Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 213 - Therapy Services › Chapter 3 - Outpatient Speech-Language Pathology (Speech Therapy) › Rule 23-213-3.4 - Non-Covered Speech-Language Pathology or Audiology Services

Current through June 25, 2024
The Division of Medicaid does not cover or reimburse for
				  speech-language pathology or audiology services in the outpatient setting
				  when:
A. Services are not
				certified/ordered by a physician, physician assistant, or nurse practitioner,
B. The plan of care (POC) has not
				been approved, signed, and dated by the physician, physician assistant, or
				nurse practitioner within established timeframes [Refer to Miss. Admin. Code
				Part 213, Rule 3.3.A.4.],
C.
				Services do not meet medical necessity criteria,
D. Services do not require the knowledge,
				skill, and judgment of a state-licensed speech-language pathologist or
				audiologist,
E. Documentation
				supports that the beneficiary has attained the speech-language pathology or
				audiology goals or has reached the point where no further significant
				improvement can be expected,
F.
				Documentation supports that the beneficiary has not reached the speech-language
				pathology or audiology goals and is unable to participate and/or benefit from
				skilled intervention, refuses to participate, or is otherwise noncompliant with
				the speech-language pathology or audiology regimen,
G. The beneficiary can perform services
				independently or with the assistance of unskilled personnel or family members,
H. Services duplicate other
				concurrent therapy,
I. Services
				are for maintenance and/or palliative therapy which maintains function and
				generally does not involve complex procedures or the professional skill,
				judgment, or supervision of a state-licensed speech-language pathologist or
				audiologist,
J. Conditions could
				be reasonably expected to improve spontaneously without therapy,
K. Services are ordered daily, or multiple
				times per day, from the initiation of therapy through discharge,
L. Services are normally considered part of
				nursing care,
M. Services are
				provided through a Comprehensive Outpatient Rehabilitation Facility (CORF),
N. Services are billed as separate
				fees for self-care/home-management training,
O. Services are related solely to employment
				opportunities or the purpose is vocationally based,
P. Services are for general wellness,
				exercise, and/or recreational programs,
Q. Services are provided by speech-language
				pathology or audiology aides,
R.
				Services are delivered in a group therapy or co-therapy session,
S. Services are investigational or
				experimental,
T. Services consist
				of acupuncture or biofeedback,
U.
				Services are outside the scope/and or authority of the state-licensed
				speech-language pathologist's or audiologist's specialty and/or area of
				practice,
V. The provider has not
				met the prior authorization/pre-certification requirements,
W. Services are provided in the home setting,
				or
X. Services are not
				specifically listed as covered by the Division of Medicaid.
42 CFR § 410.61
				  -62; Miss. Code Ann. §
										43-13-121.