to coordinate services for Medicaid beneficiaries,
3. Have established referral systems,
				linkages, and referral ability with essential social and health services
				agencies, and
4. Employ Registered
				Nurses with the following qualifications as case managers:
a) Be licensed by the Mississippi Board of
				Nursing and in good standing,
b)
				Have one (1) year documented experience working with the target
				population,
c) Have experience,
				skills, and/or training in crisis intervention,
d) Have effective communication
				skills,
e) Have access to
				multi-disciplinary staff, when needed, and
f) Possess knowledge of resources for the
				service community
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.2 - Freedom of Choice

Current through June 25, 2024
A. Medicaid
				beneficiaries have the right to freedom of choice of providers for Medicaid
				covered services. Refer to Part 200, Chapter 3, Rule 3.6.
B. The PHRM/ISS case management services will
				not restrict an individual's free choice of providers. An eligible beneficiary
				may choose to receive extended or enhanced services through any PHRM/ISS
				provider.
Miss. Code Ann. §
										43-13-121;
				  Social Security Act 1902(a)(23)
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.2 - Covered Services

Current through June 25, 2024
A. A medical risk
				screen must be conducted to determine the need to refer an individual for
				Targeted Case Management (TCM) services. Referrals for TCM services must be
				initiated during the pregnancy for the woman, or birth through one (1) year of
				age for the infant. The medical risk screen must:
1. Be completed by a physician, physician
				assistant, a nurse practitioner, or certified nurse-midwife,
2. Only be conducted once per pregnancy
				unless the beneficiary changes providers and the new provider is unable to
				obtain the beneficiary's medical records, and
3. Be completed up to two (2) times for
				infants, if risk factors are present.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.3 - High Risk Pregnant Women

Current through June 25, 2024
A. A maternity
				medical risk screening is required to determine if a beneficiary is eligible
				for PHRM services.
1. A beneficiary qualifies
				for PHRM services if one (1) or more positive risk factors are
				identified.
2. The medical risk
				screening must be completed by a physician, physician assistant, a nurse
				practitioner, or a certified nurse-midwife.
3. Only one (1) medical risk screening is
				covered during each pregnancy unless the beneficiary changes providers and the
				new provider is unable to obtain the beneficiary's medical records.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.3 - Documentation Requirements

Current through June 25, 2024
A. To qualify for
				reimbursement, a case file with adequate documentation must be maintained for
				each participant receiving Targeted Case Management (TCM) through the Perinatal
				High-Risk Management/Infant Services System (PHRM/ISS) program. Each TCM case
				file must, at a minimum, contain:
1. The name
				of the individual, as well as other personal information including, but not
				limited to:
a) Date of birth and Medicaid ID
				number,
b) Expected date of
				delivery,
c) Date when prenatal
				care began,
d) Name of primary
				provider,
e) Delivery
				date,
f) Delivery method,
g) Birth control plan chosen by
				participant,
h) Date(s) of
				postpartum visit(s) with medical provider,
i) Date of postpartum home visit with
				Extended Service RN,
j) Birth
				weight, and
k) Dates of EPSDT
				well-child visits
l) Release of
				information consent;
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.4 - High Risk Infants

Current through June 25, 2024
A. The Division of
				Medicaid defines high risk infants as those whose medical status during their
				first (1st) year of life places them at risk for
				morbidity or mortality.
B. An
				infant medical risk screening must be completed by a physician, physician
				assistant, certified nurse-midwife, or a nurse practitioner to determine if the
				infant is high risk for mortality or morbidity.
1. An infant is considered high risk if one
				(1) or more risk factors are indicated.
2. An infant is limited to two (2) medical
				risk assessments.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.4 - Freedom of Choice

Current through June 25, 2024
A. Medicaid
				beneficiaries have the right to freedom of choice of providers for Medicaid
				covered services. Refer to Part 200, Chapter 3, Rule 3.6.
B. Perinatal High-Risk Management/Infant
				Services System (PHRM/ISS) Targeted Case Management (TCM) services will not
				restrict an individual's free choice of providers. An eligible beneficiary may
				choose to receive extended or enhanced services through any PHRM/ISS
				provider.
Miss. Code
				  Ann. §
										43-13-121;
				  42 CFR §
											441.18; Social Security Act
				  1902(a)(23)
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.5 - Plan of Care

Current through June 25, 2024
A. A plan of care
				must be developed and implemented for problems identified from the detailed
				enhanced services assessment.
B. A
				PHRM/ISS case manager must be assigned.
1.
				The case manager must be a physician, physician assistant, registered nurse,
				nurse practitioner, certified nurse-midwife, social worker, or
				nutritionist/dietitian.
2. The
				nutritionist/dietitian may only serve as the case manager if the enrollee's
				primary risk is nutritional problems.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.5 - Reimbursement

Current through June 25, 2024
A. The provider
				must bill the appropriate HCPCs code and modifier HD for maternity and infant
				services to be reimbursed under the PHRM/ISS program.
B. Payments under the plan must not duplicate
				payments made to public agencies or private entities under other program
				authorities for the same purpose.
C.
				Only medically necessary services are covered under the Medicaid
				program.
Miss. Code
				  Ann. §§
										43-13-121,
				  43-13-117;
				  42 CFR §
											441.18.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.6 - Medical Record Documentation Requirements

Current through June 25, 2024
PHRM/ISS medical record documentation must contain the
				  following on each patient:
A. Signed
				consent for treatment,
B. Date of
				service,
C. Demographic information
				including:
1. Name,
2. Address,
3. Medicaid number,
4. Date of birth,
5. Sex, and
6. Marital status.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.6 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Current through June 25, 2024
The Division of Medicaid pays for all medically necessary
				  services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title
				  23, without regard to service limitations and with prior
				  authorization.
Miss. Code
				  Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 222 - Maternity Services › Chapter 2 - Perinatal High-Risk Management and Infant Services › Rule 23-222-2.7 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Current through June 25, 2024
The Division of Medicaid pays for all medically necessary
				  services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title
				  23, without regard to service limitations and with prior
				  authorization.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 1 - General › Rule 23-223-1.1 - Program Description

Current through June 25, 2024
A. The Division of
				Medicaid has established a program of Early and Periodic Screening, Diagnosis,
				and Treatment (EPSDT) which provides screenings, preventive and comprehensive
				health services for certain beneficiaries who are eligible for full Medicaid
				benefits. EPSDT services are provided to beneficiaries under age twenty-one
				(21).
B. EPSDT stands for:
1. Early is assessing health care in early
				life so that potential disease and disabilities can be prevented or detected in
				their preliminary states, when they are most effectively treated.
2. Periodic is assessing a child's health at
				regular, recommended intervals in the child's life to assure continued healthy
				development.
3. Screening is the
				use of tests and procedures to determine if children being examined have
				conditions warranting closer medical or dental attention.
4. Diagnosis is the determination of the
				nature or cause of conditions identified by the screening.
5. Treatment is the provision of services
				needed to control, correct or lessen health problems.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 1 - General › Rule 23-223-1.2 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Provider Enrollment

Current through June 25, 2024
A. Physicians,
				physician assistants or nurse practitioners who wish to provide EPSDT
				screenings must meet the Mississippi Medicaid enrollment requirements, complete
				and sign an EPSDT specific provider agreement and pass an onsite clinic
				inspection performed by the Division of Medicaid.
B. Registered nurses employed through the
				Mississippi Department of Education (MDE), who meet the certification
				requirement and the established protocols mandated by the Mississippi State
				Department of Health (MSDH), MDE, Mississippi School Nurse Association, and
				Mississippi Board of Nursing, may perform EPSDT health assessments following
				the protocols established by the MSDH. MDE employed registered nurses must have
				the educational basis and clinical basis needed to perform health assessments.
				In addition to the certification requirement, claims submitted for these
				services must be submitted under the school's provider number and the billing
				provider must have a current letter of referral affiliation on file with the
				Division of Medicaid.
42
				  U.S.C §
											1396d; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 1 - General › Rule 23-223-1.3 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Provider Participation Requirements

Current through June 25, 2024
A. Enrolled
				Mississippi Medicaid providers who have signed an Early and Periodic Screening,
				Diagnosis, and Treatment (EPSDT) specific provider agreement must conduct
				periodic screenings and medically necessary inter periodic visits for all
				EPSDT-eligible beneficiaries in accordance with the EPSDT Periodicity Schedule
				as recommended by the American Academy of Pediatrics (AAP) Bright Futures
				Periodicity Schedule and must provide or refer EPSDT-eligible beneficiaries
				with an identified need for additional assessment, diagnosis, and/or treatment
				services to an appropriate provider.
B. Dental providers must provide services to
				all EPSDT-eligible beneficiaries in accordance with the dental schedule of the
				American Academy of Pediatric Dentistry (AAPD) and in accordance with AAP
				guidelines. Dental providers must provide or refer EPSDT-eligible beneficiaries
				with an identified need for additional assessment, diagnosis, and/or treatment
				services to an appropriate provider.
C. EPSDT screening providers must refer
				EPSDT-eligible beneficiaries to other enrolled Mississippi Medicaid licensed
				practitioners of the beneficiary's choice for assessment, diagnosis and/or
				treatment services necessary to correct or ameliorate any physical, mental,
				psychosocial and/or behavioral health conditions discovered by the screenings,
				whether or not such services are covered under the State Plan.
D. Off-site Early and Periodic Screening,
				Diagnosis and Treatment (EPSDT) screening providers must submit the following
				information to the Division of Medicaid:
1. A
				completed and signed secondary location form documenting the off-site
				provider's ability to complete all age-appropriate components of EPSDT
				screenings;
2. An attestation that
				the EPSDT screenings will be completed by an approved EPSDT screening provider
				who has completed the Division of Medicaid's EPSDT provider agreement and that
				all required equipment and supplies are available at the off-site
				location.
3. A signed agreement
				between the off-site location authority including, but not limited to, a school
				superintendent, principal, day care director, and the screening
				provider.
4. A list of all physical
				addresses of the off-site locations where the EPSDT screenings will be provided
				and a monthly schedule for each location designating the dates and times the
				EPSDT screenings will be offered.
5. Information packet materials including,
				but not limited to, letters, consent forms, and examples of anticipatory
				guidance information sheets to be provided which must be prior approved by the
				Division of Medicaid.
6. A copy of
				the provider's Clinical Laboratory Improvement Amendments (CLIA) Certificate of
				Waiver or CLIA number, if applicable.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 1 - General › Rule 23-223-1.4 - Periodicity Schedule

Current through June 25, 2024
A. EPSDT providers
				must adhere to the current American Academy of Pediatrics (AAP) Bright Futures
				Periodicity Schedule.
B. EPSDT
				providers must schedule all health assessment screening appointments for the
				EPSDT-eligible beneficiary according to the AAP Bright Futures Periodicity
				Schedule.
C. EPSDT providers must
				maintain a screening periodicity tracking system for EPSDT-eligible
				beneficiaries seen for initial screening to ensure that subsequent screenings
				are performed timely and in accordance to the AAP Bright Futures Periodicity
				Schedule. EPSDT-eligible beneficiaries, guardians and/or legal representatives
				must be informed of the AAP Bright Futures Periodicity Schedule.
1. EPSDT providers must follow up on missed
				appointments. If the beneficiary fails to keep the scheduled appointment, or
				the beneficiary, guardian and/or legal representative fails to contact the
				provider to reschedule, an appointment letter or telephone contact must be made
				providing the beneficiary another opportunity to be screened within thirty (30)
				days of the initial appointment.
2. Two (2) good faith efforts, defined as an
				attempt to contact the beneficiary, guardian and/or legal representative, are
				required to reschedule a screening appointment. EPSDT providers must document
				in the medical record any missed appointments and two (2) good faith efforts to
				reschedule the appointment.
3.
				Failure of a beneficiary, guardian and/or legal representative to keep the
				second appointment and respond to the provider's attempted contact is
				considered a declination of that screening only. The provider must continue to
				maintain periodicity and schedule the beneficiary for the next screening due
				following the same process.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 1 - General › Rule 23-223-1.5 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Screenings

Current through June 25, 2024
A. An initial or established age-appropriate
				medical screening which must include at a minimum:
1. A comprehensive health and developmental
				history including assessment of both physical and mental health development and
				family history,
2. A comprehensive
				unclothed physical examination,
3.
				Appropriate immunizations according to the Advisory Committee on Immunization
				Practices (ACIP), and specific to age and health history,
4. Laboratory tests adhering to the AAP
				Bright Futures Periodicity Schedule,
5. Sexual development and sexuality screening
				adhering to the AAP Bright Futures Periodicity Schedule, and
6. Health education, including anticipatory
				guidance.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 1 - General › Rule 23-223-1.7 - Diagnostic and Treatment Program Services

Current through June 25, 2024
The Division of Medicaid covers any medically necessary Early
				  and Periodic Screening, Diagnosis, and Treatment (EPSDT) diagnostic and
				  treatment services required to correct or ameliorate physical, mental,
				  psychosocial, and/or behavioral health conditions discovered by a screening,
				  whether or not such services are covered under any Medicaid Administrative Rule
				  or the State Plan for EPSDT-eligible beneficiaries and, if required, prior
				  authorized by a Utilization Management/Quality Improvement Organization
				  (UM/QIO), the Division of Medicaid or designated entity. [Refer to Miss. Admin.
				  Code Part 200, Rule 5.1 ]
42
				  U.S.C §
											1396d; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 1 - General › Rule 23-223-1.8 - Reimbursement

Current through June 25, 2024
A. The Division of Medicaid reimburses a
				separate fee in addition to the Early and Periodic Screening, Diagnosis, and
				Treatment (EPSDT) periodic screenings and medically necessary interperiodic
				visits for each of the following when documented in accordance with Miss.
				Admin. Code Title 23, Part 223, Rule
				1.6.A.
1. Developmental screenings according to the
				American Academy of Pediatrics (AAP) guidelines,
2. Vision screenings,
3. Hearing screenings,
4. Autism screenings,
5. Depression screenings,
6. Maternal depression screening,
				and
7. Other medically necessary
				services prior authorized by the Division of Medicaid or designee, if required:
a) Lab tests, excluding hemoglobin or
				hematocrit,
b) Diagnostic tests,
				and
c) Other procedures.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 2 - Early Intervention / Targeted Case Management › Rule 23-223-2.1 - Provider Participation

Current through June 25, 2024
A. Providers
1. Qualified providers shall be state
				agencies, private and public providers and their subcontractors.
2. Providers must meet the following Medicaid
				criteria to ensure that case managers for the children with developmental
				disabilities are capable of providing needed services to the targeted group:
a) Demonstrated successfully a minimum of
				three (3) years of experience in all core elements of case management
				including:
1) Assessment,
2) Care/services plan development,
3) Linking/coordination of services,
				and
4)
				Reassessment/follow-up.
b) Demonstrated case management experience in
				coordinating and linking such community resources as required by the target
				population,
c) Demonstrated
				experience with the target population, and
d) Demonstrated the ability to provide or has
				a financial management system that documents services delivered and costs
				associated.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 2 - Early Intervention / Targeted Case Management › Rule 23-223-2.2 - TCM Activities

Current through June 25, 2024
A. Early
				Intervention/Targeted Case Management (EI/TCM) is an active ongoing process
				that involves activities carried out by a case manager to assist and enable a
				child enrolled and participating in the Mississippi Early Intervention Program
				to gain access to needed medical, social, educational and other services.
				Service Coordination to assist the child and child's family, as it relates to
				the child's needs, from the notice of referral through the initial development
				of the child's needs identified on the Individualized Family Services Plan
				(IFSP). Additionally, Service Coordination assists the child and child's
				family, as it relates to the child's needs, with ongoing service coordination,
				for the child, provided by the individual service coordinator selected at the
				time the IFSP is finalized.
B.
				These activities include:
1. Arranging for
				evaluation and assessment activities to determine the identification of
				services as it relates to the child's medical, social, educational and other
				needs,
2. Arranging for and
				coordinating the development of the child's IFSP,
3. Arranging for the delivery of the needed
				services as identified in the IFSP,
4. Assisting the child and his/her family, as
				it relates to the child's needs, in accessing needed services for the child and
				coordinating services with other programs,
5. Monitoring the child's progress by making
				referrals, tracking the child's appointments, performing follow-up on services
				rendered, and performing periodic reassessments of the child's changing service
				needs,
6. Make a minimum of one (1)
				face-to-face contact quarterly and documented successful contacts
				monthly,
7. Obtaining, preparing
				and maintaining case records, reports, documenting contacts, services needed,
				and the child's progress,
8.
				Providing case consultation, with the service providers/collaterals in
				determining child's status and progress,
9. Coordinating crisis assistance,
				intervention on behalf of the child, making arrangements for emergency
				referrals and coordinating other needed emergency services, and
10. Coordinating the transition of an
				enrolled child to ongoing services prior to the child's third (3rd)
				birthday.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 2 - Early Intervention / Targeted Case Management › Rule 23-223-2.3 - Quality Assurance and Monitoring

Current through June 25, 2024
A. The Division
				will establish and maintain an assurance process that ensures a quality case
				management program and the delivery of necessary covered services that
				appropriately address the individual needs. The provider agrees to share data
				as part of the quality assurance program timely upon request by the
				Division.
B. The providers will
				make available to the Division the documentation/records maintained for case
				management services with the following information:
1. The name of eligible client,
2. Dates of case management
				services,
3. The nature, content,
				and units of the case management services received and whether goals specified
				in the care plan have been achieved,
4. Whether the client has declined services
				in the care plan, the need for and occurrences of coordination with other case
				managers,
5. The time line for
				obtaining needed services,
6. The
				time line for reevaluation of the plan,
7. Case Management Needs Assessment to
				determine the services needed and requested by the individual,
8. Service Coordination and Linkage to
				identify, assess, and link eligible individuals with the appropriate medical,
				social, and educational services to ensure that appropriate services are being
				provided while reducing duplication of services, and
9. Individual Service Monitoring to assure
				that all services are being appropriately delivered according to the
				Individualized Family Service Plan (IFSP) and in accordance with the
				established time lines.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 2 - Early Intervention / Targeted Case Management › Rule 23-223-2.4 - Freedom of Choice

Current through June 25, 2024
A. Enrolled and
				participating recipients will have free choice of the available providers of
				case management services; and
B.
				Enrolled and participating recipients will have free choice of the available
				providers of other medical care under the plan.
Miss. Code Ann. §
										43-13-121;
				  Section 1920(a) (23) of the Social Security
				  Act.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 2 - Early Intervention / Targeted Case Management › Rule 23-223-2.5 - Reimbursement

Current through June 25, 2024
A. The Division of Medicaid uses rate setting
				as a prospective method of reimbursement on both the state and federal level.
				This method does not allow for retrospective settlements. The rates are
				determined from cost reports and appropriate audits.
B. Standard rates will remain the same as
				those in effect for State Fiscal Year (SFY) 2021. The Division of Medicaid uses
				a fee-for-service reimbursement rate which will remain the same as those in
				effect for State Fiscal Year (SFY) 2021. In no case may the reimbursement rate
				for services provided exceed an individual facility's customary charge to the
				public for such services in the aggregate, except for those public facilities
				rendering such services free of charge or at a nominal charge.
C. Payments under the plan do not duplicate
				payments made to public agencies or private entities under other program
				authorities for the same purpose.
Miss. Code
				  Ann. §
										43-13-121;
				  43-13-117(19)(b); 34 CFR 303
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 3 - Prescribed Pediatric Extended Care (PPEC) Services › Rule 23-223-3.1 - Definitions

Current through June 25, 2024
The Division of Medicaid defines:
A. Early and Periodic Screening, Diagnosis
				and Treatment (EPSDT)-eligible beneficiaries as beneficiaries who qualify for
				the federally mandated EPSDT program according to
				42 U.S.C. §
										1396 d and 42 C.F.R. Part 441.
B. Prescribed pediatric extended care (PPEC)
				services as medically necessary skilled nursing services and therapeutic
				interventions for EPSDT eligible, medically complex beneficiaries who:
1. Are medically or technologically
				dependent, and
2. Require continual
				care.