reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 300 - Appeals › Chapter 3 - Provider Appeals › Rule 23-300-3.8 - All Other Matters Not Defined

Current through June 25, 2024
Any matter involving a provider requiring an administrative
				  hearing or an appeal not otherwise defined within these rules will be allowed
				  as outlined in this chapter. If specific time frames of the matter relating to
				  the requesting, granting, and concluding of the hearing are contrary to the
				  time frames as set out in the general administrative procedures above, those
				  specific time frames will govern over the time frames set out in this
				  chapter.
42 C.F.R. Part
				  431 Subpart E; Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 300 - Appeals › Chapter 4 - Claim Denials › Rule 23-300-4.1 - Definitions

Current through June 25, 2024
A. Administrative Review for a Denied Claim
				is defined as a review of a claim denied for timely filing that is conducted by
				the Division's Office of Provider Solutions.
B. Final Administrative Decision is defined
				as the final decision regarding an Administrative Review for a Claim made by
				the Division's Office of Provider Solutions, acting as the designee of the
				Executive Director. This decision may be appealed to the court of proper
				jurisdiction for Judicial Review.
C. Fiscal Agent is defined as the agency,
				under contract with the Division of Medicaid, for the purpose of disbursing
				funds to providers of services under the Medicaid program. The fiscal agent
				collects eligibility and payment information from agencies administering
				Medicaid and processes the information for payment to providers.
D. Fiscal Agent Error is defined as an error
				made by the Division's Fiscal Agent in the administration of the services it
				has been contracted by the Division to perform.
E. Provider Billing Error is defined as an
				error made by a Provider in the submission of a claim, including failure to
				obtain prior authorization, claims made for services and/or providers not
				covered, duplicate services, other insurance and/or incorrect beneficiary
				identification.
F. Timely filing
				period is defined as three hundred and sixty-five (365) days from the date of
				service.
G. Timely processing
				period is defined as three hundred and sixty-five (365) from the date the claim
				is filed.
42 C.F.R. §
											447.45; Miss. Code Ann. §§
										43-13-113,
				  43-13-117,
				  43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 300 - Appeals › Chapter 4 - Claim Denials › Rule 23-300-4.2 - Errors Made within the Timely Processing Period

Current through June 25, 2024
A. The Provider may not seek relief from the
				Division for a claim denied due to an error within the timely processing period
				until the provider exhausts the applicable process for the type of error as
				detailed below.
1. Fiscal Agent Error
a) When a claim is denied due to Fiscal Agent
				Error(s) within the timely processing period, the provider must notify the
				fiscal agent to correct the error.
b) If the Fiscal Agent does not correct the
				error within the timely processing period, the provider may contact Division of
				Medicaid Office of Provider Solutions within ninety (90) days of the end of the
				timely processing period for an Administrative Review for the Denied
				Claim.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 301 - School Based Administrative Claiming › Chapter 1 - School Based Administrative Claiming › Rule 23-301-1.1 - Purpose

Current through June 25, 2024
A. The Division of Medicaid, the Mississippi
				Department of Education (MDE) and individual schools share in the
				responsibility for promoting access to healthcare for students in the public
				school system, preventing costly or long term healthcare problems for at-risk
				students, and coordinating student's healthcare needs with other
				providers.
B. The Medicaid
				School-Based Administrative Claiming program (SBAC) allows school districts to
				be reimbursed for some of their costs associated with school-based health and
				outreach activities which are not claimable under the Medicaid School
				Health-Related Services "fee for service" program or under other Medicaid "fee
				for service" programs. In general, the types of school-based health and
				outreach activities funded under SBAC are the referral of students/families for
				Medicaid eligibility determinations, the provision of health care information
				and referral, coordination and monitoring of health services and interagency
				coordination. These activities include:
1.
				Medicaid Outreach,
2. Facilitating
				application for Medicaid and eligibility determination,
3. Transportation-related activities in
				support of Medicaid covered services,
4. Medicaid related Translation
				services,
5. Program planning,
				policy development and interagency coordination related to medical
				services,
6. Medicaid specific
				training, and
7. Referral,
				coordination and monitoring of Medicaid services.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 301 - School Based Administrative Claiming › Chapter 1 - School Based Administrative Claiming › Rule 23-301-1.2 - Provider Qualifications

Current through June 25, 2024
State school districts that participate in the School Based
				  Administrative Claiming (SBAC) program must meet the following
				  requirements:
A. Have a signed
				agreement with the Mississippi Department of Education (MDE),
B. Attend staff training conducted by
				MDE,
C. Keep time studies of work
				activities via computer generated electronic documentation,
D. Determine statistically valid time sample
				results,
E. Prepare cost
				determinations and allocations,
F.
				Prepare and submit to MDE a quarterly invoice, and
G. Follow the yearly calendar published by
				MDE.
Miss. Code Ann. §
										43-13-121;
				  Section 1903 (a)(7) of the Act;
				  42 CFR
				  430.1 and
				  42 CFR
				  431.15; OMB Circular
				  A-87
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 301 - School Based Administrative Claiming › Chapter 1 - School Based Administrative Claiming › Rule 23-301-1.3 - Quality Assurance Monitoring Plan

Current through June 25, 2024
A. The Division of
				Medicaid will establish and maintain a quality assurance process which ensures
				the quality management of the program. It is necessary to monitor the SBAC
				program in order to assure that Medicaid dollars are utilized to make
				Administrative Claiming available to eligible Mississippi Public School
				Districts enrolled in the SBAC program.
B. Mississippi Department of Education (MDE)
				Oversight and Monitoring
1. MDE will implement
				and provide oversight and monitoring actions to ensure that school districts
				are in compliance with SBAC requirements. At a minimum, these actions are to
				ensure that:
a) The time study is performed
				correctly,
b) The time study
				results are valid,
c) The financial
				data submitted is true and correct,
d) Training requirements are met,
				and
e) Appropriate documentation is
				maintained to support the time study and invoices.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 301 - School Based Administrative Claiming › Chapter 1 - School Based Administrative Claiming › Rule 23-301-1.4 - Reimbursement

Current through June 25, 2024
Reimbursement under the SBAC program is paid from those
				  invoices filed during the quarter directly following the quarter of billing,
				  for reported allowable reimbursable activities, in accordance with the
				  Mississippi School Based Administrative Claiming Guide (as approved by CMS),
				  following applicable federal and state rules and regulations. However, it is
				  imperative that claims for all allowable reimbursable activities be documented.
				  The school district will be responsible for any refund due to an audit
				  exception or denial considered appropriate by CMS or the Division of Medicaid.
				  In the event of determination by federal authorities of non-compliance with
				  federal regulations and standards, the school district will be liable to the
				  Division of Medicaid in full for all penalties, sanctions and disallowances
				  assessed against the Division of Medicaid.
Miss. Code Ann. §
										43-13-121;
				  Section 1903 (a)(7) of the Act;
				  42 CFR
				  430.1 and
				  42 CFR
				  431.15; OMB Circular
				  A-87
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 304 - Audit › Chapter 1 - Audit › Rule 23-304-1.1 - Audit Rule

Current through June 25, 2024
A. General: It is
				the mission of the Division of Medicaid to ensure compliance, efficiency, and
				accountability within the Mississippi Medicaid program by detecting and
				preventing fraud, waste, program abuse, and by ensuring that Medicaid dollars
				are paid appropriately by implementing tort recoveries, pursuing recoupment,
				and identifying avenues for cost avoidance. The Division of Medicaid shall
				conduct auditing and monitoring reviews of Medicaid providers
				accordingly.
B. Audit and
				Monitoring Reviews
1. The Division of
				Medicaid utilized bureau staff, contracted audit entities or combination of
				both, selects Medicaid providers for review.
2. An audit or monitoring review has the
				following objectives:
a) To determine if
				services billed and paid under the State's Medicaid program were:
1) Provided to an eligible
				beneficiary,
2) Medically
				necessary,
3) Provided at the
				appropriate level of care,
4)
				Appropriately documented, specifically including the assignment of diagnosis
				and procedure codes submitted by providers and that may be used by the Division
				of Medicaid to calculate payment.
5) In accordance with the Mississippi
				Medicaid Provider Manual, Mississippi State Plan, and official notices through
				other means such as, but not limited to, the Mississippi Medicaid Provider
				Bulletin, Remittance Advice header messages, and official communications from
				the Agency, and
6) For service for
				which the reimbursement rate is based on a cost report, that the cost report
				contains only allowable costs and were completed in accordance with the
				Mississippi Medicaid Provider Manual, the Cost Report Instructions as posted on
				the Mississippi Medicaid website and Mississippi State Plan.
b) To provide a systematic and
				uniform method of determining compliance with state and federal program rules
				and regulations,
c) To provide a
				mechanism for data gathering this can be used to modify the State's Medicaid
				program and State Medicaid Rules and procedures,
d) To determine if the services provided meet
				the community standard of care, and
e) To determine if the provider is
				maintaining clinical and fiscal records which substantiate claims submitted for
				payment during the review period.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 304 - Audit › Chapter 1 - Audit › Rule 23-304-1.2 - False Claims Act

Current through June 25, 2024
A. General
1. Section 6032 of the federal Deficit
				Reduction Act (DRA) of 2005 (
				Public Law
				109-171 ) set forth administrative requirements
				which impacts entities receiving annual Medicaid payments of at least
				$5,000,000. The DRA requires certain governmental, for-profit and non-profit
				providers and other entities that receive Medicaid funding to provide employee
				education regarding the False Claims Act and take actions that will address
				fraud, waste and abuse in health care programs that receive federal funds. Any
				entity that receives $5,000,000 or more annually must establish the following
				policies as a condition of participation in the Medicaid program:
a) The entity must establish written policies
				for all employees of the entity including management and of any contractor or
				agency of the entity that provides detailed information about the False Claims
				Act established under Sections 3729 through 3733 of Title 31, United States
				Code.
b) The entity must include as
				part of such written policies, detailed provisions regarding the entity's
				policies and procedures for detecting and preventing fraud, waste, and
				abuse.
c) The entity must include
				in any employee handbook for the entity, a specific discussion of the laws
				described above, the rights of employees to be protected as whistleblowers, and
				the entity's policies and procedures for detecting and preventing fraud, waste,
				and abuse.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 1 - Program Integrity › Rule 23-305-1.1 - Definitions

Current through June 25, 2024
A. Abuse is defined as beneficiary practices
				that result in unnecessary cost to the Medicaid program and/or provider
				practices that are inconsistent with sound fiscal, business, or medical
				practices that result in:
1. An unnecessary
				cost to the Mississippi Medicaid Program,
2. Reimbursement for services that are not
				medically necessary, or
3.
				Reimbursement for services that fail to meet professionally recognized
				standards for health care.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 1 - Program Integrity › Rule 23-305-1.2 - Fraud, Waste, and Abuse

Current through June 25, 2024
A. The Division of
				Medicaid investigates suspected cases of fraud, waste, and abuse using methods
				that:
1. Do not infringe on the legal rights
				of persons involved, and
2. Afford
				due process of law to individuals under investigations.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 1 - Program Integrity › Rule 23-305-1.3 - Overpayments

Current through June 25, 2024
A. Providers must notify the Division of
				Medicaid's Office of Program Integrity in writing within thirty (30) calendar
				days of the discovery of any overpayments.
1.
				Any self-disclosure of overpayments submitted to the Division of Medicaid must
				include the following information:
a) Name
				and address of the affected provider,
b) A provider which is entity owned,
				controlled, or otherwise part of a system or network must include:
1) A description or diagram of any pertinent
				business/legal relationships,
2)
				The names and addresses of any related and/or affected entities, corporate
				divisions, departments, or branches, and
3) The name and address of the disclosing
				entity's designated representative,
c) Medicaid provider number(s) associated
				with claims,
d) Tax identification
				number(s),
e) Payee identification
				number(s),
f) Affected claims
				submitted in Excel or Access which must include the following information:
1) Beneficiary name,
2) Claim transmittal control number (TCN),
3) Procedure code,
4) Dates of service,
5) Billed amount,
6) Paid amount,
7) Paid date, and
8) Refund amount,
g) A report that includes a full description
				of the information being disclosed, the person who identified the overpayment
				and the manner in which the individual discovered it,
h) A detailed account of the provider's
				investigation of the overpayment,
i) A statement disclosing whether the
				provider is under investigation by any government agency or contractor,
j) A statement detailing the
				provider's explanation of the cause of the overpayment,
k) A certification that the information
				submitted to the Division of Medicaid is based upon a good faith effort to
				disclose a billing inaccuracy and is true and correct, and
l) The methodology used in determining the
				amount of the overpayment.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 1 - Program Integrity › Rule 23-305-1.4 - Provider Peer Review Protocol

Current through June 25, 2024
A. Mississippi Medicaid providers must ensure
				that the services or items provided to beneficiaries are:
1. Provided economically, to the extent
				medically necessary,
2. Of a
				quality that meets professionally recognized standards of health
				care,
3. Supported by the
				appropriate documentation of medical necessity and quality,
4. Provided when no other effective and more
				conservative or substantially less costly treatment, service and/or setting are
				available,
5. Not solely for the
				convenience of the beneficiary, the beneficiary's family, or the provider,
				and/or
6. Not primarily custodial
				care, unless custodial care is a covered service.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 1 - Program Integrity › Rule 23-305-1.5 - Improper Payments Due to Inaccurate Eligibility Information

Current through June 25, 2024
A. The Division of Medicaid will identify the
				cause of any improper payments due to an error in the beneficiary's eligibility
				information including, but not limited to, incorrect income or deductions, and
				take corrective action.
B. All
				underpayments are corrected upon discovery:
1. Underpayments resulting from agency error
				may be corrected retroactively.
2.
				Underpayments resulting from beneficiary errors are corrected, but they are not
				corrected retroactively.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 1 - Program Integrity › Rule 23-305-1.6 - Medicaid Eligibility Quality Control

Current through June 25, 2024
A. A beneficiary
				must cooperate with Medicaid Eligibility Quality Control (MEQC) reviews.
B. If a beneficiary fails to
				cooperate with MEQC reviews and an investigator is unable to obtain information
				needed to complete a review, the case will be referred back to the regional
				office for a redetermination.
1. As part of
				the redetermination process, the information needed by the MEQC will be
				requested.
2. If the information
				is not provided to the regional office, coverage will be terminated because the
				Division of Medicaid will be unable to determine eligibility.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 2 - Beneficiary Health Management › Rule 23-302-2.1 - Authority and Purpose

Current through June 25, 2024
A. The Division of
				Medicaid defines Beneficiary Health Management (BHM) as the program implemented
				by the Division of Medicaid to:
1. Closely
				monitor program usage and to identify beneficiaries who may be potentially over
				utilizing or misusing their Medicaid services and benefits.
2. Restrict beneficiaries whose utilization
				of medical and/or pharmacy services is documented at a frequency or amount that
				is not medically necessary.
3.
				Prevent beneficiaries from obtaining non-medically necessary quantities of
				prescribed drugs through multiple visits to physicians and pharmacies.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 2 - Beneficiary Health Management › Rule 23-302-2.2 - Program Oversight

Current through June 25, 2024
A. The Division of
				Medicaid's Office of Program Integrity:
1.
				Manages the Beneficiary Health Management (BHM) program,
2. Screens beneficiaries against criteria
				designed to identify drug seeking behavior and inappropriate use of
				prescription drugs, and
3. Reviews
				claims and pharmacy point-of-sale data to identify patterns of inappropriate,
				excessive or duplicative use of pharmacy services.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 2 - Beneficiary Health Management › Rule 23-302-2.3 - Provider Participation

Current through June 25, 2024
The Beneficiary Health Management (BHM) program may include
				  physician only, pharmacy only, or physician and pharmacy providers.
Miss. Code Ann.
				  §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 2 - Beneficiary Health Management › Rule 23-302-2.4 - Beneficiary Notification

Current through June 25, 2024
A. The Division of
				Medicaid will notify the beneficiary in writing prior to the imposing of the
				restrictions of:
1. Its intent to enroll them
				in the Beneficiary Health Management (BHM) program, and
2. Their opportunity for a hearing as
				outlined in Miss. Admin. Code Part 300.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 2 - Beneficiary Health Management › Rule 23-302-2.5 - Provider Selection

Current through June 25, 2024
A. The beneficiary
				has ten (10) days to choose his/her Beneficiary Health Management (BHM)
				designated physician and/or pharmacy provider(s) from the date of receipt of
				the notification letter.
B. The
				Division of Medicaid will designate a BHM physician and/or pharmacy provider
				for the beneficiary if the beneficiary does not specify a provider within the
				ten (10) day time-frame.
C.
				Beneficiaries are required to specify one (1) physician and/or one (1) pharmacy
				and up to three (3) physician specialists, if requested, for his/her medical
				and/or pharmacy services while in the Beneficiary Health Management (BHM)
				program.
D. The beneficiary may
				request a change in his/her BHM physician and/or pharmacy provider if any of
				the following occur:
1. Change in physical
				address of the beneficiary or a provider,
2. Death, retirement, or closing of the
				specified physician, pharmacy and/or specialist,
3. Change in primary diagnosis which requires
				a different specialist, or
4. The
				BHM physician and/or pharmacy provider disenrolls or loses eligibility to
				participate in the Mississippi Medicaid Program.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 2 - Beneficiary Health Management › Rule 23-302-2.6 - Beneficiary Health Management (BHM) Services

Current through June 25, 2024
The Division of Medicaid locks-in a beneficiary in the
				  Beneficiary Health Management (BHM) program for a period of twelve (12) months
				  with ongoing reviews to monitor patterns of care.
A. Beneficiaries in the BHM program are
				allowed two (2) counseling sessions in addition to State Plan service limits
				per month during the twelve (12) month lock-in.
B. Beneficiaries locked-in the BHM program
				will continue to have access to the following services with applicable State
				Plan service limits:
1. Emergency department,
2. Inpatient hospital,
3. Outpatient hospital,
4. Dental,
5. Vision,
6. Mental Health,
7. Home Health and Durable Medical Equipment
				(DME), medical appliances and medical supplies,
8. Hospice, and
9. Medicaid Waivers.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 2 - Beneficiary Health Management › Rule 23-302-2.7 - Exclusions

Current through June 25, 2024
The Division of Medicaid may exclude a beneficiary from the
				  Beneficiary Health Management (BHM) program if the beneficiary:
A. Has one (1) of the following diagnoses
				including, but not limited to:
1.
				Cancer,
2. Sickle cell anemia,
				or
3. Burns.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 305 - Program Integrity › Chapter 2 - Beneficiary Health Management › Rule 23-302-2.8 - Reimbursement

Current through June 25, 2024
A. The Division of Medicaid reimburses for:
1. Office visits only with the Beneficiary
				Health Management (BHM) designated physician,
2. Drugs prescribed only by the BHM
				designated physician, by the consultant physician, or by an emergency
				department physician, and
3. Drugs
				dispensed only by the BHM designated pharmacy provider.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 306 - Third Party Recovery › Chapter 1 - Third Party Recovery › Rule 23-306-1.1 - Definitions

Current through June 25, 2024
The Division of Medicaid defines:
A. Third party as any individual, entity or
				program that is, or maybe, liable to pay all, or part of the expenditures for
				medical assistance furnished under the State Plan.
B. Cost Avoidance as a method of avoiding
				payment of Medicaid claims when other insurance resources are available to the
				Medicaid beneficiary.
C. Pay and
				Chase method as reimbursing the provider for a specific covered service and
				pursuing recovery of the payment from a third party source.
D. Casualty Cases as claims that involve the
				treatment of injuries arising out of vehicular collision, industrial accident,
				product liability, malpractice cases, etc. in which collection from the third
				party may be contingent upon legal action.
E. Preferred provider organization (PPO) as a
				medical care arrangement in which medical professionals and facilities provide
				services to subscribed beneficiaries at reduced rates. PPO medical and
				healthcare providers are called preferred providers.
42
				  CFR §§
											433.136,
				  433.137,
				  433.145;
				  Miss. Code Ann. §§
										43-13-121,
				  43-13-125,
				  43- 13-305, 43-13-311, 43-13-313.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 306 - Third Party Recovery › Chapter 1 - Third Party Recovery › Rule 23-306-1.2 - Provider Requirements

Current through June 25, 2024
A. Medicaid
				providers must:
1. Identify and report any
				third party source to the Division of Medicaid.
2. Cooperate with the Division of Medicaid in
				the recovery of payments from the third party source. Providers will be held
				liable, to the extent of the Division of Medicaid's payment, for failure to
				cooperate with the Division of Medicaid's staff when they have knowledge of
				third party coverage.
3. Accept
				either the third party payment or the Division of Medicaid's payment for
				services provided as payment in full.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 306 - Third Party Recovery › Chapter 1 - Third Party Recovery › Rule 23-306-1.3 - Billing

Current through June 25, 2024
A. Providers must file a claim with the third
				party prior to billing Medicaid. Documentation of payment or denial must be
				submitted to the Division of Medicaid with the claim including but not limited
				to:
1. The explanation of benefits
				(EOB),
2. Any amount paid by the
				third party, and
3. If the claim is
				denied by the third party, the reason for the denial.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 306 - Third Party Recovery › Chapter 1 - Third Party Recovery › Rule 23-306-1.4 - Casualty Cases

Current through June 25, 2024
A. In the event a
				provider has knowledge that an individual is a Medicaid beneficiary and is
				receiving or has received health care services which may be covered by Medicaid
				as a result of the accident or incident, the provider is prohibited from:
1. Demanding any payment from the Medicaid
				beneficiary or his representative, or
2. Pursuing collection of any type against
				the Medicaid beneficiary or his representative.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 306 - Third Party Recovery › Chapter 1 - Third Party Recovery › Rule 23-306-1.5 - Reimbursement

Current through June 25, 2024
A. The Division of Medicaid must be billed as
				the payor of last resort.
B.
				Providers are required to file a claim with the third party prior to filing
				with the Division of Medicaid except in the following circumstances:
1. Preventive pediatric service, including
				EPSDT services, claims must be paid in accordance with the usual payment
				schedule.
2. Covered services
				furnished to an individual on whose behalf child support enforcement is being
				carried out by the state Title IV-D program must be paid in accordance with the
				usual payment schedule.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 306 - Third Party Recovery › Chapter 1 - Third Party Recovery › Rule 23-306-1.6 - Third Party Sources

Current through June 25, 2024
Third party sources that must be used to reduce Medicaid
				  program cost include, but are not limited to the following:
A. Medicare Parts A and B,
B. Health Insurance:
1. Includes both reimbursement policies and
				indemnity policies that make payment because medical care and/or services are
				rendered. Indemnity policies that restrict payment to periods of hospital
				confinement are considered a third party source.
2. Does not include policies that provide for
				income supplementation for lost income due todisability (without regard to
				hospital confinement), or policies that make payment for disability (without
				regard to hospital confinement), such as weekly disability policies.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 306 - Third Party Recovery › Chapter 1 - Third Party Recovery › Rule 23-306-1.7 - Coordination of Benefits

Current through June 25, 2024
A. Coverage
				available through the Mississippi Medicaid program is secondary to any third
				party benefits to which a beneficiary may be entitled. If a beneficiary has
				other insurance, the primary insurance should be used before billing Medicaid.
				Benefits available from insurance or other third party liability are used to
				reduce costs to the Medicaid program. To be eligible for Medicaid
				reimbursement, all Division of Medicaid policies including prior authorization
				requirements must be followed.
B.
				Policies that provide wage or income supplementation for lost income due to
				disability are not considered third party resources. However, policies,
				including indemnity policies that provide for payment while the beneficiary
				receives medical care and services such as during a period of hospitalization
				covered by Medicaid, are considered third party resources. The assignment of
				third party medical payments is a condition of eligibility for Medicaid per
				federal and state laws.
42 CFR
				  §§433.138, 433.145; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 306 - Third Party Recovery › Chapter 1 - Third Party Recovery › Rule 23-306-1.8 - Estate Recovery Requirements

Current through June 25, 2024
A. The Division of
				Medicaid is required to seek recovery of payments for nursing facility services
				and Home and Community-Based Services (HCBS) as well as related hospital and
				prescription drug services from the estates of deceased Medicaid recipients who
				were fifty-five (55) or older when Medicaid benefits were received.
B. The estate recovery provision applies to
				all Medicaid recipients in a nursing facility as of July 1, 1994, and all
				Medicaid recipients who entered the Home and Community-Based Waiver (HCBS)
				Program on or after July 1, 2001, who:
1. Are
				age fifty-five (55) or older at time of death;
2. Own real or personal property at time of
				death that can be considered an estate.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 1 - Department of Mental Health › Rule 24-1-1.2 - PURPOSE

Current through June 25, 2024
This regulation shall serve to inform the public about the
				  Department of Mental Health relating to the organization, method of operations,
				  and where the public may contact and receive information from the agency.
Miss Code Ann. §
										41-4-1,
				  et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 1 - Department of Mental Health › Rule 24-1-1.3 - SCOPE OF ACTIVITIES

Current through June 25, 2024
A. The purpose of
				the Department of Mental Health is to coordinate, develop, improve, plan for,
				and provide services for persons with mental illness, persons with emotional
				disturbance, substance use disorder, and persons with intellectual and
				developmental disabilities, and Alzheimer's and other dementias. Further, the
				department's goal is to seek means for the prevention of these disabilities.
B. The Department of Mental Health
				is committed to developing and maintaining a comprehensive, statewide system of
				prevention and service options for adults and children with mental illness or
				emotional disturbance, with withsubstancesubstance use disorder, and/or with
				intellectual or developmental disabilities. This array of services includes
				prevention, treatment, and training services in inpatient or institutional
				settings as well as a system of community-based treatment, residential, and
				support services that includes transitional and recovery support programs. The
				department is also committed to developing and implementing state plans for the
				purpose of assisting with the care and treatment of persons with Alzheimer's
				disease and other dementia.
Miss Code Ann. §
										41-4-1,
				  et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 1 - Department of Mental Health › Rule 24-1-1.4 - PROGRAM LOCATIONS

Current through June 25, 2024
The Department of Mental Health operates five programs
				  throughout the state.
A. Psychiatric
				Programs
Programs for the care of persons with mental illness are
				  Mississippi State Hospital at Whitfield with Specialized Treatment Program in
				  Gulfport as a satellite program, East Mississippi State Hospital in Meridian
				  with Central Mississippi Residential Center in Newton, North Mississippi State
				  Hospital in Tupelo and South Mississippi State Hospital in Purvis as satellite
				  programs.
B. Programs for
				Persons with Intellectual and Developmental Disabilities
The Department operates three programs for persons with
				  intellectual and developmental disabilities at North Mississippi Regional
				  Center in Oxford, Boswell Regional Center in Magee with Hudspeth Regional
				  Center in Whitfield and the Mississippi Adolescent Center at Brookhaven as
				  satellite programs, Ellisville State School in Ellisville, with South
				  Mississippi Regional Center in Long Beach as a satellite program.
Miss Code Ann. §
										41-4-1,
				  et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 1 - Department of Mental Health › Rule 24-1-1.5 - LICENSURE AND CERTIFICATION

Current through June 25, 2024
The Department of Mental Health is responsible for
				  developing and implementing licensure and certification programs for categories
				  of professionals who work for organizations which are operated/administered by
				  the Department of Mental Health and/or who work for organizations which are
				  certified and/or funded by DMH. The Department of Mental Health Professional
				  Credentialing Programs include the following categories: community support
				  specialists, mental health therapists, addiction therapists, intellectual and
				  developmental disabilities therapists, peer support specialists and licensed
				  administrators.
Miss Code Ann. §
										41-4-1,
				  et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 1 - Department of Mental Health › Rule 24-1-1.6 - INFORMATION

Current through June 25, 2024
Public requests for information or submissions may be made
				  to the Department of Mental Health at 239 N. Lamar, Suite 1101, Robert E. Lee
				  Building, Jackson, Mississippi 39201. Calls will be received at 601-359-1288.
				  Also see the Department of Mental Health website at
www.dmh.state.ms.us
.
Miss Code Ann. §
										41-4-1,
				  et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.1 - SOURCE OF AUTHORITY

Current through June 25, 2024
Section
					 41-4-1,
					 et seq.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.2 - PURPOSE

Current through June 25, 2024
To ensure that the purpose, goals, operations and
					 functions of the Department of Mental Health are carried out according to
					 established by-laws.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.3 - NAME AND OFFICE

Current through June 25, 2024
A.
Name.
The name of this Board is the State Board of
				  Mental Health, created to direct the operations and functions of the State
				  Department of Mental Health.
B.
Office.
The principal office of the Board shall be in
				  Jackson, Mississippi. The Board may also have offices at such other places as
				  the Board may from time to time appoint or the purpose of the Board may
				  require.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.5 - POWERS AND DUTIES OF THE BOARD AND ITS OFFICERS

Current through June 25, 2024
A.
Control
. The business and property of the Department
				  shall be managed and controlled by the State Board of Mental Health.
B.
Powers
. All the
				  legal powers, except such as are otherwise provided for in these bylaws and in
				  the laws of the State of Mississippi, shall be and are hereby vested in and
				  shall be exercised by the Board. The Board may by general resolution delegate
				  to committees of their own number, to officers of the Board, or to agents such
				  powers as they may see fit; and shall have authority to delegate such powers as
				  they may see fit to any member of the Board.
C.
Duties.
The Board
				  shall cause to be presented annually and filed with the minutes thereof a
				  report, verified by the Chairman and Executive Secretary, or by a majority of
				  the members, showing:
1. The proposed annual
				  budget for the operation of the Department of Mental Health and funding
				  authorized by State Legislature;
2. The names and places of residence of the
				  persons who have been admitted to the Board during the year; and
3. The said Board shall procure the services
				  of the State Auditor for the reparation of an annual audit of the Department.
				  The said audit report shall be available for inspection by all members and the
				  public at large.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.7 - AGENTS AND REPRESENTATIVES

Current through June 25, 2024
The Board may appoint such agents and representatives of
					 the Board with such powers and to perform such acts or duties on behalf of the
					 Board as the Board may see fit, so far as may be consistent with these by-laws,
					 to the extent authorized or permitted by law.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.8 - CONTRACTS

Current through June 25, 2024
The Board, except as by law or in these bylaws otherwise
					 provided, may authorize an officer or agent to enter into any contract or
					 execute and deliver any instrument in the name of and on behalf of the Board,
					 and such authority may be general or confined to a specific instance; and
					 unless so authorized by the Board, no officer, agent, or employee shall have
					 any power or authority to bind the Department by any contract or engagement, or
					 to pledge its credit, or render it liable monetarily for any purpose or for any
					 amount.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.9 - PRIOR NOTICE OF MEETING TOPICS

Current through June 25, 2024
The executive secretary shall, on or before five (5) days
					 prior to any regular or special meeting of the Board, serve or cause to be
					 served, either personally or by mail upon each person who appears on the books
					 of the Board as a member or agent thereof, notice of each topic, subject
					 matter, and/or decision to be reached with supporting or explanatory data
					 attached. If such information be mailed, it shall be directed as provided in
					 Article II, paragraph E of these bylaws and shall be mailed along with the
					 notice as provided in Article II, paragraph E.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.10 - FISCAL YEAR

Current through June 25, 2024
The fiscal year of the Board shall commence on July first
					 (1st) of each year and end on June thirtieth (30th) of the next calendar year.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.11 - PROHIBITION AGAINST SHARING IN EARNINGS

Current through June 25, 2024
No member, officer or employee of, or member of a
					 committee of, or person connected with, the Board, or any other private
					 individual, shall receive at any time any of the net earnings or pecuniary
					 profit from the operations of the Department, provided that this shall not
					 prevent the payment to any such person of such reasonable compensation for
					 services rendered to or for the Department in effecting any of its purposes as
					 shall be fixed by the law or the Board; and no such person or persons shall
					 been titled to share in the distribution of any of the Department assets upon
					 the dissolution of the Department. All members of the Board shall be deemed to
					 have expressly consented and agreed that upon such dissolution or winding up of
					 the affairs of the Department, whether voluntary or involuntary, and the assets
					 of the Department, after all debts have been satisfied, then remaining in the
					 hands of the Board shall be distributed, transferred, conveyed, delivered, and
					 paid over, in such amounts as the law may determine or as may be determined by
					 a Court of competent jurisdiction, exclusively to the State of Mississippi, or
					 other entity authorized by statute.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.12 - RENEWAL AND AMENDMENTS

Current through June 25, 2024
Only members of the Board shall have power to make, alter,
					 amend and repeal the by-laws of the Board by affirmative vote of a majority,
					 provided, however, that such action shall be proposed at a regular meeting,
					 except as otherwise provided by law. The by-laws of the Board shall be reviewed
					 as needed upon the recommendation of a member of the Board.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.13 - EXEMPT ACTIVITIES

Current through June 25, 2024
Notwithstanding any other provision of these bylaws, no
					 member, officer, employee, or representative of this Board shall take any
					 action or carry on any activity by or on behalf of the Board not permitted to
					 be taken or carried on by the law of the State of Mississippi.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.14 - OPEN MEETINGS

Current through June 25, 2024
With the exception of any matter or matters specifically
					 and individually determined by the Board to be heard, voted upon and/or
					 otherwise acted upon in executive session, all matters presented to, discussed
					 and/or acted upon by this Board of Directors shall, at all times, be done in an
					 open public meeting. This open meeting policy be and it shall remain, the
					 philosophical policy of this Board and Department and shall, under the
					 direction of the executive director of the Department, be the example for all
					 operation and functions of this Department.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.15 - APPROVAL OF MEDICAL STAFF, ORGANIZATION, BY-LAWS, AND REGULATIONS

Current through June 25, 2024
The Board of Mental Health will provide mechanism for the
					 formal approval of the organization, bylaws, rules, and regulations of the
					 Medical Staff of a Department of Mental Health hospital or intellectual and
					 developmental disabilities program.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 1 - By Laws of the Mississippi State Board of Mental Health › Rule 24-1-2.1.16 - MEDICAL APPOINTMENTS

Current through June 25, 2024
The Board of Mental Health, on the recommendation of the
					 active Medical Staff of a Department of Mental Health hospital or intellectual
					 and developmental disabilities program, will appoint members of the Medical
					 Staff.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 2 - Appeals to Board of Mental Health › Rule 24-1-2.2.1 - SOURCE OF AUTHORITY: Section 41

Current through June 25, 2024
Section
					 41-4-1,
					 et seq.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.
Mississippi Administrative Code › Title 24 - Mental Health › Part 1 - Policies of the Mississippi Board of Mental Health › Chapter 2 - Board of Mental Health › Subchapter 2 - Appeals to Board of Mental Health › Rule 24-1-2.2.2 - PURPOSE

Current through June 25, 2024
To ensure an orderly and equitable hearing of appeals
					 before the Board of Mental Health.
Miss Code Ann.
					 §
											41-4-1,
					 et seq.