reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.6 - Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid covers the following services through the Independent Living (IL)
				Waiver:
1. Case Management services are
				mandatory services provided by a Registered Nurse (RN) and/or a Case Manager
				and include the following activities:
a) Must
				initiate and oversee the process of assessment and reassessment of the
				participant's level of care and review the Plan of Services and Supports (PSS)
				to ensure services specified on the PSS are appropriate and reflective of the
				participant's individual needs, preferences, and goals.
b) Must assist waiver applicants/participants
				in gaining access to needed waiver and other State plan services, as well as
				needed medical, social, educational, and other services, regardless of the
				funding source for the services to which access is gained.
c) Are responsible for ongoing monitoring of
				the provision of services included in the participant's PSS.
d) Must conduct quarterly face-to-face
				reviews to determine the appropriateness and adequacy of the services and to
				ensure that the services furnished are consistent with the nature and severity
				of the participant's disability and make monthly phone contact with the person
				to ensure that services remain in place without issue and to identify any
				problems or changes that are required. More frequent visits are expected in the
				event of alleged abuse, neglect or exploitation of waiver participants.
e) Are responsible for ensuring
				that all personal care attendants for the waiver meet basic competencies that
				include both academic requirements (i.e. infection control, principles of
				safety, disability awareness, etc.) and functional requirements (i.e. bathing,
				transferring, skin care, dressing, bowel and bladder programs).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.7 - Prior Approval/Certification

Current through June 25, 2024
A. Prior approval
				must be obtained from the Division of Medicaid before a beneficiary can receive
				services through the Independent Living (IL) Home and Community-Based Waiver
				program. To obtain approval, the Mississippi Department of Rehabilitation
				Services (MDRS) must complete and submit the current Division of
				Medicaid-approved forms as follows:
1. Long
				Term Services and Supports (LTSS) Assessment,
2. Bill of Rights,
3. Plan of Services and Supports (PSS),
4. Emergency Preparedness Plan,
5. Informed Choice Form,
6. Physician's Certification of
				Medical Stability and Nursing Facility Level of Care, and
7. Other supportive documentation as needed
				including, but not limited to, prescriptions and assistive technology
				recommendations.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.8 - Documentation/Record Maintenance

Current through June 25, 2024
Documentation/record maintenance for reimbursement purposes
				  must, at a minimum, reflect requirements set forth in the Independent Living
				  (IL) Waiver. [Refer to Miss. Admin. Code Part 200, Rule
				  1.3.]
42 C.F.R. §§
				  440.180, 441.303; Miss. Code Ann. §§
										37-33-157,
				  43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.9 - Reserved

Current through June 25, 2024
42 U.S.C.
				  1396a; 42 C.F.R. § 447.50 et seq.; Miss.
				  Code Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.10 - Reimbursement

Current through June 25, 2024
A. Claims must be based on services that have
				been rendered to waiver persons as authorized by the Plan of Services and
				Supports (PSS), accurately billed by qualified waiver providers, and in
				accordance with the approved waiver.
B. The Division of Medicaid conducts
				financial audits of waiver providers. If warranted, immediate action is taken
				to address compliance or financial discrepancies.
C. The Division of Medicaid denies payment
				for services when a waiver person or applicant is not Medicaid eligible on the
				date of service.
D. The Division
				of Medicaid conducts post utilization reviews to ensure the services provided
				were on the person's approved PSS.
E. Records documenting the provision of
				services must be maintained by the operating agency (if applicable) and
				providers of waiver services for a minimum of five (5) years.
F. Payment for all waiver services is made
				through an approved Medicaid Management Information System (MMIS).
Miss Code Ann.
				  §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.11 - Due Process Protection

Current through June 25, 2024
A. The Division of
				Medicaid and Mississippi Department of Rehabilitation Services (MDRS) are
				responsible for operating the dispute mechanism separate from a fair hearing
				process. The Division of Medicaid has the final authority over any dispute.
1. The types of disputes addressed by an
				informal dispute resolution process include issues concerning service
				providers, waiver services, and other issues that directly affect their waiver
				services.
2. MDRS must inform the
				person/representative at the initial assessment, of the specific criteria for
				the dispute, complaint/grievance and hearing processes.
3. MDRS must inform the person/representative
				of their rights which address disputes, complaints/ grievances and hearings.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.12 - Hearings and Appeals

Current through June 25, 2024
A. The waiver
				person or his/her representative may request to present an appeal through a
				local-level hearing, a state-level hearing, or both. The request for a local or
				state hearing must be made in writing by the person or his/her legal
				representative.
B. The waiver
				person may be represented by anyone he/she designates. If the person elects to
				be represented by someone other than a legal representative, he/she must
				designate the person in writing.
C. The person has thirty (30) days from the
				date the appropriate notice is mailed to request either a local or state
				hearing. This thirty (30) day filing period is extended if the person can show
				good cause for not filing within (30) days.
D. A hearing cannot be scheduled until a
				written request is received by either the MDRS or the State Division of
				Medicaid office. If the written request is not received within the thirty (30)
				days of the NOA, services will be discontinued.
E. At the local hearing level, MDRS issues a
				determination within thirty (30) days of the date of the initial request for a
				hearing.
F. The person has the
				right to appeal a local hearing decision by requesting a State hearing; A State
				hearing request must be made within fifteen (15) days of the mailing date of
				the local hearing decision.
G. At
				the State hearing level, the Division of Medicaid issues a determination within
				ninety (90) days of the date of the receipt initial request for a for a State
				Fair hearing.
H. The waiver person
				or his representative has the following rights in connection with a local or
				state hearing:
1. The right to examine at a
				reasonable time before the date of the hearing and during the hearing the
				contents of the applicant or recipient's case record.
2. The right to have legal representation at
				the hearing and to bring witnesses.
3. The right to produce documentary evidence
				and establish all pertinent facts and circumstances concerning eligibility.
4. The right to present an
				argument without undue interference and to question or refute testimony or
				evidence, including an opportunity to confront and cross-examine adverse
				witnesses.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.13 - Person Centered Planning (PCP)

Current through June 25, 2024
A. The Division of
				Medicaid defines Person-Centered Planning (PCP) as an ongoing process used to
				identify a person's desired outcomes based on their personal needs, goals,
				desires, interests, strengths, and abilities. The PCP process helps determine
				the services and supports the person requires in order to achieve these
				outcomes and must:
1. Allow the person to
				lead the process where possible with the person's guardian and/or legal
				representative having a participatory role, as needed and as defined by the
				person and any applicable laws.
2.
				Include people chosen by the person.
3. Provide the necessary information and
				support to ensure that the person directs the process to the maximum extent
				possible, and is enabled to make informed choices and decisions.
4. Be timely and occur at times and locations
				of convenience to the person.
5.
				Reflect cultural considerations of the person and be conducted by providing
				information in plain language and in a manner that is accessible to individuals
				with disabilities and persons who are limited English proficient.
6. Include strategies for solving conflict or
				disagreement within the process, including clear conflict-of-interest
				guidelines for all planning persons.
7. Provide conflict free case management and
				the development of the PSS by a provider who does not provide home and
				community-based services (HCBS) for the person, or those who have an interest
				in or are employed by a provider of HCBS for the person, except when the only
				willing and qualified entity to provide case management and/or develop PSS in a
				geographic area also provides HCBS. In these cases, conflict of interest
				protections including separation of entity and provider functions within
				provider entities, must be approved by the Centers of Medicare and Medicaid
				Services (CMS) and these persons must be provided with a clear and accessible
				alternative dispute resolution process.
8. Offer informed choices to the person
				regarding the services and supports they receive and from whom.
9. Include a method for the person to request
				updates to the PSS as needed.
10.
				Record the alternative HCBSs that were considered by the person.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 2 - Home and Community Based Services (HCBS) Independent Living Waiver › Rule 23-208-2.14 - Monitoring Safeguards

Current through June 25, 2024
A. Mississippi
				Department of Rehabilitation Services (MDRS) case managers are required to
				provide each individual with written information regarding their rights as a
				waiver person at the initial assessment.
B. Case managers must provide the person's
				information at the initial assessment regarding the Mississippi Vulnerable
				Person's Act and phone numbers of when and who to call if abuse, neglect or
				exploitation is alleged.
Miss. Code Ann.
				  §§
										37-33-157,
				  43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.1 - General

Current through June 25, 2024
A. The Division of Medicaid covers certain
				Home and Community Based Services (HCBS) services as an alternative to
				institutional care in a nursing facility through the Assisted Living (AL)
				Waiver.
B. The AL Waiver is
				administered and operated by the Division of Medicaid.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.2 - Eligibility

Current through June 25, 2024
A. To be eligible for the Assisted Living
				Waiver Program a waiver participant must:
1.
				Be twenty-one (21) years of age or older,
2. Require nursing facility level of care as
				determined by a standardized comprehensive preadmission screening, and
3. Be in the Supplemental Security
				Income (SSI) Category of Eligibility (COE) or an aged, blind or disabled
				individual who meets all factors of institutional eligibility. If income
				exceeds the current institutional limit, the individual must pay the Division
				of Medicaid the portion of their income that is due under the terms of an
				Income Trust in order to qualify.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.3 - Provider Enrollment

Current through June 25, 2024
To become an HCBS/AL Waiver provider, the prospective
				  provider must:
A. Submit a provider
				enrollment packet complete with all necessary information.
B. Submit a copy of the current and active
				license/certification to function as a Personal Care Home Assisted Living
				Facility (PCH-AL) or meet licensure requirements deemed acceptable by the
				Division of Medicaid to meet minimum requirements specific for a Traumatic
				Brain Injury Residential facility.
C. Successfully pass a facility inspection by
				a Division of Medicaid inspector.
D. Satisfy all criteria and requirements for
				enrollment as a Medicaid provider in accordance with Miss. Admin. Code Part
				208, Chapter 1, Rule 1.1, upon completion of items A., B. and C. in Miss.
				Admin. Code Part 208, Rule 3.3.
42 CFR Part 455, Subpart
				  E; Miss. Code Ann. §§
										43-13-5;
				  43-11-13; 43-11-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.4 - Freedom of Choice

Current through June 25, 2024
A. Medicaid
				beneficiaries have the right to freedom of choice of approved Medicaid
				providers for services as outlined in Miss. Admin. Code Part 200, Chapter 3,
				Rule
				3.6
B. The person and/or guardian or legal
				representative must be informed of setting options based on the person's needs
				and preferences, including non-disability specific settings. The setting
				options must be selected by the person and identified and documented in the
				plan of services and supports (PSS).
42 U.S.C. §
											1396a; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.5 - Prior Approval/Physician Certification

Current through June 25, 2024
A. Prior
				approval must be obtained from the Division of Medicaid before an individual
				can receive services through the Home and Community-Based Waiver
				Program.
B. Functional eligibility
				for waiver services is determined through a comprehensive PreAdmission
				Screening.
1. The physician must certify that
				the individual meets nursing home level of care.
2. Clinical eligibility must be determined
				annually using the pre-admission screening for continued AL Waiver
				services.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.6 - Covered Services

Current through June 25, 2024
A. The Assisted
				Living (AL) Waiver covers Case Management Services provided by a social worker
				licensed to practice in the State of Mississippi with at least two (2) years of
				full-time experience in direct services to elderly and disabled individuals.
B. AL Services include the
				following:
1. Personal care services rendered
				by personnel of the licensed facility,
2. Homemaker services,
3. Attendant care services,
4. Medication oversight/administration with
				personnel operating within the scope of applicable licenses and/or
				certifications,
5. Therapeutic,
				social, and recreational programming services,
6. Intermittent skilled nursing services and
				interventions ordered by the physician and provided:
a. At least eight (8) hours a day, including
				weekends and holidays, to assess and assist the waiver person with services
				including, but not limited to, medication administration and oversight, and
b. By a nurse with an active and
				unencumbered license acting within their scope of practice. If the facility
				employs a Licensed Practical Nurse (LPN), the LPN must have supervision by
				either a Registered Nurse (RN), nurse practitioner, or a physician.
7. Transportation services must be
				provided by the AL Waiver provider or through the Division of Medicaid's
				Non-Emergency Transportation (NET) program if the waiver person has not reached
				the maximum NET service limits.
8.
				An electronic emergency attendant call system in each Personal Care
				Home-Assisted Living (PCH-AL) facility which:
a) Is available to waiver persons who are:
1) At risk of falling,
2) At risk of becoming disoriented, or
3) Experiencing some disorder
				placing them in physical, mental or emotional jeopardy.
b) Includes twenty-four (24) hour on-site
				response staff to meet scheduled or unpredictable needs in a way that promotes
				maximum dignity and independence, and provides for supervision, safety and
				security.
9. Provision
				of normal, daily personal hygiene items including, at a minimum, deodorant,
				soap, shampoo, toilet paper, facial tissue, laundry soap and dental hygiene
				products.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.7 - Quality Management

Current through June 25, 2024
A. AL Waiver
				providers must meet applicable service specifications. Refer to the Miss.
				Admin. Code, Part 208, Chapter 1.
B. AL Waiver providers must report changes in
				contact information, staffing, and licensure within ten (10) calendar days to
				Division of Medicaid.
C. Providers
				must maintain compliance with all current waiver requirements, regulatory rules
				and regulations and administrative codes as specified by the licensing agency.
1. If an AL Waiver provider fails to maintain
				compliance, the Division of Medicaid may halt the acceptance of Medicaid
				referrals or waiver admissions until the AL Waiver provider demonstrates
				compliance with the regulatory agency.
2. The decision to halt Medicaid referrals or
				waiver admissions is at the discretion of the Division of Medicaid.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.8 - Documentation and Record Maintenance Requirements

Current through June 25, 2024
A.
				Providers participating in the HCBS/AL Waiver program are required to:
1. Maintain legible, accurate, and complete
				records.
2. Document the services
				rendered and billed under the program including when a participant is out of
				the facility and the reason why.
3.
				Make records available immediately, upon request, to representatives of the
				Division of Medicaid in substantiation of any and all claims.
4. Maintain records for a minimum of six (6)
				years or until resolution of any pending investigation, audit or
				litigation.
5. Maintain statistical
				and financial data supporting a cost report for at least five (5) years from
				the date of the cost report, or amended cost report or appeals submitted to the
				Division of Medicaid.
6. Identify
				and maintain records of medication allergies of waiver participants.
7. Maintain a current, signed and dated copy
				of the Division of Medicaid approved admission agreement for each waiver
				participant which includes, at a minimum:
a)
				Basic charges agreed upon separating costs for room & board and personal
				care services,
b) Period to be
				covered,
c) List of itemized
				charges, and
d) Agreement regarding
				refunds for payments.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.9 - Reserved

Current through June 25, 2024
Social Security Act 1902
				  (a)(14); 42 CFR §447.50447.59; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.10 - Reimbursement

Current through June 25, 2024
A. Reimbursement for AL Waiver provider
				services cannot be requested earlier than the first (1st) day of the month
				following the month in which services were rendered.
B. Reimbursement for AL Waiver provider
				services is only for those services provided within the facility. The Division
				of Medicaid does not reimburse for room and board.
C. Transportation is an integral part of AL
				Waiver provider services and is not reimbursed separately.
Miss. Code Ann. §
				  43-13-17, 121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.11 - Hearings and Appeals for Denied/Terminated Services

Current through June 25, 2024
A.
				Decisions made by the Division of Medicaid that result in services being
				denied, reduced or terminated, may be appealed in accordance with Part 300 of
				the Miss. Admin. Code.
B. The
				waiver participant/legal representative has thirty (30) days from the date of
				the notice regarding services to appeal the decision.
42 CFR
				  §§431.210, 441.307, 441.308; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.12 - Education, Training and Supervision

Current through June 25, 2024
A. All AL Waiver
				providers must have policies and procedures assuring safeguards to protect the
				safety, health and well-being of all waiver participants which must include:
1. Definitions of abuse, neglect and
				exploitation,
2. Education for
				employees in detection of abuse, neglect and exploitation,
3. Guidance for facility staff to prevent
				abuse, neglect and exploitation, and
4. Reporting requirements for abuse, neglect,
				exploitation and critical incidents.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.13 - Background Checks

Current through June 25, 2024
AL Waiver providers must:
A. Conduct a search of the Mississippi Nurse
				Aide abuse registry prior to hiring an individual who will provide care to
				waiver participants including, but not limited to:
1. Any individual providing direct care or
				supervision to the residents,
2.
				Owners,
3. Operators, and
4. Transportation drivers.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.14 - Disaster Preparedness

Current through June 25, 2024
A. AL Waiver
				providers must have disaster preparedness and management procedures to ensure
				that waiver participant's care, safety, and well- being are maintained during
				and following instances of natural disasters, disease outbreaks, or similar
				situations.
B. In the event of
				termination of an AL Waiver provider agreement, the Division of Medicaid, the
				participants and their designated representatives, and the licensing agency
				will work collaboratively to arrange for appropriate transfer of waiver
				participants to other Medicaid approved providers.
42 CFR
				  §§431.210, 441.307, 441.308; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 3 - Home and Community Based Services (HCBS) Assisted Living Waiver › Rule 23-208-3.15 - Person Centered Planning (PCP)

Current through June 25, 2024
A. The Division of
				Medicaid defines Person-Centered Planning (PCP) as an ongoing process used to
				identify a person's desired outcomes based on their personal needs, goals,
				desires, interests, strengths, and abilities. The PCP process helps determine
				the services and supports the person requires in order to achieve these
				outcomes and must:
1. Allow the person to
				lead the process where possible with the person's guardian and/or legal
				representative having a participatory role, as needed and as defined by the
				person and any applicable laws.
2.
				Include people chosen by the person.
3. Provide the necessary information and
				support to ensure that the person directs the process to the maximum extent
				possible, and is enabled to make informed choices and decisions.
4. Be timely and occur at times and locations
				of convenience to the person.
5.
				Reflect cultural considerations of the person and be conducted by providing
				information in plain language and in a manner that is accessible to individuals
				with disabilities and persons who are limited English proficient.
6. Include strategies for solving conflict or
				disagreement within the process, including clear conflict-of-interest
				guidelines for all planning participants.
7. Provide conflict free case management and
				the development of the PSS by a provider who does not provide home and
				community-based services (HCBS) for the person, or those who have an interest
				in or are employed by a provider of HCBS for the person, except when the only
				willing and qualified entity to provide case management and/or develop PSS in a
				geographic area also provides HCBS. In these cases, conflict of interest
				protections including separation of entity and provider functions within
				provider entities, must be approved by the Centers of Medicare and Medicaid
				Services (CMS) and these persons must be provided with a clear and accessible
				alternative dispute resolution process.
8. Offer informed choices to the person
				regarding the services and supports they receive and from whom.
9. Include a method for the person to request
				updates to the PSS as needed.
10.
				Record the alternative HCBSs that were considered by the person.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.1 - General

Current through June 25, 2024
A. The Division of Medicaid covers certain
				Home and Community-Based Services (HCBS) as an alternative to
				institutionalization in a nursing facility through its Traumatic Brain
				Injury/Spinal Cord Injury (TBI/SCI) Waiver. Waiver services are available
				statewide.
1. Persons enrolled in the TBI/SCI
				Waiver must reside in private homes or a relative's home which is fully
				integrated with opportunities for full access to the greater community, and
				meet the requirements of the Home and Community-Based (HCB) settings.
2. The Division of Medicaid does
				not cover TBI/SCI waiver services to persons in congregate living facilities,
				institutional settings, on the grounds of or adjacent to institutions, or any
				other setting that has the effect of isolating persons receiving Medicaid Home
				and Community-Based Services (HCBS).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.2 - Eligibility

Current through June 25, 2024
A. Eligibility is limited to individuals with
				the following disease(s) or condition(s):
1.
				Traumatic brain injury which the Division of Medicaid defines as an insult to
				the skull, brain, or its covering resulting from external trauma, which
				produces an altered state of consciousness or anatomic, motor, sensory, or
				cognitive/behavioral deficits.
2.
				Spinal cord injury which the Division of Medicaid defines as a traumatic injury
				to the spinal cord or cauda equina with evidence of motor deficit, sensory
				deficit, and/or bowel and bladder dysfunction. The lesions must have
				significant involvement with two (2) of the above three (3) deficits.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.3 - Freedom of Choice

Current through June 25, 2024
A. Medicaid
				beneficiaries have the right to freedom of choice of providers for Medicaid
				covered services. Refer to Part 200, Chapter 3, Rule 3.6.
B. Personal care services may be furnished by
				family members provided they are not legally responsible for the individual.
1. The Division of Medicaid defines a person
				legally responsible for an individual as the parent, or step-parent, of a minor
				child or an individual's spouse.
2.
				Family members must meet provider standards and must be certified competent to
				perform the required tasks by the beneficiary and the TBI/SCI
				counselor/registered nurse.
3.
				There must be adequate justification for the family member to function as the
				attendant.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.4 - Quality Assurance Standards

Current through June 25, 2024
A. Waiver providers
				must meet applicable quality assurance standards.
B. Only the Division of Medicaid can
				initiate, in writing, any interpretation or exception to Medicaid rules or
				regulations.
Miss. Code Ann. §
										43-13-121;
				  §
										43-13-117;
				  §1915(c) of the Social Security Act;
				  42 CFR 441.302
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.5 - Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid covers the following traumatic brain injury/spinal cord injury
				(TBI/SCI) Waiver services:
1. Case Management
				services are defined as services assisting beneficiaries in accessing needed
				waiver and other services, as well as needed medical, social, educational, and
				other services, regardless of the funding source for the services.
a) Case Management services must be provided
				by Mississippi Department of Rehabilitation Services (MDRS) TBI/SCI
				counselors/registered nurses who meet minimum qualifications listed in the
				waiver.
b) Responsibilities
				include, but are not limited to, the following:
1) Initiate and oversee the process of
				assessment and reassessment of the person's level of care.
2) Provide ongoing monitoring of the services
				included in the person's plan of care.
3) Develop, review, and revise the plan of
				care at intervals specified in the waiver.
4) Conduct monthly contact and quarterly
				face-to-face visits with the person.
5) Document all contacts, progress, needs,
				and activities carried out on behalf of the person.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.6 - Prior Approval/Certification

Current through June 25, 2024
A. Prior approval
				must be obtained from the Division of Medicaid before a beneficiary can receive
				services through the Home and Community-Based Waiver program. Prior Approval is
				based on clinical eligibility.
B.
				Clinical eligibility for waiver services is determined through the utilization
				of a comprehensive Pre-Admission Screening.
C. The physician must certify the level of
				care.
D. A physician must verify
				that the beneficiary has a traumatic brain/spinal cord injury. A brain or
				spinal cord injury that is due to a degenerative or congenital condition, or
				that result, intentionally or unintentionally, from medical intervention is
				excluded.
E. The Plan of Care must
				be developed by the case manager and, in conjunction with the PreAdmission
				Screening, should contain objectives, types of services to be furnished, and
				frequency of services.
F. After the
				applicant has made an Informed Choice, understands the criteria for the waiver,
				and meets clinical eligibility, the application along with the Plan of Care
				(POC) must be submitted to the Division of Medicaid for approval.
G. At the time of the initial certification,
				the Pre-Admission Screening and the Plan of Care must be completed jointly by
				the TBI/SCI counselor and registered nurse.
H. At the time of recertification, the Plan
				of Care must be completed by the IL counselor or the registered
				nurse.
I. A beneficiary can only be
				enrolled in one HCBS waiver program at a time.
J. Request to add or change services listed
				on the approved plan of care requires prior approval.
Miss. Code Ann. §
										43-13-121;
				  42 CFR
				  441.301(b)(1)
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.7 - Documentation and Record Keeping

Current through June 25, 2024
A.
				Documentation/record maintenance for reimbursement purposes must, at a minimum,
				reflect procedures set forth for applicable waiver quality assurance standards.
				Refer to Maintenance of Records Part 200, Ch.1, Rule 1.3.
B. Waiver providers must submit copies of all
				service logs/documentation of visits.
Miss. Code Ann. §
										43-13-121;
				  43-13-117; 43-13-118; 43-13-129
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.8 - Reserved

Current through June 25, 2024
Miss. Code Ann. §
										43-13-121;
				  Social Security Act 1902 (a)(14)
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.9 - Reimbursement

Current through June 25, 2024
Reimbursement for waiver services can be requested no earlier
				  than the first day of the month following the month in which services were
				  rendered.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.10 - Due Process Protection

Current through June 25, 2024
Whenever the service amounts, frequencies, duration, and
				  scope are reduced, denied, or terminated, the beneficiary must be provided
				  written notice of recourse/appeal procedures within ten (10) calendar days of
				  the effective reduction or termination of services or within ten (10) calendar
				  days of the decision to deny additional services.
Miss. Code Ann. §
										43-13-121;
				  42 CFR §431.210
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.11 - Hearings and Appeals

Current through June 25, 2024
A. Decisions made
				by the Division of Medicaid that result in services being denied, terminated,
				or reduced may be appealed.
1. The
				beneficiary/legal representative has thirty (30) days from the date of the
				notice regarding services to appeal the decision.
2. All appeals must be in writing.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver › Rule 23-208-4.12 - Person Centered Planning (PCP)

Current through June 25, 2024
A. The Division of
				Medicaid defines Person-Centered Planning (PCP) as an ongoing process used to
				identify a person's desired outcomes based on their personal needs, goals,
				desires, interests, strengths, and abilities. The PCP process helps determine
				the services and supports the person requires in order to achieve these
				outcomes and must:
1. Allow the person to
				lead the process where possible with the person's guardian and/or legal
				representative having a participatory role, as needed and as defined by the
				person and any applicable laws.
2.
				Include people chosen by the person.
3. Provide the necessary information and
				support to ensure that the person directs the process to the maximum extent
				possible, and is enabled to make informed choices and decisions.
4. Be timely and occur at times and locations
				of convenience to the person.
5.
				Reflect cultural considerations of the person and be conducted by providing
				information in plain language and in a manner that is accessible to individuals
				with disabilities and persons who are limited English proficient.
6. Include strategies for solving conflict or
				disagreement within the process, including clear conflict-of-interest
				guidelines for all planning participants.
7. Provide conflict free case management and
				the development of the PSS by a provider who does not provide home and
				community-based services (HCBS) for the person, or those who have an interest
				in or are employed by a provider of HCBS for the person, except when the only
				willing and qualified entity to provide case management and/or develop PSS in a
				geographic area also provides HCBS. In these cases, conflict of interest
				protections including separation of entity and provider functions within
				provider entities, must be approved by the Centers of Medicare and Medicaid
				Services (CMS) and these persons must be provided with a clear and accessible
				alternative dispute resolution process.
8. Offer informed choices to the person
				regarding the services and supports they receive and from whom.
9. Include a method for the person to request
				updates to the PSS as needed.
10.
				Record the alternative HCBSs that were considered by the person.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.1 - Eligibility

Current through June 25, 2024
A. Intellectual Disabilities/Developmental
				Disabilities (ID/DD) Waiver services are services covered by the Division of
				Medicaid as an alternative to institutionalization in an Intermediate Care
				Facility for Individuals with Intellectual Disabilities (ICF/IID) which:
1. Are operated jointly with the Mississippi
				Department of Mental Health (DMH). The Division of Medicaid is the single state
				Medicaid agency having administrative responsibility in the administration and
				supervision of the ID/DD Waiver. DMH is responsible for the daily operation of
				the ID/DD Waiver,
2. Are available
				statewide, and
3. Carry no age
				restrictions for eligibility.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.2 - Provider Enrollment

Current through June 25, 2024
A. The Division of
				Medicaid Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver
				providers must be certified by the Department of Mental Health (DMH) except for
				the providers listed below:
1. Occupational
				therapists,
2. Speech-language
				pathologists,
3. Physical
				therapists, and
4. Providers of
				specialized medical supplies.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.3 - Freedom of Choice

Current through June 25, 2024
A. Intellectual
				Disabilities/Developmental Disabilities (ID/DD) Waiver persons have the right
				to freedom of choice of providers for Medicaid covered services. [Refer to
				Miss. Admin. Code Part 200, Rule
				3.6 ]
B. The person and/or guardian or legal
				representative must be informed of alternatives available through the ID/DD
				Waiver, and given the option of choosing either institutional or home and
				community-based services (HCBS) once eligibility requirements for the ID/DD
				Waiver have been met.
C. The
				person and/or guardian or legal representative must be informed of setting
				options based on the person's needs and preferences, including non-disability
				specific settings and an option for a private unit in a residential setting
				with identified resources available for room and board. The setting options
				must be selected by the person and identified and documented in the plan of
				services and supports.
D. The
				choice made by the person and/or guardian or legal representative must be
				documented and signed by the person and/or guardian or legal representative and
				maintained in the ID/DD Waiver case record.
42 U.S.C. §
											1396a; 42 C.F.R. §§ 431.51,
				  441.301, 441.302; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.4 - Evaluation/Reevaluation of Level of Care (LOC)

Current through June 25, 2024
A. A participant's
				level of care (LOC) is determined by an initial evaluation and required
				reevaluations to assess the needs for services through the Intellectual
				Disabilities/Developmental Disabilities (ID/DD) Waiver.
1. All LOC initial evaluations and required
				reevaluations must be conducted by one (1) of the five (5) Diagnostic and
				Evaluation (D&E) Teams housed at the Department of Mental Health's (DMH's)
				five (5) comprehensive regional programs.
2. The specific battery of standardized
				diagnostic and assessment instruments must accurately assess the individual's
				level of function in all areas of development and serve as a baseline for
				future reassessments.
3. There is
				not a single instrument/tool required to determine LOC eligibility requirements
				for Intermediate Care Facility for Individuals with Intellectual Disabilities
				(ICF/IID).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.5 - Covered Services

Current through June 25, 2024
A. Intellectual
				Disabilities/Developmental Disabilities (ID/DD) Waiver services must only be
				provided to persons when approved by the Department of Mental Health (DMH) and
				authorized by the ID/DD Waiver support coordinator as part of the approved Plan
				of Services and Supports (PSS).
B.
				All providers must follow DMH Operational Standards regarding criminal
				background checks, valid driver's license and current vehicle insurance.
C. The ID/DD Waiver services
				include the following:
1. Support
				Coordination is defined by the Division of Medicaid as the monitoring and
				coordinating of all person services, regardless of funding source, to ensure
				the person's health and welfare needs are met.
a) Support Coordination activities must
				include:
1) Developing, reviewing, revising
				and ongoing monitoring and assessing of each person's PSS which must include,
(a) Information on the person's health and
				welfare, including any changes in health status,
(b) Information about the person's
				satisfaction with current service(s) and provider(s) (ID/DD Waiver and others),
(c) Information addressing the
				need for any new ID/DD Waiver or other services based upon expressed needs or
				concerns and/or changing circumstances and actions taken to address the
				need(s),
(d) Information
				addressing whether the amount/frequency of service(s) listed on the PSS remains
				appropriate,
(e) A review of
				individual plans developed by agencies which provide ID/DD Waiver services to
				the person, and
(f) Ensuring all
				services a person receives, regardless of funding source, are coordinated to
				maximize the benefit for the person.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 208 - Home and Community Based Services (HCBS) Long Term Care › Chapter 5 - Home and Community Based Services (HCBS) Intellectual Disabilities/Developmental Disabilities Waiver › Rule 23-208-5.6 - Reserved

Current through June 25, 2024
Miss. Code Ann. §
										43-13-121;
				  Social Security Act 1915(b)(c);
				  42 CFR 441.302