reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.7 - Reimbursement

Current through June 25, 2024
A. Providers cannot bill the Division of
				Medicaid for Intellectual Disabilities/Developmental Disabilities (ID/DD)
				Waiver services until the first (1 
				st) day of the month after the services
				were rendered for the following services:
1.
				Support Coordination,
2. Community
				Respite,
3. Supervised Living,
4. Day Services-Adult,
5. Prevocational services,
6. Supported Employment,
7. Behavior Support,
8. Therapy services,
9. Specialized Medical Supplies,
10. Supported Living,
11. Crisis Intervention,
12. Crisis Support,
13. Host Home,
14. Job Discovery, and
15. Transition Assistance.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.8 - Serious Events/Incidents and Abuse/Neglect/Exploitation

Current through June 25, 2024
A. Department of Mental Health (DMH)
				certified providers must receive training at least annually regarding
				Mississippi's Vulnerable Persons Act and the following:
1. Education as to what constitutes possible
				abuse/neglect/exploitation,
2.
				Abuse/neglect/exploitation reporting requirements and procedures, and
3. Reporting of serious
				events/incidents to DMH as outlined in the DMH Operational Standards.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.9 - Medication Management and Medical Treatment

Current through June 25, 2024
A. Nurses
				employed by an agency enrolled as an Intellectual Disabilities/Developmental
				Disabilities (ID/DD) Waiver provider must practice within the current
				guidelines outlined in the Mississippi Nurse Practice Act and applicable state
				and federal laws and regulations, regardless of the setting.
1. A registered nurse (RN) and/or licensed
				practical nurse (LPN) must be supervised by appropriately qualified staff
				through a home health agency or other entity allowed by state and federal laws
				and regulations.
2. RNs and LPNs
				must be employed by a Medicaid provider and work under the direction of
				physician, physician assistant or nurse practitioner.
3. If a participant cannot self-administer
				medications and the guardian or legal representative is unavailable, only a
				licensed nurse, nurse practitioner, physician, physician assistant or dentist
				may administer or oversee administration of medications at ID/DD Waiver program
				sites in the community or in the home setting.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.10 - Documentation and Record Maintenance

Current through June 25, 2024
A. Documentation of
				each Intellectual Disabilities/Developmental Disabilities (ID/DD) service
				provided must be in the case record. [Refer to Miss. Admin. Code, Part 200,
				Rule 1.3.]
B. The entry or
				clinical note must include all of the following documentation:
1. Date of service,
2. Type of service provided,
3. Time service began and time service ended,
4. Length of time spent delivering
				service,
5. Identification of
				participant(s) receiving or participating in the service,
6. Summary of what transpired during delivery
				of the service,
7. Evidence that
				the service is appropriate and approved on the PSS, and
8. Name, title, and signature of individual
				providing the service.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.11 - Reserved

Current through June 25, 2024
42 USC § 1396 a;
				  42 CFR §§447.50 -.52; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.12 - Grievances and Complaints

Current through June 25, 2024
A. The Department
				of Mental Health (DMH) is responsible for investigating and documenting all
				grievances/complaints regarding all programs operated and/or certified by DMH.
				Grievances may be made via phone, written letter format or email.
B. Personnel issues are not within the
				purview of DMH.
C. A toll-free
				Helpline is available twenty-four (24) hours a day, seven (7) days per week.
				All providers are required to post the toll-free number in a prominent place
				throughout each program site.
D.
				Providers of waiver services must cooperate with both DMH and the Division of
				Medicaid to resolve grievances/complaints.
E. All grievances must be resolved within
				thirty (30) days of receipt by DMH unless additional time is required due to
				the nature of the grievance. The individual filing the grievance must be
				provided a formal notification from DMH of the resolution and all activities
				performed in order to reach the resolution.
F. Providers must ensure the person's rights
				of privacy, dignity and respect, and freedom from coercion and restraint.
42 C.F.R. §
											441.301; Miss. Code Ann. §§
										41-4-7,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.13 - Reconsiderations, Appeals, and Hearings

Current through June 25, 2024
A. If it is
				determined that an applicant does not meet Intermediate Care Facility for
				Individuals with Intellectual Disabilities (ICF/IID) level of care (LOC) at the
				completion of an initial evaluation by the Diagnostic and Evaluation (D&E)
				team, the applicant and/or guardian or legal representative may request
				reconsideration from DMH.
B.
				Decisions that result in services being denied, terminated, or reduced may be
				appealed according to DMH appeal procedures.
1. If the participant and/or guardian or
				legal representative disagrees with the decision made by DMH regarding services
				being denied, terminated, or reduced, a written request to appeal the decision
				may then be made to the Executive Director of the Division of Medicaid. [Refer
				to Miss. Admin. Code, Part 300.]
2. During the appeals process, contested
				services that were already in place must remain in place, unless the decision
				is for immediate termination due to possible danger, racial considerations or
				sexual harassment of the service providers. The ID/DD Waiver support
				coordinator is responsible for ensuring that the beneficiary continues to
				receive all services that were in place prior to the notice of
				change.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.14 - Person Centered Planning (PCP)

Current through June 25, 2024
A. The Division of
				Medicaid defines Person-Centered Planning (PCP) as an ongoing process used to
				identify a person's desired outcomes based on their personal needs, goals,
				desires, interests, strengths, and abilities. The PCP process helps determine
				the services and supports the person requires in order to achieve these
				outcomes and must:
1. Allow the person to
				lead the process where possible with the person's guardian and/or legal
				representative having a participatory role, as needed and as defined by the
				person and any applicable laws.
2.
				Include people chosen by the person.
3. Provide the necessary information and
				support to ensure that the person directs the process to the maximum extent
				possible, and is enabled to make informed choices and decisions.
4. Be timely and occur at times and locations
				of convenience to the person.
5.
				Reflect cultural considerations of the person and be conducted by providing
				information in plain language and in a manner that is accessible to individuals
				with disabilities and persons who are limited English proficient.
6. Include strategies for solving conflict or
				disagreement within the process, including clear conflict-of-interest
				guidelines for all planning participants.
7. Provide conflict free case management and
				the development of the PSS by a provider who does not provide home and
				community-based services (HCBS) for the person, or those who have an interest
				in or are employed by a provider of HCBS for the person, except when the only
				willing and qualified entity to provide case management and/or develop PSS in a
				geographic area also provides HCBS. In these cases, conflict of interest
				protections including separation of entity and provider functions within
				provider entities, must be approved by the Centers of Medicare and Medicaid
				Services (CMS) and these persons must be provided with a clear and accessible
				alternative dispute resolution process.
8. Offer informed choices to the person
				regarding the services and supports they receive and from whom.
9. Include a method for the person to request
				updates to the PSS as needed.
10.
				Record the alternative HCBSs that were considered by the person.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 6 - Bridge to Independence (B2I) › Rule 23-208-6.1 - General

Current through June 25, 2024
A. Bridge to Independence (B2I),
				Mississippi's Money Follows the Person (MFP) initiative, is a six (6) year
				federal demonstration grant that was awarded to the Division of Medicaid on
				April 1, 2011, and is funded by the United States Department of Health and
				Human Services (DHHS) and the Centers for Medicare and Medicaid Services
				(CMS).
B. The purpose of B2I is to
				establish a person-driven and sustainable home and community-based long-term
				care system offering choice and access to quality services in the community for
				institutionalized individuals:
1. With a
				physical disability,
2. With a
				mental illness,
3. With an
				intellectual or developmental disability, or
4. Sixty-five (65) years of age or
				older.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 6 - Bridge to Independence (B2I) › Rule 23-208-6.2 - Eligibility

Current through June 25, 2024
A. To participate in the Bridge to
				Independence (B2I) demonstration project, the person:
1. Must reside in an Intermediate Care
				Facility for Individuals with Intellectual Disabilities (ICF-IID) or a nursing
				facility for at least ninety (90) consecutive days with at least one (1) day of
				the stay reimbursed by Medicaid.
2. Cannot have received short-term
				rehabilitation services reimbursed under Medicare during the ninety (90) day
				stay requirement.
3. Must be
				eligible for one (1) of the following Medicaid Home and Community-Based
				Services (HCBS):
a Assisted Living (AL)
				Waiver,
b Elderly and Disabled
				(E&D) Waiver,
c Independent
				Living (IL) Waiver,
d Intellectual
				Disability/Developmental Disability (ID/DD) Waiver,
e Traumatic Brain Injury/Spinal Cord Injury
				(TBI/SCI) Waiver, and/or
f
				Community Mental Health Center (CMHC) Services/Rehabilitation option of the
				State Plan.
4. Must
				meet the level of care criteria for an ICF/IID or a nursing facility and, if
				not for the provision of HCB long-term care services, the person would continue
				to require the level of care provided in the facility.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 6 - Bridge to Independence (B2I) › Rule 23-208-6.3 - Covered Services

Current through June 25, 2024
The following services are available to B2I persons as
				  documented in the Plan of Services and Supports (PSS):
A. Transition Care Management, defined as
				transition care planning occurring for up to one-hundred eighty (180) days
				pre-discharge from the institution and post-transition care planning for three
				hundred sixty-five (365) days following transition into the community.
1. Transition Care Management includes:
a) Crisis Support, defined as a response to
				the transitioning person and/or person's caregiver who is experiencing a crisis
				event during the transition process.
1) The
				service must be available twenty-four (24) hours a day, seven (7) days a week.
2) Initial contact may take place
				over the telephone, but if the situation is determined to be an emergency, the
				provider must provide in-person support.
3) Staff must be available to meet with the
				person in transition, as well as any other member of the person-centered
				planning team, to resolve the crisis and thereby enable the person to remain in
				the community.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 6 - Bridge to Independence (B2I) › Rule 23-208-6.4 - Quality Management

Current through June 25, 2024
B2I providers must maintain quality control measures to
				  ensure the health, safety, and welfare of individuals including, but not
				  limited to:
A. A twenty-four (24) hours
				a day, seven (7) days a week crisis and response system,
B. A critical incident reporting system,
				and
C. A system to assess and
				mitigate risks to individuals.
Olmstead v. L.C., 119 S.
				  Ct. 2176 (1999); Section 6071 Deficit Reduction Act of 2005
				  Public Law
				  109-171; Section 2403, Affordable Care Act,
				  Public Law
				  111-148; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 6 - Bridge to Independence (B2I) › Rule 23-208-6.5 - Appeals and Hearings

Current through June 25, 2024
A. Decisions made
				by B2I staff or representatives resulting in reduced, suspended or terminated
				services of the Division of Medicaid may be appealed. [Refer to Miss. Admin.
				Code Part 300: Appeals, Chapter 1: Appeals]
Olmstead v. L.C., 119 S.
				  Ct. 2176 (1999); Section 6071 Deficit Reduction Act of 2005
				  Public Law
				  109-171; Section 2403, Affordable Care Act,
				  Public Law
				  111-148; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 7 - 1915(i) HCBS › Rule 23-208-7.1 - Eligibility

Current through June 25, 2024
A. The Division of Medicaid covers certain
				1915(i) Home and Community-Based Services (HCBS) as an alternative to
				institutionalization in an Intermediate Care Facility for Individuals with
				Intellectual Disabilities (ICF/IID) through its State Plan. The State Plan
				services:
1. Offer broad discretion, not
				generally afforded, so that the needs of beneficiaries under the State Medicaid
				Plan may be addressed,
2. Are
				operated jointly with the Mississippi Department of Mental Health
				(DMH),
3. Are available
				statewide,
4. Carry no age
				restrictions, and
5. Are covered
				only for beneficiaries not enrolled in any HCBS Waiver program.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 7 - 1915(i) HCBS › Rule 23-208-7.2 - Provider Enrollment

Current through June 25, 2024
D. Division of
				Medicaid 1915(i) providers must be certified by the Mississippi Department of
				Mental Health (DMH), Bureau of Quality Management, Operations and Standards
				(BQMOS). DMH Certification is dependent upon compliance with the Mississippi
				Department of Mental Health Operational Standards.
E. The provider must be in good standing with
				their state licensure agency and adhere to applicable state and federal
				regulations related to the license. The provider must comply with all rules and
				standards related to the 1915(i) services and have a current Mississippi
				Medicaid provider number.
F. All
				providers must comply with the CMS approved 1915(i) State Plan.
Social Security Act
				  § 1915(i); Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 7 - 1915(i) HCBS › Rule 23-208-7.3 - Freedom of Choice

Current through June 25, 2024
A. Medicaid persons
				have the right to freedom of choice of providers for Medicaid covered services.
				[Refer to Miss. Admin. Code Part 200, Rule
				3.6 ]
B. Targeted Case Managers must facilitate
				individual choice regarding services and supports and who provides them.
				Targeted Case Managers must inform the person/legal representative of qualified
				providers initially and annually thereafter as well as when new qualified
				providers are identified or if a person is dissatisfied with their current
				provider.
C. Settings are selected
				by the person from among setting options including non-disability specific
				settings based on the person's needs and preferences which are identified and
				documented in the plan of services and supports.
D. The choice made by the person/legal
				representative must be documented and signed by the person/legal representative
				and must be maintained in the person's record.
42 U.S.C. §
											1396n; 42 C.F.R. § 441.710; Miss. Code
				  Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 7 - 1915(i) HCBS › Rule 23-208-7.4 - Level of Care Evaluation/Reevaluation and Plan of Care Development

Current through June 25, 2024
A. Level of care (LOC) evaluations and
				reevaluations for eligibility must be conducted by one (1) of the five (5)
				Diagnostic and Evaluation (D&E) Teams housed at the DMH's five (5)
				comprehensive regional programs.
1.
				Re-evaluations are only required if the beneficiary has a significant change in
				condition.
2. Evaluations and
				reevaluations must be conducted in an interdisciplinary team format which must
				include a psychologist and social worker.
a)
				Additional team members, including, but not limited to, physical therapists and
				dieticians, may be utilized dependent upon the needs of the individual being
				evaluated or reevaluated.
b) All
				members of the D&E Teams must be licensed and/or certified through the
				appropriate State licensing/certification body for their respective
				disciplines.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 7 - 1915(i) HCBS › Rule 23-208-7.5 - Covered Services

Current through June 25, 2024
A. A person can
				receive:
1. 1915(i) services if not eligible
				for services available:
a) For Prevocational
				Services under a program funded under Section 110 of the Rehabilitation Act of
				1973 or Sections 602(16) and (17) of the Individuals with Disabilities
				Education Act,
				20
				U.S.C. 1401(16) and (17), or
b) For Supported Employment under
				Section 110 of the Rehabilitation Act of 1973 or the Individuals with
				Disabilities Education Act (
				20
				U.S.C. 1401 et seq.).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 7 - 1915(i) HCBS › Rule 23-208-7.6 - Serious Events/Incidents and Abuse/Neglect/Exploitation

Current through June 25, 2024
A. All Department of Mental Health (DMH)
				providers, including support coordinators and targeted case managers, must
				receive training at least annually regarding Mississippi's Vulnerable Persons
				Act and the following:
1. Education as to
				what constitutes possible abuse/neglect/exploitation,
2. Abuse/neglect/exploitation reporting
				requirements and procedures, and
3. Reporting of serious events/incidents to
				DMH as outlined in the DMH Operational Standards.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 7 - 1915(i) HCBS › Rule 23-208-7.7 - Documentation and Record Maintenance

Current through June 25, 2024
C. Documentation of
				each service provided must be in the case record. Refer to Maintenance of
				Records Part 200, Ch.1, Rule 1.3.
D. The entry or service note must include all
				of the following documentation:
1. Date of
				service,
2. Type of service
				provide,
3. Time service began and
				time service ended,
4. Length of
				time spent delivering service,
5.
				Identification of beneficiary(s) receiving or participating in the
				service,
6. Summary of what
				transpired during delivery of the service,
7. Evidence that the service is appropriate
				and approved on the Plan of Care, and
8. Name, title, credential, and signature of
				individual providing the service.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 7 - 1915(i) HCBS › Rule 23-208-7.8 - Grievances and Complaints

Current through June 25, 2024
A. The Department
				of Mental Health (DMH), Office of Consumer Support (OCS) is responsible for
				investigating and documenting all grievances/complaints regarding all programs
				operated and/or certified by DMH. The DMH, Quality Management Workgroup assists
				the OCS in development of procedures for receiving, investigating, and
				resolving the grievances/complaints.
B. Personnel issues are not within the
				purview of DMH.
C. A toll-free
				Helpline must be available twenty-four (24) hours a day, seven (7) days per
				week. All providers are required to post the DMH toll-free number in a
				prominent place throughout
D.
				Providers of 1915(i) services must cooperate with both DMH and the Division of
				Medicaid to resolve grievances/complaints.
42 U.S.C. §
											1396n; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 7 - 1915(i) HCBS › Rule 23-208-7.9 - Appeals and Hearings

Current through June 25, 2024
A. If it is
				determined that a person does not meet 1915(i) eligibility criteria or if
				decisions made by the Department of Mental Health (DMH) result in services
				being denied, terminated, or reduced the /legal representative has the right to
				request an appeal from the DMH.
B.
				If the person and/or guardian/legal representative disagrees with the decision
				made by the DMH Executive Director a written request to appeal the decision may
				be made to the Executive Director of the Division of Medicaid. [Refer to Miss.
				Admin. Code Part 300]
C. During
				the appeals process, contested services must remain in place, unless the
				decision is made for immediate termination due to immediate or perceived
				danger, racial discrimination or sexual harassment by the service providers.
				The Targeted Case Manager is responsible for ensuring that the person continues
				to receive all services that were in place prior to the notice of change.
D. Providers who must be certified
				by DMH may appeal issues related to certification to DMH as outlined in the DMH
				Operational Standards and Administrative Code.
42 U.S.C. §
											1396n; Miss. Code Ann. §§
										41-4-7,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 7 - 1915(i) HCBS › Rule 23-208-7.10 - Person Centered Planning (PCP)

Current through June 25, 2024
A. The Division of
				Medicaid defines Person-Centered Planning (PCP) as an ongoing process used to
				identify a person's desired outcomes based on their personal needs, goals,
				desires, interests, strengths, and abilities. The PCP process helps determine
				the services and supports the person requires in order to achieve these
				outcomes and must:
1. Allow the person to
				lead the process where possible with the person's guardian and/or legal
				representative having a participatory role, as needed and as defined by the
				person and any applicable laws.
2.
				Include people chosen by the person.
3. Provide the necessary information and
				support to ensure that the person directs the process to the maximum extent
				possible, and is enabled to make informed choices and decisions.
4. Be timely and occur at times and locations
				of convenience to the person.
5.
				Reflect cultural considerations of the person and be conducted by providing
				information in plain language and in a manner that is accessible to individuals
				with disabilities and persons who are limited English proficient.
6. Include strategies for solving conflict or
				disagreement within the process, including clear conflict-of-interest
				guidelines for all planning participants.
7. Provide conflict free case management and
				the development of the PSS by a provider who does not provide home and
				community-based services (HCBS) for the person, or those who have an interest
				in or are employed by a provider of HCBS for the person, except when the only
				willing and qualified entity to provide case management and/or develop PSS in a
				geographic area also provides HCBS. In these cases, conflict of interest
				protections including separation of entity and provider functions within
				provider entities, must be approved by the Centers of Medicare and Medicaid
				Services (CMS) and these persons must be provided with a clear and accessible
				alternative dispute resolution process.
8. Offer informed choices to the person
				regarding the services and supports they receive and from whom.
9. Include a method for the person to request
				updates to the PSS as needed.
10.
				Record the alternative HCBSs that were considered by the person.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.1 - Provider Participation

Current through June 25, 2024
In order to participate as a Durable Medical Equipment (DME)
				  supplier in the Medicaid program, a provider must:
A. Be certified to participate as a DME
				supplier under Title XVII (Medicare) of the Social Security Act and provide
				current documentation of their authorization to participate in the Title XVII
				program to Medicaid.
B. Meet all
				applicable requirements of law to conduct business in the State.
C. Execute a participation agreement with
				Medicaid.
Miss. Code Ann. §
										43-13-121;
				  Social Security Act § 1861, Subpart E
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.2 - Provider Enrollment Requirements

Current through June 25, 2024
DME providers must satisfy all requirements set forth in Part
				  200, Chapter 4, Rule 4.8 in addition to the following provider type specific
				  requirements:
A. National Provider
				Identifier (NPI), verification from National Plan and Provider Enumeration
				System (NPPES),
B. Provide written
				confirmation from the IRS confirming the tax identification number and legal
				business name,
C. Provide a copy of
				current Medicare certification for the servicing location. Explanation of
				Medicare Benefits (EOMB) is not acceptable, and
D. Provide a copy of DME or pharmacy permit
				from MS State Board of Pharmacy for the servicing location.
Miss. Code Ann. §
										43-13-121;
				  42 CFR 455, Subpart E
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.3 - Definitions

Current through June 25, 2024
The Division of Medicaid defines:
A. Durable Medical Equipment (DME) and/or
				medical appliance as an item meeting all five (5) criteria below:
1. It can withstand repeated use,
2. Is reusable or removable,
3. Is primarily and customarily used to serve
				a medical purpose,
4. Is generally
				not useful to a person in the absence of a disability, illness, or injury,
				and
5. Is appropriate for use in
				any setting where the beneficiary's normal life activities take place other
				than a hospital, nursing facility, intermediate care facility for individuals
				with intellectual disabilities, or any setting in which payment is or could be
				made by the Division of Medicaid for inpatient services that include room and
				board.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.5 - Reserved

Current through June 25, 2024
Miss. Code Ann. §
										43-13-121;
				  Social Security Act § 1834 (a); 42 CFR
				  §409.50
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.6 - Coverage Requests for Items and Services Not Listed as Covered through the DME Medical Appliance Program

Current through June 25, 2024
A. The Division of
				Medicaid does not cover items or services through durable medical equipment
				(DME) and medical appliance program that do not meet:
1. The definition of DME and/or medical
				appliances,
2. Medical necessity or
				standard of care criteria,
3.
				Healthcare Common Procedure Coding System (HCPCS) code descriptors that
				represent the product, or
4. The
				approval of the appropriate government regulatory bodies.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.7 - Dual Eligibles

Current through June 25, 2024
Medicaid covers durable medical equipment not covered by
				  Medicare if the reason for the Medicare denial is other than for medical
				  necessity. For dual eligible beneficiaries covered by both Medicare and
				  Medicaid, Medicaid reimburses the Medicare deductible and co-insurance for
				  those items on crossover claims.
Miss. Code Ann. §
										43-13-121;
				  Social Security Act § 1834
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.8 - Duplication of Equipment

Current through June 25, 2024
Medicaid covers the duplication of DME on an individual basis
				  only. Medicaid covers the duplication of DME item(s) that are not portable, not
				  mobile, or the size/weight of the item is such that daily or frequent
				  transportation is not feasible.
Miss. Code Ann. §
										43-13-121;
				  Social Security Act § 1834
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.9 - Documentation

Current through June 25, 2024
A. The Division of Medicaid requires that the
				beneficiary and/or the legal guardian, with medically appropriate assistance
				from the ordering physician, have freedom of choice to select the durable
				medical equipment (DME) provider and must be informed of all DME, medical
				appliances, services and charges to be billed to the Division of
				Medicaid.
B. The following must be
				available to the Division of Medicaid at all times:
1. DME licenses,
2. Permits,
3. Ownership information,
4. Employee roster of current and past
				employees,
5. DME Surety Bond
				information, and
6. Original
				purchase invoices for DME, medical appliances and supplies.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.10 - Apnea Monitors

Current through June 25, 2024
A. Medicaid defines
				an apnea monitor as a device used to monitor respiratory movements. This may be
				accomplished by use of an apnea alarm mattress or by use of alarm sensitive
				devices to measure thoracic and abdominal movement and heart rate.
B. Medicaid covers apnea monitors for all
				beneficiaries:
1. When prior authorized by
				the Utilization Management and Quality Improvement Organization (UM/QIO), the
				Division of Medicaid or designated entity.
2. For an initial three (3) month rental
				trial period, then recertification is required. The three (3) month rental
				trial period applies toward the maximum reimbursement for purchase.
3. [Reserved]
4. When the beneficiary is/had at least one
				(1) of the following:
a) An infant who has a
				diagnosis of apnea of prematurity.
b) A preterm infant with continued
				symptomatic apnea past thirty-six (36) weeks gestational age.
c) Been observed having or has a recorded
				episode of prolonged apnea within the last three (3) months that is documented
				by medical personnel and associated with bradycardia, reflux, cyanosis, or
				pallor. Medicaid defines prolonged apnea as cessation of breathing greater than
				twenty (20) seconds or bradycardia episodes less than sixty (60) beats per
				minute (bpm) for greater than five (5) seconds.
d) An infant who is a sibling of a child with
				sudden infant death syndrome (SIDS), or has two (2) siblings with a diagnosis
				of apnea.
e) Had an event or
				events requiring vigorous stimulation or resuscitation within the past three
				(3) months.
f) A
				tracheotomy.
g) An infant with
				bronchopulmonary dysplasia who requires oxygen and displays medical
				instability.
h) An adult or child
				has demonstrated symptomatic apnea due to neurological impairment, craniofacial
				malformation, central hyperventilation syndrome, or is secondary to
				gastrointestinal reflux
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.11 - Augmentative Communication Device (ACD)

Current through June 25, 2024
A. The Division of
				Medicaid defines an augmentative, or alternative, communication device (ACD) as
				any type of system that allows beneficiaries with severe, expressive
				communication disorders, or speech-language impairments, to overcome the
				disabling effects of communication impairment by representation of vocabulary
				or ideas and expression of messages.
B. The Division of Medicaid covers ACD's for
				all beneficiaries, when prior authorized by the Utilization Management/Quality
				Improvement Organization (UM/QIO), the Division of Medicaid, or a designated
				entity for rental up to the purchase amount, or purchase as indicated when the
				following criteria is met:
1. When ordered by
				a pediatrician, neurologist, or a physiatrist, a physician specializing in
				physical rehabilitation, and who has documented training in assessment for and
				prescription of ACD's.
2.
				Documentation that the beneficiary's ability to communicate using speech and/or
				writing is insufficient for communication purposes.
3. Documentation clearly supports that the
				beneficiary is mentally, emotionally, and physically capable of operating/using
				an ACD.
4. When the prescription
				includes specification for the ACD, component accessories, and all necessary
				therapies and/or training.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.12 - Bath Bench or Shower Chair

Current through June 25, 2024
A. The Division of
				Medicaid defines a bath bench or shower chair as durable medical equipment
				(DME) enabling a beneficiary to bathe or shower safely.
B. The Division of Medicaid covers a bath
				bench or shower chair when:
1.
				[Reserved],
2. Prior authorized by
				the Utilization Management and Quality Improvement Organization (UM/QIO), the
				Division of Medicaid or designated entity,
3. The ordering physician or allowed NPP
				documents the beneficiary has a medical condition that will not allow him/her
				to safely shower or bathe without use of the bath bench or shower
				chair,
4. A physician or allowed
				NPP documents that the ordered bath bench or shower chair will allow the
				beneficiary to safely bathe or shower.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.13 - Battery and Battery Charger

Current through June 25, 2024
A. The Division of
				Medicaid defines the following:
1. Battery is
				a device for generating electric current by chemical action.
2. Battery charger is a device that adds
				electrical energy to a battery.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.14 - Bi-level Positive Airway Pressure Device (BIPAP) With or Without an In-Line Heated Humidifier

Current through June 25, 2024
A. Medicaid defines
				a bi-level positive airway pressure (BiPAP) device as a non-continuous,
				bi-level airway management device that cycles between the inspiratory and
				expiratory pressure levels in response to the patient's respiratory effort. The
				rise in pressure, during inspiration, supports the patient's breathing by
				splinting the airway to overcome the additional collapsing forces from
				inspiratory efforts. When inspiration has ended, the pressure drops at the
				point of exhalation removing the sensation of expiratory effort while still
				maintaining a therapeutic level of pressure in the circuit necessary to
				overcome collapsing forces in the airway.
B. Medicaid covers a BiPAP for all
				beneficiaries when prior authorized by the Utilization Management and Quality
				Improvement Organization (UM/QIO), the Division of Medicaid or designated
				entity, for rental for an initial three (3) months trial period if one (1) or
				more of the following is met:
1. The
				beneficiary was unable to tolerate the necessary CPAP pressures,
2. The beneficiary has frequent central
				apneas that do not resolve with administration of CPAP, or
3. The beneficiary's baseline hypoxemia in
				cases involving chronic lung disease or hypoventilation syndromes is not
				corrected with administration of CPAP.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.15 - Breast Pumps

Current through June 25, 2024
A. The Division of
				Medicaid defines a breast pump as a device used to extract breast milk from a
				lactating mother.
B. The Division
				of Medicaid covers the following types of breast pumps for nursing mother
				beneficiaries when medically necessary, prior authorized by the Utilization
				Management and Quality Improvement Organization (UM/QIO), the Division of
				Medicaid or designated entity.
1. The
				Division of Medicaid defines a manual breast pump as a single-user device
				manually operated to express breast milk from a lactating mother and is covered
				for purchase when:
a) Used to promote
				lactation when natural breastfeeding has been insufficient in maintaining
				adequate nutritional needs of the infant, or
b) Used to provide lactation support when
				natural breastfeeding is not possible.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.16 - Cane

Current through June 25, 2024
A. Medicaid defines a cane as an assistive
				device held in the hand and used for support during ambulation. This includes
				canes of all materials, single, quad or three pronged, adjustable or
				fixed.
B. Medicaid covers canes for
				all beneficiaries when prior authorized by the Utilization Management and
				Quality Improvement Organization (UM/QIO), the Division of Medicaid or
				designated entity for rental up to purchase amount or purchase when indicated
				and all the following criteria met:
1.
				[Reserved]; and
2. When condition
				or injury causing impaired ambulation and when there is a potential for
				ambulation.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.17 - Combination Positive Expiratory Pressure, Airway Oscillation, and Intermittent Flow Acceleration Device

Current through June 25, 2024
A. The Division of
				Medicaid defines a combination positive expiratory pressure, airway
				oscillation, and intermittent flow acceleration device as a unit for mobilizing
				respiratory tract secretions in a beneficiary with chronic lung conditions such
				as, but not limited to:
1. Chronic
				obstructive lung disease,
2.
				Chronic bronchitis,
3. Cystic
				fibrosis, or
4.
				Emphysema.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.18 - Commode Chairs and Other Toileting Aids

Current through June 25, 2024
A. The Division
				of Medicaid defines commode chairs as toileting aids used to assist
				beneficiaries who are not able to use regular toilet facilities due to their
				physical condition.
B. The Division
				of Medicaid covers commode chairs and raised toilet seats for all beneficiaries
				when prior authorized by the Utilization Management and Quality Improvement
				Organization (UM/QIO), the Division of Medicaid or designated entity, for
				rental up to purchase amount, or purchase when indicated and all the following
				criteria met:
1. [Reserved]
2. When the beneficiary's physical condition
				is such that the beneficiary is unable to use regular toilet
				facilities.
3. A commode chair with
				detachable arms, if used to facilitate transferring the beneficiary or if the
				beneficiary has a body configuration that requires extra commode
				width.
4. A heavy duty or extra
				wide commode chair, with or without detachable arms, if the beneficiary's body
				measurements are greater than the measurements specified by the manufacturer
				for the DME or the beneficiary's weight is three hundred (300) pounds or
				greater. Documentation must be maintained for weight and
				measurements.
5. A raised toilet
				seat if the beneficiary has a medical condition such as being convalescent from
				hip surgery which prevents the beneficiary from using a regular commode without
				a raised seat.
6. A raised toilet
				seat if the beneficiary does not have a bedside commode capable of fitting over
				the toilet.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.19 - Compressors

Current through June 25, 2024
A. Medicaid defines compressors as machines
				that compress air into storage tanks for use by air driven equipment.
B. Medicaid covers for all beneficiaries when
				prior authorized by the Utilization Management and Quality Improvement
				Organization (UM/QIO), the Division of Medicaid or designated entity for rental
				up to the purchase amount or purchase.
C. Medicaid covers compressors for separate
				reimbursement when used in conjunction with a ventilator, nebulizer, or other
				types of humidification equipment that is not self-contained or cylinder
				driven.
Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.20 - Continuous Positive Airway Pressure (CPAP) With or Without an In-Line Heated Humidifier

Current through June 25, 2024
A. The Division of
				Medicaid defines continuous positive airway pressure (CPAP) with or without an
				in-line heated humidifier as a non-invasive provision of air pressure through
				nasal administration and a flow generator system to prevent collapse of the
				oropharyngeal walls during sleep. For the Division of Medicaid's purposes,
				apneas and hypopneas physiologically represent the same compromise, will be
				considered as equivalents, and will be referred to as "respiratory
				events."
B. The Division of
				Medicaid covers the rental of a CPAP during the three (3) month trial period
				for all beneficiaries when prior authorized by the Utilization Management and
				Quality Improvement Organization (UM/QIO), the Division of Medicaid or
				designated entity, when the following criteria is met:
1. [Reserved],
2. When one (1) of the following is met:
a) The beneficiary experiences fifteen (15)
				or more respiratory events per hour, or between five (5) and fourteen (14)
				respiratory events per hour with documentation of the following symptoms:
1) Excessive daytime sleepiness,
2) Impaired cognition,
3) Mood disorders or insomnia, or
4) Documented hypertension, ischemic heart
				disease, or history of stroke.
b) The beneficiary is a prepubescent child
				and the polysomnogram demonstrates an average of one (1) or more respiratory
				events per hour.
c) The beneficiary
				is a child who has documented measurements of increased end-tidal carbon
				dioxide (CO2) values that confirm the presence of obstructive sleep
				apnea.
d) The beneficiary has a
				diagnosis of upper airway resistance syndrome with the presence of at least ten
				(10) respiratory related electroencephalogram (EEG) arousals per hour of sleep
				accompanied by a history of clinically significant daytime sleepiness or
				documented excessive daytime sleepiness as determined by a Multiple Sleep
				Latency Test, with a significant reduction in EEG arousals following
				administration of CPAP.