reglab/statecodes huggingface dataset:
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 23-209-1.21 - Crutches

Current through June 25, 2024
A. Medicaid defines crutches as assistive
				devices used for support during ambulation.
1. Crutches may provide underarm or forearm
				support.
2. Crutches may be made of
				wood or metal, fixed or adjustable in height and must be supplied with tips.
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 23-209-1.22 - Diapers and Underpads

Current through June 25, 2024
Refer to Part 209, Chapter 2: Medical Supplies, Rule
				  2.2.AA.
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 23-209-1.23 - Electromyography (EMG) Biofeedback Device

Current through June 25, 2024
A. Medicaid defines
				an electromyography (EMG) biofeedback device as a device that uses recording
				equipment to detect, amplify and display a physiological response.
1. EMG uses surface electrodes that are
				attached to the skin over a specific muscle or group of muscles.
2. The EMG has an amplifier that is used to
				record the small electrical signals that are produced by contraction of the
				muscle fibers. These signals are amplified and converted into auditory and/or
				visual signals for display.
3.
				Biofeedback instruction can teach a patient to learn to modify or reinforce
				voluntary control of specific responses.
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 23-209-1.24 - Cochlear Implants and Implantable and Non-Implantable Auditory Osseointegrated Devices, Batteries and Battery Chargers

Current through June 25, 2024
A. The Division of
				Medicaid covers repairs and external replacement parts for cochlear implant
				devices when medically necessary, prior authorized by a Utilization
				Management/Quality Improvement Organization (UM/QIO), the Division of Medicaid,
				or designee , and ordered by an audiologist, otologist, otolaryngologist or
				other physician specialty who has documented training in assessment for and
				prescription of cochlear implant devices.
B. The Division of Medicaid covers repairs
				and external replacement parts of an implantable auditory osseointegrated
				device (AOD) when medically necessary, prior authorized by a UM/QIO, the
				Division of Medicaid, or designee and ordered by an audiologist, otologist,
				otolaryngologist or other physician specialty who has documented training in
				assessment for and the prescription of AODs.
C. The Division of Medicaid covers repairs
				and replacement parts of non-implantable AODs when medically necessary, prior
				authorized by a UM/QIO, the Division of Medicaid, or designee and ordered by an
				audiologist, otologist, otolaryngologist or other physician specialty who has
				documented training in assessment for and the prescription of AODs.
D. The Division of Medicaid covers batteries
				and battery chargers for cochlear implants and implantable and non-implantable
				AODs when medically necessary, prior authorized by a Utilization
				Management/Quality Improvement Organization (UM/QIO), the Division of Medicaid,
				or designee, and ordered by an audiologist, otologist, otolaryngologist or
				other physician specialty who has documented training in assessment for and the
				prescription of AODs.
E. The
				manufacturer must provide a minimum one (1) year warranty for all items. [Refer
				to Part 209, Rule
				1.4.]
42USC§§
				  1395m, 1395x; Miss. Code Ann. §§
										43-13-117,
				  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 23-209-1.25 - Gait Trainer

Current through June 25, 2024
A. The Division of
				Medicaid defines a gait trainer as a device similar to a walker and consists of
				a wide based steel frame with four (4) casters/wheels and may include a seat or
				support accessories. The user has difficulty with balance and control of the
				trunk, has an unsteady gait and is uncoordinated in ambulation.
B. The Division of 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 three (3) months, then requires recertification when
				ordered by a physician who specializes in physical medicine, orthopedics, or
				neurology and the following criteria is met:
1. The beneficiary has a condition which
				causes unsteady gait and difficulty with ambulation,
2. The beneficiary has been evaluated by a
				physical therapist (PT) or occupational therapist (OT) not employed by the DME
				supplier,
3. The PT/OT evaluation
				report must be submitted with the request for prior approval and must document
				medical necessity and indicates the approximate length of time the beneficiary
				will need the gait trainer,
4. The
				beneficiary's functional level is such that he/she is trainable in use of a
				gait trainer,
5. The beneficiary
				has the potential to be ambulatory and is involved in therapy to regain or
				strengthen ambulatory function,
6.
				There is enough space in the beneficiary's home for the beneficiary to utilize
				gait trainer, and
7. There are no
				medical contraindications to use of the gait trainer.
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 23-209-1.26 - Glucose Monitoring Devices

Current through June 25, 2024
A. The Division of
				Medicaid defines glucose monitoring devices as durable medical equipment (DME)
				for home use to measure glucose levels which includes a:
1. Blood glucose monitor (BGM) defined as a
				portable battery-operated meter used to determine the beneficiary's blood
				glucose level by exposing a reagent strip to a small blood sample resulting in
				the strip's colorimetric reaction to glucose concentrations, and
2. Continuous glucose monitoring (CGM)
				defined as DME used to detect trends and patterns in the beneficiary's glucose
				levels in the interstitial or intracellular fluid. There are two types of CGMs:
a) An adjunctive CGM requires the user verify
				their glucose levels or trends displayed on a CGM with a BGM prior to making
				treatment decisions. The glucose levels are recorded by an external recorder
				that stores the data until it is downloaded for review or sent via a
				transmitter to an external monitor for beneficiary interaction.
b) A non-adjunctive CGM can be used to make
				treatment decisions without the need for a stand-alone BGM to confirm testing
				results. These readings are intended to take the place of the information
				obtained from beneficiary self-monitoring of blood glucose via a BGM.
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 23-209-1.27 - Hip Abductor Pillow/Wedge

Current through June 25, 2024
A. Medicaid defines
				a hip abductor pillow wedge as a foam triangular shaped device placed between
				the beneficiary's thighs and secured with straps. The device maintains constant
				abduction.
B. Medicaid covers hip
				abductor pillow wedges for all beneficiaries when prior authorized by the
				Utilization Management and Quality Improvement Organization (UM/QIO), the
				Division of Medicaid or designated entity, for purchase only, when ordered by a
				physician and one (1) of the following apply:
1. A diagnosis which has resulted in a
				condition that requires maintaining the beneficiary's hips and thighs in
				abduction,
2. Subluxing or
				dislocating hip(s),
3. A diagnosis
				of an unstable hip,
4. Following
				the reduction of a dislocated hip,
5. Following hip replacement (hemi or
				total),
6. Following hip
				arthroplasty or hip fracture surgery,
7. Following adductor tenotomy or abductor
				advancement surgery, or
8.
				Wheelchair patients who must maintain a degree of hip
				abduction.
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 23-209-1.28 - Hospital Beds

Current through June 25, 2024
A. The Division of Medicaid defines a
				hospital bed as a medical device with:
1. An
				articulating frame allowing adjustment of the head and foot of the
				bed,
2. A headboard,
3. A footboard,
4. A mattress, and
5. Side rails.
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 23-209-1.29 - Hydraulic Lift with Seat or Sling

Current through June 25, 2024
A. The Division of
				Medicaid defines a patient hydraulic lift as a device used to transfer a
				beneficiary between a bed, a chair, wheelchair or portable commode chair but
				not solely for use in the bathroom.
B. The Division of Medicaid covers hydraulic
				lifts 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 ordered
				by a physician and all the following criteria is met:
1. Documentation that the beneficiary's
				condition is such that periodic position adjustment is necessary to effect
				improvement or to arrest or retard deterioration in his/her condition,
2. The beneficiary is bed or chair
				confined, and
3. There is an
				available caregiver in the home trained in the safe operation of the hydraulic
				lift.
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 23-209-1.30 - Infusion Pump, Enteral/Parenteral/External

Current through June 25, 2024
A. Medicaid
				defines an enteral pump as a device used to deliver nutritional requirements to
				the stomach or small bowel via a tube, including nasogastric, gastrostomy,
				jejunostomy and PEG tubes.
B.
				Medicaid covers enteral pumps 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
				for purchase when ordered by a physician and if the following criteria is met:
1. The beneficiary is tube fed, and
2. The enteral feedings are the
				sole source of nutrition.
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 23-209-1.31 - Insulin Pumps

Current through June 25, 2024
A. Medicaid defines
				an insulin pump as a small battery-driven pump that delivers insulin
				subcutaneously. The pump can be programmed to deliver varying doses of insulin
				in accordance with changes in need for insulin during different conditions such
				as eating, exercise, sleep, or at a specific time of day.
B. Medicaid covers insulin pumps 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 ordered by an
				endocrinologist or other physician experienced in the treatment of diabetes and
				in the management of the insulin pump therapy and when one (1) or more of the
				following criteria is met:
1. The beneficiary
				has insulin dependent diabetes where control has been difficult to achieve,
				or
2. The beneficiary has
				fluctuating blood sugars and is on three (3) or more injections per twenty four
				(24) hours, or
3. The beneficiary
				is receiving treatment of secondary diabetic complications that require closer
				blood glucose control.
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 23-209-1.32 - IV Poles

Current through June 25, 2024
A. Medicaid defines
				an IV pole as a device to suspend fluid to be administered by gravity or
				pump.
B. Medicaid covers IV poles
				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 ordered
				by physician when the beneficiary is receiving enteral or parenteral fluids or
				IV medications and the beneficiary is not using an ambulatory infusion
				pump.
42U.S.C.
				  §
											1395m; Miss. Code Ann. §§
										43-13-117(17),
				  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 23-209-1.33 - Nebulizer

Current through June 25, 2024
A. Medicaid defines a nebulizer as an
				apparatus for producing a fine spray or mist primarily for use in administering
				drugs by inhalation.
1. This may be
				accomplished by rapidly passing air through a liquid or by vibrating a liquid
				at a high frequency so that the particles produced are extremely
				small.
2. Medicaid expects that the
				practitioner will have considered the use of a metered dose inhaler with and
				without a reservoir or spacer device, if age appropriate, and has determined
				that, for medical reasons, it was not sufficient for the administration of
				needed inhalation drugs.
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 23-209-1.34 - Neuromuscular Electrical Stimulator (NMES)

Current through June 25, 2024
A. Medicaid defines
				a neuromuscular electrical stimulator (NMES) as a device that transmits an
				electrical impulse to the skin over selected muscle groups by way of electrodes
				to treat disuse atrophy where the nerve supply to the muscle is
				intact.
B. Medicaid covers for all
				beneficiaries when prior authorized, for rental only, when ordered by an
				orthopedist, neurologist or physiatrist, a physician specialized in physical
				rehabilitation, and when there is a documented diagnosis of disuse atrophy and
				the nerve supply to the muscle is intact, including brain, spinal cord and
				peripheral nerves and one (1)of the following apply:
1. The beneficiary has or has had casting or
				splinting of a limb.
2. The
				beneficiary has a contracture(s) due to scarring of soft tissue as in burn
				lesions.
3. The beneficiary has had
				hip replacement surgery, until orthotic training begins.
4. The beneficiary requires one (1) of the
				following:
a) Relaxation of muscle
				spasms,
b) Prevention or
				retardation of disuse atrophy,
c)
				Re-education of muscle,
d)
				Increasing of local blood circulation, or
e) Maintenance or increasing of range of
				motion.
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 23-209-1.35 - Oxygen and Oxygen Related Equipment

Current through June 25, 2024
A. The Division of
				Medicaid covers oxygen and oxygen related equipment that allows for the safe
				delivery of oxygen as durable medical equipment (DME) and includes:
1. Stationary gaseous oxygen systems which
				include container, contents, regulator, flow meter, humidifier, nebulizer,
				cannula or mask and tubing,
2.
				Stationary liquid oxygen systems, which include container, contents, regulator,
				flow meter, humidifier, nebulizer, cannula or mask and tubing,
3. Portable gaseous or liquid oxygen systems,
				which include portable container, regulator, flow meter, humidifier, cannula or
				mask and tubing,
4. Oxygen
				concentrators, both stationary and portable, which include a humidifier,
				cannula or mask and tubing, or
5.
				Oxygen contents, liquid or gaseous.
6. Portable gaseous oxygen systems, which
				include home compressor used to fill portable oxygen cylinders, portable
				containers, regulator, flow meter, humidifier, cannula or mask and
				tubing.
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 23-209-1.36 - Pacemaker Monitor

Current through June 25, 2024
A. Medicaid defines
				a pacemaker monitor as a self-contained device used in the evaluation of a
				pacemaker by trans-telephonic monitoring of the transmission of the generator's
				pulse rate.
1. By means of special equipment,
				the sound tone of the patient's pacemaker is transmitted over the telephone to
				a receiving system at a pacemaker clinic.
2. The sounds are converted into an
				electronic signal and permanently recorded on an ECG strip.
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 23-209-1.37 - Pulse Oximeter

Current through June 25, 2024
A. Medicaid defines
				pulse oximeter as a photoelectric apparatus for determining the amount of
				oxygen in the blood. This is usually done by measuring the amount of light
				transmitted through a translucent part of the skin.
B. Medicaid covers pulse oximeters 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 if indicated when ordered
				by a physician and one (1) of the following criteria is met for a non-recording
				pulse oximeter:
1. The beneficiary has a
				documented serious respiratory diagnosis and requires short-term oximetry to
				rule out hypoxemia and/or determine the need for supplemental oxygen.
2. The beneficiary is dependent on a
				ventilator with supplemental oxygen.
3. The beneficiary has a tracheostomy and
				requires monitoring of O2 saturation as determined by the
				practitioner.
4. The beneficiary
				requires supplemental oxygen and has unstable saturations.
5. The beneficiary is on supplemental oxygen
				and weaning is in process.
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 23-209-1.38 - Spacer/Aerosol-Holding Chamber

Current through June 25, 2024
A. Medicaid defines
				a spacer/aerosol-holding chamber as a cylinder shaped device usually four (4)
				to eight (8) inches long with a one (1) way valve.
1. The device is attached to a metered dose
				inhaler (MDI).
2. Use of the
				spacer/aerosol-holding chamber slows the delivery of medication from the
				pressurized MDI and decreases the amount of medication deposited in the mouth
				and throat.
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 23-209-1.39 - Suction Pump, Respiratory/Gastric

Current through June 25, 2024
A. Medicaid defines
				a mobile or stationary home model suction pump as a lightweight, compact,
				electric aspirator designed for upper respiratory oral, pharyngeal and tracheal
				suction for use in the home. A suction device must be appropriate for home use
				without technical or professional supervision.
B. Medicaid covers stationary home model
				suction pump 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 when ordered by a physician and if the beneficiary is unable to
				clear the airway of secretions by coughing secondary to, but not limited to,
				one (1) of the following:
1. Cancer or
				surgery of the throat,
2.
				Paralysis of the swallowing muscles,
3. Tracheostomy, or
4. Comatose or semicomatose
				condition.
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 23-209-1.40 - Traction Equipment

Current through June 25, 2024
A. Medicaid defines
				traction equipment as encompassing a variety of equipment used to apply a
				pulling force to a part of the body. It may be used to minimize muscle spasms,
				to reduce, align, and immobilize fractures, to lessen deformity or to increase
				space between opposing surfaces within a joint.
B. Medicaid covers traction equipment for all
				beneficiaries when prior authorized, for rental up to three (3) months, then
				requires recertification when all the following criteria is met:
1. When ordered by an orthopedic physician,
				neurosurgeon, neurologist or a physiatrist, a physician who specializes in
				physical rehabilitation.
2. The
				beneficiary has a cervical or pelvic orthopedic impairment verified by
				radiographic documentation or has a documented history of chronic pain from an
				orthopedic impairment that has been unrelieved by other treatment
				modalities.
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 23-209-1.41 - Transcutaneous Electrical Nerve Stimulator (TENS)

Current through June 25, 2024
A. Medicaid
				defines a transcutaneous electrical nerve stimulator (TENS) as a device that
				utilizes electrical current delivered through electrodes placed on the surface
				of the skin to decrease the patient's perception of pain by inhibiting the
				transmission of afferent pain nerve impulses and/or stimulating the release of
				endorphins.
B. Medicaid covers TENS
				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
				when ordered by a physician and one (1) of the following criteria is met:
1. The TENS unit is being used for acute
				post-operative pain, the beneficiary is within thirty (30) days post-op, other
				treatment modalities have failed and the patient is being treated at home
				rather than an inpatient hospital. Approval is limited to thirty (30) days
				rental.
2. The beneficiary has
				intractable chronic pain of at least three (3) months duration from date of
				onset and a history of failed response to other treatment modalities. A thirty
				(30) to sixty (60) day trial period is required.
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 23-209-1.42 - Transfer Board

Current through June 25, 2024
A. Medicaid defines
				a transfer board as a wooden or plastic device used to transfer individuals
				from one (1) surface to another. It may be used by caregivers to assist with
				bed mobility of a dependent patient.
B. Medicaid covers transfer boards 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 when
				ordered by a physician and one (1) of the following criteria is met:
1. The patient has decreased to absent lower
				extremity function and the board can be used by the patient or caregivers for
				successful transfer.
2. The
				patient is obese and unable to transfer without lifting.
3. It is required by the caregiver to assist
				with the bed mobility of the patient.
4. The caregiver is unable to lift the
				patient for transfer.
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 23-209-1.43 - Trapeze Bar/Equipment

Current through June 25, 2024
Medicaid covers trapeze bars/equipment 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 when ordered by a
				  physician and one of the following criteria is met:
A. A trapeze bar or freestanding trapeze
				equipment when a beneficiary has truncal or lower extremity weakness and needs
				this device in order to rise to sit, change body position, or get in and/or out
				of bed.
B. An attached trapeze bar
				when it is either an integral part of or used on a hospital bed, and it has
				been determined that both the hospital bed and the trapeze bar are medically
				necessary.
C. A freestanding
				trapeze only when used with a non-hospital bed. The beneficiary must not be
				renting or own a hospital bed.
42U.S.C.
				  §
											1395m; Miss. Code Ann. §§
										43-13-117(17),
				  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 23-209-1.44 - Ventilator

Current through June 25, 2024
A. Medicaid defines a ventilator as a
				mechanical device used for artificial ventilation of the lungs.
B. Medicaid covers ventilators 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 only, and ordered by a physician and one (1) of the
				following criteria is met:
1. The beneficiary
				is unable to maintain spontaneous respiration.
2. The beneficiary is unable to maintain safe
				levels of arterial carbon dioxide or oxygen with spontaneous breathing.
3. The beneficiary has a medical
				condition that requires mechanically assisted ventilation that is appropriate
				for home use, without continuous technical or professional
				supervision.
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 23-209-1.45 - Walker

Current through June 25, 2024
A. Medicaid defines a walker as an assistive
				device used to provide a wide base of support (BOS) for ambulation and stance.
1. It may be rigid or folding, rolling or a
				pickup type, and/or fixed or height adjustable.
2. The walker may have accessories to provide
				increased support.
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 23-209-1.46 - Wedge Seat Insert, Custom

Current through June 25, 2024
A. Medicaid defines
				a custom wedge seat insert as an item that is made of various materials and is
				inserted into a seating system. It is used either for positioning or pressure
				reduction and has been uniquely constructed or substantially modified for a
				specific beneficiary.
B. Medicaid
				covers custom wedge seat inserts for all beneficiaries with prior authorization
				for purchase only, when ordered by pediatrician, orthopedist, neurosurgeon,
				neurologist, or a physiatrist, a physician specializing in physical
				rehabilitation, and has a stable seating device or a mobility device such as a
				buggy/stroller, stable seating device, or wheelchair to allow use of the item
				and is needed to:
1. Decrease posterior pelvic
				tilt, or
2. Assist with proper
				positioning for stable seating.
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 23-209-1.47 - Wheelchairs

Current through June 25, 2024
A. The Division of Medicaid defines a
				wheelchair as a seating system that is designed to increase the mobility of
				beneficiaries who would otherwise be restricted by inability to ambulate or
				transfer from one place to another.
B. The Division of Medicaid covers
				wheelchairs for all beneficiaries when ordered by the appropriate medical
				professional, is medically necessary and prior authorized by the Utilization
				Management/Quality Improvement Organization (UM/QIO), the Division of Medicaid
				or designated entity for rental up to purchase amount or for purchase as
				follows:
1. The provider must fully assess the
				beneficiary's needs and must ensure that the prescribed wheelchair is adequate
				to meet those needs, including measuring to ascertain proper height, width and
				weight and providing an automatic or special locking mechanism for those who
				are unable to apply manual brakes to prevent falls.
2. The beneficiary, family or caregiver and
				supplying vendor must be present for the wheelchair assessment. It is also
				recommended that each of these people be present at the delivery of the
				wheelchair.
3. At a minimum, all
				wheelchairs must include a seat, back, armrests (may be desk or full length,
				fixed or removable), leg rest (may be fixed, swing away detachable, or
				elevating), footplates, safety belts, anti-tipping device, wheels, and an
				appropriate type of wheellocking mechanism, manual or automatic.
4. A standard wheelchair is covered when the
				beneficiary's condition is such that without the use of a wheelchair, he/she
				would be otherwise bed or chair confined.
5. An amputee wheelchair is covered if the
				beneficiary has had an amputation of one (1) or both lower
				extremities.
6. Hemi-wheelchairs
				are covered with appropriate documentation and medical necessity
				justification.
7. A tilt-in-space
				wheelchair is one that maintains the congruency of the seat to back angle while
				tilting the patient in space.
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 23-209-1.49 - Wheelchairs, Drivers and Seating, Custom

Current through June 25, 2024
Refer to Part 209, Chapter 1, Rule 1.47
				  Wheelchairs
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 23-209-1.50 - 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 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 1 - Durable Medical Equipment and Medical Appliances › Rule 23-209-1.51 - Humidifier/Vaporizer

Current through June 25, 2024
A. Medicaid defines a humidifier, heated or
				non-heated, as a device used to increase the moisture content of the
				air.
B. Medicaid covers humidifiers
				for all beneficiaries when ordered by a physician, medically necessary and
				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 for purchase.
C. Room Humidifiers and Vaporizers
1. Medicaid defines a room humidifier as a
				mechanical device used to increase the moisture content of the air in a room
				with a cool mist. Medicaid defines a steam vaporizer as a mechanical device
				that creates moisture in the air by heating the water into a hot mist. Medicaid
				defines a warm mist humidifier as a type of steam vaporizer that cools the
				moist steam before it is released into the room.
2. Room humidifiers and vaporizers are
				covered for beneficiaries who have a chronic diagnosis(es) indicating a
				respiratory condition in which ease of breathing could be facilitated by
				increasing the moisture content of the air. The diagnosis may include, but are
				not limited to:
a) Chronic
				bronchitis,
b) Asthmatic
				bronchitis,
c) Chronic
				Asthma,
d) Bronchopulmonary
				dysplasia, or
e) Chronic airway
				obstruction.
3.
				Documentation must be provided that the patient or caregiver is able to use and
				care for the equipment.
4.
				Humidifiers are not covered for acute upper respiratory infections, a chronic
				cough or colds unrelated to another diagnosis.
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 23-209-1.52 - Pressure Reducing Support Surface

Current through June 25, 2024
A. Medicaid defines
				pressure reducing support surfaces as surfaces designed for beneficiaries with
				limited or no mobility who are bed confined most or all of the day and prone to
				developing pressure ulcers.
B.
				Medicaid covers pressure reducing support surfaces for all eligible
				beneficiaries when ordered by a physician, medically necessary and 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.
C.
				Beneficiaries requiring pressure reducing support surfaces must have a care
				plan, established by the beneficiary's physician or home care nurse, documented
				in the beneficiary's medical record, which includes all of the following:
1. Education of the beneficiary and caregiver
				on the prevention and/or management of pressure ulcers.
2. Regular assessment by a nurse, physician,
				or other licensed health care practitioner.
3. Appropriate turning and
				positioning.
4. Appropriate wound
				care for a stage II, III or IV ulcer.
5. Appropriate management of
				moisture/incontinence.
6.
				Nutritional assessment and intervention consistent with the overall plan of
				care.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 2 - Medical Supplies › Rule 23-209-2.1 - General Provider Information

Current through June 25, 2024
A. The Division of
				Medicaid defines medical supplies as medically necessary health care related
				items that are consumable or disposable, or cannot withstand repeated use by
				more than one individual, that are required to address an individual medical
				disability, illness or injury..
B.
				Certification or prior authorization is not required for covered medical
				supplies except for diapers and underpads. Providers must submit the required
				documentation with their claim to the fiscal agent for manual
				pricing.
C. All medical supplies,
				including those required for operation of DME, must be prescribed by a
				licensed, qualified physician.
1. A Medical
				Supply Certificate of Medical Necessity (CMN) form must be completed by the DME
				provider.
2. The Medical Supply CMN
				form must be signed by the ordering physician within thirty (30) days of the
				date of delivery which can be used as the physician prescription.
3. The Medical Supply CMN form must be
				retained by the DME provider in the beneficiary's medical record and is subject
				to review by the Division of Medicaid
4. The DME provider must provide a copy of
				the Medical Supply CMN form to the ordering physician, nurse practitioner, or
				physician assistant for their records.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 2 - Medical Supplies › Rule 23-209-2.2 - Covered Medical Supplies

Current through June 25, 2024
The Division of Medicaid covers the following medical
				  supplies when they are medically necessary and considered standard care for the
				  treatment of a beneficiary's medical condition and dispensed in quantities that
				  meet a beneficiary's medical needs without excessive utilization, including,
				  but not limited to: [Refer to Miss. Admin. Code Part 207 for coverage of
				  medical supplies in a long-term care facility.]
A. Alcohol preps, swabs, wipes and bottle are
				covered for quantity or number of pints appropriate for the plan of care for
				all beneficiaries for injection site cleanings, for self-administration, or
				care giver administration of intramuscular or subcutaneous injections ordered
				by a practitioner.
B. Apnea monitor
				supplies for beneficiaries who have an apnea monitor.
1. Electrodes,
2. Lead wires, and
3. Battery pack.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 2 - Medical Supplies › Rule 23-209-2.3 - Non-Covered Medical Supplies

Current through June 25, 2024
Oral Hygiene supplies that include tooth brushes, dental
				  floss, toothpaste, toothettes, lemon glycerin swabs and other non-specific oral
				  hygiene items.
Miss. Code Ann.
				  §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 2 - Medical Supplies › Rule 23-209-2.4 - 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 209 - Durable Medical Equipment, Medical Appliances and Medical Supplies › Chapter 2 - Medical Supplies › Rule 23-209-2.5 - Reserved

Current through June 25, 2024
42U.S.C.
				  1395m; Miss. Code Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 210 - Ambulatory Surgical Centers › Chapter 1 - General › Rule 23-210-1.1 - General

Current through June 25, 2024
A. Medicaid considers an Ambulatory Surgical
				Center (ASC) a publicly, or privately, owned institution not considered a part
				of a hospital, in accordance with its function.
B. Ambulatory surgical centers must be
				operated by its own organized medical and administrative staff primarily for
				the purpose of providing elective surgical treatment for "outpatients" whose
				recovery under normal and routine circumstances will not require "inpatient"
				care.
C. The facility cannot
				include the offices of private physicians or dentists, whether practicing
				individually or in groups, but does include facilities engaged in such
				outpatient surgery, whether using the name "ambulatory surgical" facility or a
				similar or different name.
D. A
				facility considered to be operated by a hospital or hospital holding, leasing,
				or management company, whether for-profit or non-profit, must be a separate,
				identifiable entity which is physically, administratively and financially
				independent and distinct from other operations of any hospital.
E. Once licensed and certified as such, the
				"facility" will not be allowed to revert to the position as a component part of
				any hospital without securing a Certificate of Need to do so.
Miss. Code Ann. §
										43-13-121;
				  42 CFR § 416
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 210 - Ambulatory Surgical Centers › Chapter 1 - General › Rule 23-210-1.2 - Definitions

Current through June 25, 2024
A. Add-on codes are defined as procedures
				performed in addition to the primary service/procedure and are never reported
				as a stand-alone code. Add-on codes describe additional intra-service work
				associated with the primary procedure.
B. Ambulatory surgery is defined as surgical
				procedure(s) that are more complex than office procedures, under local
				anesthesia, but less complex than procedures requiring prolonged postoperative
				monitoring and hospital care to ensure safe recovery and desirable
				results.
C. Bilateral procedures
				are defined as exact procedures identified by the same procedure codes which
				are performed on anatomically bilateral sides of the body during the same
				operative session.
D. Endoscopic
				procedure is defined as the performance of a procedure on interior organs and
				cavities of the body through an endoscope. An endoscope is a flexible fiber
				optic instrument used to visual the interior of a body cavity or
				organ.
E. Incidental procedure is a
				procedure carried out at the same time as a primary procedure, but is
				clinically integral to the performance of the primary procedure or requires
				little additional physician resources.
F. Multiple surgeries are defined as separate
				procedures performed by the same physician on the same patient at the same
				operative setting.
G. Mutually
				exclusive procedures are defined as separate billing for two (2) or more
				procedures that are usually not performed for the same patient on the same date
				of service.
H. Unbundled procedures
				are defined as the use of two (2) or more procedure codes to describe a
				procedure or event when a single procedure code exists that comprehensively
				describes the surgery performed.
Miss. Code Ann. §
										43-13-121;
				  42 CFR § 416
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 210 - Ambulatory Surgical Centers › Chapter 1 - General › Rule 23-210-1.3 - Provider Enrollment Requirements

Current through June 25, 2024
Ambulatory surgical centers must satisfy all requirements set
				  forth in Part 200, Chapter 4, Rule 4.8 in addition to the following provider
				  type specific requirements listed below:
A. National Provider Identifier (NPI),
				verification from National Plan and Provider Enumeration System
				(NPPES),
B. Written confirmation
				from the IRS confirming the providers tax identification number and legal
				business name, and
C. Copy of
				Medicare certification letter:
1. EOMB not
				acceptable, and
2. Must be from
				Medicare Intermediary.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 210 - Ambulatory Surgical Centers › Chapter 1 - General › Rule 23-210-1.4 - Covered Services

Current through June 25, 2024
A. The Ambulatory
				Surgical Center (ASC) must have procedures for obtaining routine and emergency
				laboratory and radiology services from Medicare-approved facilities. The ASC,
				when contracting for those lab, x-ray and hospital services which directly
				relate to the surgical procedure, must be billed by the provider performing
				these services.
B. ASC services
				must be Medicare-approved items and services furnished by an ASC in connection
				with a covered surgical procedure furnished to a Medicaid
				beneficiary.
C. ASC services do not
				include items and services for which payment may be made under other provisions
				including, but not limited to, physician services, lab, x-ray or diagnostic
				procedures, other than those directly related to performance of the surgical
				procedure.
D. The ASC payment rate
				includes all the costs incurred by the ASC in providing services in connection
				with performing a specific procedure including, but not limited to, surgical
				supplies, equipment, and nursing services.
E. The Division of Medicaid covers the cost
				of corneal tissue used in corneal transplant cases. The reimbursement will be
				one hundred percent (100¢) of the cost reflected on the invoice from the
				donor supplier excluding transportation fees. Transportation fees are not
				covered under the Medicaid program. This rule is applicable only to an ASC.
F. The Division of Medicaid covers
				medically necessary dental treatment in the ASC setting when all the following
				are met:
1. Quality, safe, and effective
				treatment cannot be provided in an office setting,
2. Inpatient hospitalization is not medically
				necessary [Refer to Miss. Admin. Code Part 204, Rule 1.11.B.], and
3. Certain dental procedures have been prior
				authorized by the Division of Medicaid or designee.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 210 - Ambulatory Surgical Centers › Chapter 1 - General › Rule 23-210-1.5 - Non-Covered Procedures

Current through June 25, 2024
Non-covered services and procedures as outlined in Part 200,
				  Chapter 2, Rule 2.2 performed in an Ambulatory Surgical Center are subject to
				  Medicaid rules for reimbursement.
Miss. Code Ann. §
										43-13-121;
				  42 CFR § 416