Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 3 - Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) › Rule 23-207-3.5 - Per Diem

Current through June 25, 2024
A. The intermediate
				care facility for individuals with intellectual disabilities (ICF/IID) must
				provide for all items and services required to meet the needs of a resident
				according to the comprehensive functional assessment and the individual program
				plan (IPP).
B. Items and services
				covered by Medicare or any other third party must be billed to Medicare or the
				other third party and are considered non-allowable on the cost report.
				Applicable crossover claims must also be filed with the Division of
				Medicaid.
C. The following items
				and services are included in the Medicaid per diem rates and cannot be billed
				separately to the Division of Medicaid or charged to a resident:
1. Room/bed maintenance services.
2. Nursing services.
3. Physical Therapy (PT), Occupational
				Therapy (OT), and Speech-Language Pathology (SLP) services.
4. Dietary services, including nutritional
				supplements.
5. Activity
				services.
6. Medically-related
				social services.
7. Laundry
				services including the residents' personal laundry.
8. Over-the-counter (OTC) drugs.
9. Legend drugs not covered by the Medicaid
				program, Medicare, private, Veteran's Administration (VA) or any other payor
				source.
10. Medical supplies
				including, but not limited to, those listed below. The Division of Medicaid
				defines medical supplies as medically necessary disposable items, primarily
				serving a medical purpose, having therapeutic or diagnostic characteristics
				essential in enabling a resident to effectively carry out a practitioner's
				prescribed treatment for illness, injury, or disease and appropriate for use in
				the ICF/IID. [Refer to Miss. Admin. Code Part 207, Rule
				3.4.D. for medical supplies which
				must be billed outside the per diem rate.]
a)
				Enteral supplies,
b) Diabetic
				supplies,
c) Incontinence garments
				and
d) Oxygen administration
				supplies.
11. Durable
				medical equipment (DME), except for DME listed in Miss. Admin. Code Part 207,
				Rule
				3.4.D. The Division of Medicaid
				defines DME as an item that (1) can withstand repeated use, (2) is primarily
				and customarily used to serve a medical purpose, (3) is generally not useful to
				a resident in the absence of illness, injury or congenital defect, and (4) is
				appropriate for use in the ICF/IID. [Refer to Miss. Admin. Code Part 207, Rule
				3.4.D. for DME which must be billed
				outside the per diem rate.]
12.
				Routine personal hygiene items and services as required to meet the needs of
				the residents including, but not limited to:
a) Hair hygiene supplies,
b) Comb and brush,
c) Bath soap,
d) Disinfecting soaps or specialized
				cleansing agents when indicated to treat special skin problems or to fight
				infection,
e) Razor and shaving
				cream,
f) Toothbrush and
				toothpaste,
g) Denture adhesive and
				denture cleaner,
h) Dental
				floss,
i) Moisturizing
				lotion,
j) Tissues, cotton balls,
				and cotton swabs,
k)
				Deodorant,
l) Incontinence
				supplies,
m) Sanitary napkins and
				related supplies,
n) Towels and
				washcloths,
o) Hair and nail
				hygiene services, including shampoos, trims and simple haircuts as part of
				routine grooming care, and
p)
				Bathing.
13. Private room
				coverage as medically necessary.
a) The
				Medicaid per diem reimbursement rate includes reimbursement for a resident's
				placement in a private room if medically necessary and ordered by a physician.
				The Medicaid reimbursement for a medically necessary private room is considered
				payment in full for the private room. The resident, the resident's family or
				the Division of Medicaid cannot be charged for the difference between a private
				and semi-private room if medically necessary.
b) The resident may be charged the difference
				between the private room rate and the semiprivate room rate when it is the
				choice of the resident or family if the provider informs the resident in
				writing of the amount of the charge at the time of admission or when the
				resident becomes eligible for Medicaid.
14. The ICF/IID must provide non-emergency
				transportation unless the resident chooses to be transported by a family member
				or friend.
15. The ICF/IID cannot
				use the Non-Emergency Transportation (NET) Broker to arrange transportation for
				residents. ICF/IIDs may use NET providers that also provide NET services for
				the NET Broker if:
a) The ICF/IID arranges the
				transportation, and
b) Pays the NET
				provider directly.