reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 7 - UTILIZATION REVIEW STANDARDS › Rule 15-16-1-82.7.2

Current through June 25, 2024
Information Upon Which Utilization Review is
						Conducted
1. When conducting routine
					 prospective and concurrent utilization review, the private review agent shall
					 collect only the information necessary to certify the admission, procedure or
					 treatment and length of stay.
2. A
					 private review agent should not routinely expect hospitals and physicians to
					 supply numerically codified diagnoses or procedures. The private review agent
					 may ask for such coding, since if it is known, its inclusion in the data
					 collected increases the effectiveness of the communication.
3. The private review agent shall not
					 routinely request copies of medical records on all patients reviewed. During
					 prospective and concurrent review, copies of medical records should only be
					 required when a difficulty develops in certifying the medical necessity or
					 appropriateness of the admission or extension of stay. In those cases, only the
					 necessary or pertinent sections of the record should be required.
4. Private review agents may request copies
					 of medical records retrospectively for a number of purposes, including auditing
					 the services provided, quality assurance, evaluation of compliance with the
					 terms of the health benefit plan or UR provisions. With the exception of the
					 reviewing of records associated with an appeal or with an investigation of data
					 discrepancies and unless otherwise provided for by contract or law, health care
					 providers should be reimbursed the reasonable direct costs of duplicating
					 requested records for retrospective review.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 7 - UTILIZATION REVIEW STANDARDS › Rule 15-16-1-82.7.3

Current through June 25, 2024
Except as otherwise provided in these standards, a
						private review agent should limit its initial data requirements to the
						following elements:
1. Patient
					 Information
a. Name
b. Address
c. Date of Birth
d. Sex
e. Social Security Number or Patient ID
					 Number
f. Name of Carrier or
					 Plan
g. Plan ID Number
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 7 - UTILIZATION REVIEW STANDARDS › Rule 15-16-1-82.7.4 - Special Situations

Current through June 25, 2024
1. Additional
					 information may be required for other specific review functions such as
					 discharge planning or catastrophic case management. Second opinion information
					 may also be required, when applicable, sufficient to support benefit plan
					 requirements.
2. Information in
					 addition to that described in this section may be requested by the private
					 review agent or voluntarily submitted by the provider, when there is
					 significant lack of agreement between the private review agent and health care
					 provider regarding the appropriateness of certification during the review or
					 appeal process. "Significant lack of agreement" means that the private review
					 agent has:
a. Tentatively determined, through
					 its professional staff, that a service cannot be certified;
b. Referred the case to a physician for
					 review; and
c. Talked to or
					 attempted to talk to the attending physician for further information.
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 7 - UTILIZATION REVIEW STANDARDS › Rule 15-16-1-82.7.6

Current through June 25, 2024
Notwithstanding language to the contrary elsewhere
						contained herein, if a licensed physician certifies in writing to an insurer
						within seventy-two (72) hours of an admission that the insured person admitted
						was in need of emergency admission to hospital care, such shall constitute a
						prima facie case of the medical necessity of the admission. An emergency
						admission results from sudden onset of a medical condition manifested by acute
						symptoms of sufficient severity that absence of immediate inpatient
						hospitalization could reasonably result in:
1. Permanently placing the patient's health
					 in jeopardy;
2. Serious impairment
					 to bodily functions; or
3. Serious
					 and permanent dysfunction of any bodily organ or part, or other serious medical
					 consequences.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 7 - UTILIZATION REVIEW STANDARDS › Rule 15-16-1-82.7.7

Current through June 25, 2024
To overcome this, the entity requesting the utilization
						review and/or the private review agent must show by clear and convincing
						evidence that the admitted person was not in need of immediate hospital
						care.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 7 - UTILIZATION REVIEW STANDARDS › Rule 15-16-1-82.7.8

Current through June 25, 2024
Private review agents shall have in place written
						procedures to address the failure of a health care provider, patient, or their
						representative to provide the necessary information for review. If the patient
						or provider will not release the necessary information to the UR Organization,
						the UR Organization may deny certification in accordance with its own policy or
						that of the health benefit plan.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 8 - APPEALS OF DETERMINATIONS NOT TO CERTIFY › Rule 15-16-1-82.8.1

Current through June 25, 2024
Each private review agent shall have in place procedures
						for appeals of determinations not to certify an admission, procedure, service
						or extension of stay. The right to appeal shall be available to the patient or
						enrollee, and to the attending physician on behalf of the patient. The
						procedures for appeals shall include, at a minimum, the following
						statement:
1. Any person aggrieved by
					 a final decision of the department or a private review agent in a contested
					 case under this act shall have the right of judicial appeal to the chancery
					 court of the county of the residence of the aggrieved person.
2. Notwithstanding any provision of this act,
					 the insured shall have the express right to pursue any legal remedies he may
					 have in a court of competent jurisdiction.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 9 - EXPEDITED APPEAL › Rule 15-16-1-82.9.1

Current through June 25, 2024
When an initial determination not to certify a health
						care service is made prior to or during an ongoing service requiring review,
						and the attending physician believes that the determination warrants immediate
						appeal, the attending physician shall have an opportunity to appeal that
						determination over the telephone on an expedited basis, within one working day.
						Each private review agent shall provide for reasonable access to its consulting
						physician(s) for such appeals. Both providers of care and private review agents
						should attempt to share the maximum information by phone, FAX, or otherwise to
						resolve the expedited appeal (sometimes called a reconsideration request)
						satisfactorily.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 9 - EXPEDITED APPEAL › Rule 15-16-1-82.9.1

Current through June 25, 2024
Expedited appeals which do not resolve a difference of
						opinion may be resubmitted through the standard appeal
						process.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 10 - STANDARD APPEAL › Rule 15-16-1-82.10.1

Current through June 25, 2024
The private review agents shall establish procedures for
						appeals to be made in writing and/or by telephone.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 10 - STANDARD APPEAL › Rule 15-16-1-82.10.2

Current through June 25, 2024
Each private review agent shall notify in writing the
						patient, provider and claims administrator of its determination on the appeal
						as soon as practical, but in no case later that 60 days after receiving the
						required documentation on the appeal. The documentation required by the private
						review agent may include copies of part or all of the medical record and/or a
						written statement from the attending physician.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 10 - STANDARD APPEAL › Rule 15-16-1-82.10.3

Current through June 25, 2024
Prior to upholding the original decision not to certify
						for clinical reasons, the private review agent shall conduct a review of such
						documentation by a physician who did not make the original determination not to
						certify.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 10 - STANDARD APPEAL › Rule 15-16-1-82.10.4

Current through June 25, 2024
The process established by a private review agent may
						include a period within which an appeal must be filed to be
						considered.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 10 - STANDARD APPEAL › Rule 15-16-1-82.10.5

Current through June 25, 2024
An attending physician who has been unsuccessful in an
						attempt to reverse a determination not to certify should be provided, upon
						request, the clinical basis for the determination.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 11 - NOTIFICATION TO THE CLAIMS ADMINISTRATOR › Rule 15-16-1-82.11.1

Current through June 25, 2024
Each private review agent shall forward, either
						electronically or in writing, a notification of certification or determination
						not to certify to the appropriate claims administrator for the health benefit
						plan.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 12 - CONFIDENTIALITY › Rule 15-16-1-82.12

Current through June 25, 2024
Each private review agent shall have written procedures
						for assuring that patient-specific information obtained during the process of
						utilization review will be:
1. Kept
					 confidential in accordance with applicable federal and state laws;
2. Used solely for the purposes of
					 utilization review, quality assurance, discharge planning and catastrophic case
					 management; and
3. Shared with only
					 those agencies (such as the claims administrator) who have authority to receive
					 such information.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 12 - CONFIDENTIALITY › Rule 15-16-1-82.12.2

Current through June 25, 2024
Summary data shall not be considered confidential if it
						does not provide sufficient information to allow identification of individual
						patients.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 13 - STAFF AND PROGRAM QUALIFICATIONS › Rule 15-16-1-82.13.1

Current through June 25, 2024
Each private review agent shall have utilization review
						staff who are properly trained, qualified, supervised and supported by written
						clinical criteria and review procedures. Clinical criteria and review
						procedures shall be established with appropriate involvement from
						physicians.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 13 - STAFF AND PROGRAM QUALIFICATIONS › Rule 15-16-1-82.13.2

Current through June 25, 2024
Nurses, physicians and other licensed health
						professionals conducting reviews of medical services, and other clinical
						reviewers conducting specialized reviews in their area of specialty shall be
						currently licensed or certified by an approved state licensing agency in the
						United States.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 13 - STAFF AND PROGRAM QUALIFICATIONS › Rule 15-16-1-82.13.3

Current through June 25, 2024
A physician shall review all cases in which the private
						review agent has concluded that a determination not to certify for clinical
						reasons is appropriate. The physician should be reasonably available by
						telephone to discuss the determination with the attending
						physician.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 13 - STAFF AND PROGRAM QUALIFICATIONS › Rule 15-16-1-82.13.4

Current through June 25, 2024
In cases where an appeal to reverse a determination not
						to certify for clinical reasons is unsuccessful, the private review agent
						should assure that a physician in the same or similar general specialty as
						typically manages the medical condition, procedure or treatment under
						discussion is reasonably available, as appropriate, to review the case. For the
						purpose of this review, the phrase "reasonably available" shall mean within one
						working day, unless extenuating circumstances exist. These extenuating
						circumstances shall be in writing.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 13 - STAFF AND PROGRAM QUALIFICATIONS › Rule 15-16-1-82.13.5

Current through June 25, 2024
Private review agents shall utilize the
						following:
1. Written clinical
					 criteria, as needed, for the purpose of determining the Appropriateness of the
					 certification; such criteria should be periodically evaluated and
					 updated;
2. Physician consultants
					 or specialists who are certified by the Boards within the American Board of
					 Medical Specialists or the American Board of Osteopathy from the major areas of
					 clinical services;
3. A formal
					 program for orientation and training of UR staff; and
4. Written documentation of an active Quality
					 Assessment Program.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 14 - ACCESSIBILITY AND ON-SITE REVIEW PROCEDURES › Rule 15-16-1-82.14.1

Current through June 25, 2024
Each private review agent shall provide access to its
						review staff by a toll free or collect call phone line, at a minimum, from 9:00
						A.M. to 5:00 P.M. of each normal business day in this state.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 14 - ACCESSIBILITY AND ON-SITE REVIEW PROCEDURES › Rule 15-16-1-82.14.2

Current through June 25, 2024
Each private review agent shall also have a mechanism to
						receive timely callbacks from providers and shall establish written procedures
						for receiving or redirecting after-hours calls, either in person or by
						recording.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 14 - ACCESSIBILITY AND ON-SITE REVIEW PROCEDURES › Rule 15-16-1-82.14.3

Current through June 25, 2024
Each private review agent shall conduct its telephone
						and on-site information gathering reviews and hospital communications during
						the hospitals' and physicians' reasonable and normal business hours, unless
						otherwise mutually agreed.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 14 - ACCESSIBILITY AND ON-SITE REVIEW PROCEDURES › Rule 15-16-1-82.14.4

Current through June 25, 2024
Each private review agent's staff shall identify
						themselves by name and by the name of their organization and, for on-site
						reviews, should carry picture identification and the private review agent
						company identification card. On-site reviews should, whenever possible, be
						scheduled at least one business day in advance with the appropriate hospital
						contact. Private review agents shall agree, if so requested, that the medical
						records remain available in designated areas during the on-site review and that
						reasonable hospital administrative procedures shall be followed by on-site
						review staff so as to not disrupt hospital operations or patient care. Such
						procedures, however, should not limit the ability of the private review agent
						to efficiently conduct the necessary review on behalf of the patient's health
						benefit plan.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 15 - REPORTING REQUIREMENTS › Rule 15-16-1-82.15.1

Current through June 25, 2024
The Director shall establish reporting requirements
						to:
1. Evaluate the effectiveness of
					 private review agents
2. Determine
					 if all the utilization review programs are in compliance with the provisions of
					 these rules and regulations.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 16 - EXEMPTIONS › Rule 15-16-1-82.16.1

Current through June 25, 2024
The Director may waive the requirements of these rules
						and regulations for a private review agent that operates solely under contract
						with federal government for utilization review of patients eligible for
						hospital services under Title XVIII of the Social Security Act (Medicare) and
						Title XIX (Medicaid).
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 16 - EXEMPTIONS › Rule 15-16-1-82.16.2

Current through June 25, 2024
No certificate is required for utilization review by any
						Mississippi licensed pharmacist or pharmacy, or organizations of either, while
						engaged in the practice of pharmacy in this state.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 16 - EXEMPTIONS › Rule 15-16-1-82.16.8

Current through June 25, 2024
No certificate is required for those private review
						agents conducting general in-house utilization review for hospitals, home
						health agencies, preferred provider organizations or other managed care
						entities, clinics, private physician offices or any other health facility or
						entity, so long as the review does not result in the approval or denial of
						payment for hospital or medical services for a particular case. Such general
						in-house utilization review is completely exempt.
Miss. Code Ann.
						§41.83.1
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 82 - MINIMUM STANDARDS FOR UTILIZATION REVIEW AGENTS › Subchapter 17 - AMENDMENTS › Rule 15-16-1-82.17.1

Current through June 25, 2024
House Bill 1330 of the Mississippi Legislature 2000
						Regular Session amended Section
						41-83-31,
						Mississippi Code of 1972, as follows:
1. 41-83-31. Any program of utilization
					 review with regard to hospital, medical or other health care services provided
					 in this state shall comply with the following:
a. No determination adverse to a patient or
					 to any affected health care provider shall be made on any question relating to
					 the necessity or justification for any form of hospital, medical or other
					 health care services without prior evaluation and concurrence in the adverse
					 determination by a physician licensed to practice in Mississippi. The physician
					 who made the adverse determination shall discuss the reasons for any adverse
					 determination with the affected health care provider, if the provider so
					 requests. The physician shall comply with this request within fourteen (14)
					 calendar days of being notified of a request. Adverse determination by a
					 physician shall not be grounds for any disciplinary action against the
					 physician by the State Board of Medical Licensure.
b. Any determination regarding hospital,
					 medical or other health care services rendered or to be rendered to a patient
					 which may result in a denial of third-party reimbursement or a denial of
					 pre-certification for that service shall include the evaluation, findings and
					 concurrence of a physician trained in the relevant specialty or subspecialty,
					 if requested by the patient(s physician, to make a final determination that
					 care rendered or to be rendered was, is, or may be medically
					 inappropriate.
c. The requirement
					 in this section that the physician who makes the evaluation and concurrence in
					 the adverse determination must be licensed to practice in Mississippi shall not
					 apply to the Comprehensive Health Insurance Risk Pool Association or its
					 policyholders and shall not apply to any utilization review company which
					 reviews fewer than ten persons residing in the State of Mississippi.
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - GENERAL : LEGAL AUTHORITY › Rule 15-16-1-83.1.1 - Adoption of Rules, Regulations, and Minimum Standards

Current through June 25, 2024
By virtue of authority vested in it by the Legislature
						of the State of Mississippi as per Section
						43-11-13
						of the Mississippi Code of 1972, as amended, the Mississippi State Department
						of Health does hereby adopt and promulgate the following Rules, Regulations,
						and Minimum Standards for Adult Foster Care Facilities. Upon adoption of these
						Rules, Regulations, and Minimum Standards, all former rules, regulations and
						minimum standards in conflict therewith, previously adopted by the licensing
						agency, are hereby repealed.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - GENERAL : LEGAL AUTHORITY › Rule 15-16-1-83.1.2 - Codes and Ordinances

Current through June 25, 2024
Every licensed facility located inside the boundaries of
						a municipality shall comply with all local municipal codes and ordinances
						applicable thereto. In addition, each licensed facility shall comply with all
						applicable state and federal laws.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - GENERAL : LEGAL AUTHORITY › Rule 15-16-1-83.1.3 - Fire Safety

Current through June 25, 2024
No facility may be licensed until it shows conformance
						to the safety regulations providing minimum standards for prevention and
						detection of fire as well as for
protection
of life and property
						against fire.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - GENERAL : LEGAL AUTHORITY › Rule 15-16-1-83.1.4 - Duty to Report

Current through June 25, 2024
All fires, explosions, natural disasters as well as
						avoidable deaths, or avoidable, serious, or life-threatening injuries to
						residents resulting from fires, explosions, and natural disasters shall be
						reported by telephone to the Life Safety Code Division of the licensing agency
						by the next working day after the occurrence
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.1 - Adult Foster Care

Current through June 25, 2024
The term "adult foster care" shall mean the provision of
						services to individuals who require personal care services through
						individualized plans of care which provide a variety of health, social, and
						related support services in a protective setting, enabling persons to live in
						the community.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.2 - Ambulation

Current through June 25, 2024
The terms "ambulation" or "ambulatory" shall mean the
						resident's ability to bear weight, pivot, and safely walk independently or with
						the use of a cane, walker, or other mechanical supportive device (i.e.,
						including, but not limited to, a wheelchair). A resident who requires a
						wheelchair must be capable of transferring to and propelling the wheelchair
						independently or with prompting.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.3 - Criminal History Record Checks

Current through June 25, 2024
1. Employee. For
					 the purpose of fingerprinting and criminal background history checks, employee
					 shall mean any individual employed by a licensed entity. The term "employee",
					 also includes any individual who by contract with the facility provides patient
					 care in a patient's, resident's, or client's room or in treatment rooms. The
					 term employee does not include healthcare professional/technical students, as
					 defined in Section
					 37-29-232,
					 performing clinical training in a licensed entity under contracts between their
					 schools and the licensed entity, and does not include students at high schools
					 who observe the treatment and care of patients in a licensed entity as part of
					 the requirements of an allied health course taught in the school if:
a. The student is under the supervision of a
					 licensed healthcare provider; and
b. The student has signed the affidavit that
					 is on file at the student's school stating that he or she has not been
					 convicted of or plead guilty or nolo contendere to a felony of possession or
					 sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any
					 sexual offenses listed in section
					 45-33-23(g),
					 child abuse, arson, grand larceny, burglary, gratification of lust, aggravated
					 assault, or felonious abuse and/or battery of a vulnerable adult, or that any
					 such conviction or plea was reversed on appeal or a pardon was granted for the
					 conviction or plea.
c. Further,
					 applicants and employees of the University of Mississippi Medical Center for
					 whom criminal history record checks and fingerprinting are obtained in
					 accordance with Section
					 37-115-41
					 are exempt from application of the term employee under Section
					 43-11-13.
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.4 - Facility

Current through June 25, 2024
The term "facility" shall mean any home or institution
						that (1) has sought or is currently seeking designation as a "licensed
						facility" under the terms of these regulations; or (2) is operating a home or
						institution unlawfully which, by its nature and operational intent, is required
						to be a licensed facility under the terms of these
						regulations.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.5 - Immediate Jeopardy (Serious and Immediate to Health and Safety)

Current through June 25, 2024
A situation in which the licensed facility's failure to
						meet one or more regulatory requirements has caused, or is likely to cause,
						serious injury, harm, impairment, or death to a resident.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.6 - Licensing Agency

Current through June 25, 2024
The term "licensing agency" shall mean the Mississippi
						State Department of Health
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.7 - IGRA(s) (Interferon-Gamma Release Assay(s)

Current through June 25, 2024
A whole blood test used in to assist in diagnosing
						Mycobacterium Tuberculosis infection. The IGRA blood test used must be approved
						by the U.S. Food and Drug Administration (FDA).
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.8 - Licensed Facility

Current through June 25, 2024
The term "licensed facility" shall mean adult foster
						care facility which has been issued a license for operation by the licensing
						agency.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.9 - Mantoux Test

Current through June 25, 2024
A method of skin testing that is performed by injecting
						one-tenth (0.1) milliliter of purified protein derivative-tuberculin containing
						five (5) tuberculin units into the dermis (i.e., the second layer of skin) of
						the forearm with a needle and syringe. The area is examined between forty-eight
						(48) and seventy-two (72) hours after the injection. A reaction is measured
						according to the size of the induration. The classification of a reaction as
						positive or negative depends on the patient's medical history and various risk
						factors (see definition for significant tuberculin skin test. This test is used
						to evaluate the likelihood that a person is infected with M. tuberculosis. The
						Mantoux (TST) test should be administered only by persons certified in the
						intradermal technique.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.10 - Medication Administration

Current through June 25, 2024
For the purposes of these regulations, the term
						"medication administration" is limited to these decisions, made by someone
						other than the person for whom the medication has been prescribed, regarding
						(1) which medication is to be taken, (2) the dosage of the medication, or (3)
						the time at which the medication is to be taken.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.11 - Medication Assistance

Current through June 25, 2024
For the purposes of these regulations, the term
						"medication assistance" is any form of delivering medication which has been
						prescribed which is not defined as "medication administration" including, but
						not limited to, the physical act of handing an oral prescription medication to
						the patient along with liquids to assist the patient in
						swallowing.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.12 - Personal Care

Current through June 25, 2024
The term "personal care" shall mean the assistance
						rendered by personnel of the licensed facility to residents in performing one
						or more of the activities of daily living, including but not limited to
						bathing, walking, excretory functions, feeding, personal grooming, and
						dressing.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.13 - Plan of Care

Current through June 25, 2024
(Care Plan) A written document established and
						maintained for each resident admitted to the licensed Adult Foster Care
						Facility. Care provided to a resident must be in accordance with the plan. The
						plan must include a comprehensive assessment of the individual's needs and the
						identification of services needed to attain or maintain the resident's highest
						practicable physical, mental, and psychosocial well-being.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.14 - Significant Tuberculin Skin Test

Current through June 25, 2024
An induration of five (5) millimeters or greater is
						significant (or positive) in the following:
8. Persons known to have or suspected of
					 having human immunodeficiency virus (HIV).
9. Close contacts of a person with infectious
					 tuberculosis.
10. Persons who have
					 a chest radiograph suggestive of previous tuberculosis.
11. Persons who inject drugs (if HIV status
					 is unknown).
An induration of ten (10) millimeters or greater is
						significant (or positive) in all other persons tested in Mississippi. A
						tuberculin skin test is recorded in millimeters of induration. For accurate
						results, measure the widest diameter of the palpable induration transverse
						(across) the arm.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.15 - Supervision

Current through June 25, 2024
Supervision means guidance of the resident as the
						individual carries out activities of daily living including reminding a
						resident to maintain his/her medication schedule as directed by his/her
						physician, reminding him/her of important activities to be carried out,
						assisting him/her in keeping appointments and being aware of his/her general
						whereabouts even though he/she may travel independently about the
						community.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.16 - Surveyor

Current through June 25, 2024
The term "surveyor" shall mean an individual employed,
						or hired on a contractual basis, by the licensing agency for the purpose of
						conducting surveys, inspections, investigations, or other related functions as
						part of the licensing agency's responsibilities for licensure and regulation of
						institutions for the aged and infirm.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 2 - DEFINITIONS › Rule 15-16-1-83.2.17 - Two-step Testing

Current through June 25, 2024
A procedure used for the baseline testing of person who
						will periodically receive tuberculin skin tests (e.g., health care workers) to
						reduce the likelihood of mistaking a boosted reaction for a new infection. If
						the initial tuberculin-test result is classified as negative, a second test is
						repeated one (1) to three (3) weeks later. If the reaction to the second test
						is positive, it probably represents a boosted reaction. If the second test is
						also negative, the person is classified as not infected. A positive reaction to
						a subsequent test would indicate new infection (i.e., a skin-test conversion)
						in the person.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 3 - PROCEDURE GOVERNING ADOPTION AND AMENDMENT › Rule 15-16-1-83.3.1 - Authority

Current through June 25, 2024
The licensing agency shall have the power to adopt,
						amend, promulgate and enforce such rules, regulations and minimum standards as
						it deems appropriate, within the law.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 4 - INSPECTION › Rule 15-16-1-83.4.1 - Inspections Required

Current through June 25, 2024
Each licensed facility shall be inspected by the
						licensing agency or by persons delegated with authority by said licensing
						agency at such intervals as the licensing agency may direct. The licensing
						agency and/or its authorized representatives shall have the right to inspect
						construction work in progress. New facilities shall not be licensed without
						having first been inspected for compliance with these rules, regulations, and
						minimum standards.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 5 - CLASSIFICATION › Rule 15-16-1-83.5.1 - Adult Foster Care Facility

Current through June 25, 2024
The term "Adult Foster Care Facility" means a home
						setting for vulnerable adults in the community who are unable to live
						independently due to physical, emotional, developmental or mental impairments,
						or in need of emergency and continuing protective social services for purposes
						of preventing further abuse or neglect and for safeguarding and enhancing the
						welfare of the abused or neglected vulnerable adult. Adult foster care programs
						shall be designed to meet the needs of the vulnerable adults with impairments
						through individual plans of care, which provide a variety of health, social and
						related support services in a protective setting, enabling participants to live
						in the community. Adult Foster Care programs may be:
1. Traditional, where the foster care
					 provider lives in the residence and is the primary caregiver to clients in the
					 home;
2. Corporate, where the
					 foster care home is operated by a corporation or other entity with shift staff
					 delivery services to clients; or
3.
					 Shelter, where the foster care home accepts clients on an emergency short-term
					 basis for up to thirty (30) days.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 6 - TYPES OF LICENSE › Rule 15-16-1-83.6.1 - Regular License

Current through June 25, 2024
A license shall be issued to each facility that meets
						the requirements as set forth in these regulations. Each license shall be
						issued under one of the following classes:
1. Traditional, where the foster care
					 provider lives in the residence and is the primary caregiver to clients in the
					 home;
2. Corporate, where the
					 foster care home is operated by a corporation or other entity with shift staff
					 delivery services to clients; or
3.
					 Shelter, where the foster care home accepts clients on an emergency short-term
					 basis for up to thirty (30) days. The licensing agency shall have the power and
					 authority to waive any provision herein it deems appropriate for any license
					 issued for the Shelter class facility.
Miss. Code Ann.
						§
												43-11-13
Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 83 - MINIMUM STANDARDS FOR ADULT FOSTER CARE FACILITIES › Subchapter 6 - TYPES OF LICENSE › Rule 15-16-1-83.6.2 - Provisional License

Current through June 25, 2024
Within its discretion, the licensing agency may issue a
						provisional license only if the licensing agency is satisfied that preparations
						are being made to qualify for regular license and that the health and safety of
						residents will not be endangered.
Miss. Code Ann.
						§
												43-11-13