Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 207 - Institutional Long Term Care › Chapter 2 - Nursing Facility › Rule 23-207-2.6 - Per Diem

Current through June 25, 2024
A. The nursing
				facility must provide and pay for all items and services required to meet the
				needs of a resident.
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. Respiratory therapy (RT)
				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 Medicaid drug
				program, Medicare, private, Veterans Affairs (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 nursing facility. [Refer to Miss. Admin. Code Part 207, Rule 2.6.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), and/or medical appliances, except for DME and/or medical appliances
				listed in Miss. Admin. Code Part 207, Rule 2.6.D. The Division of Medicaid
				defines DME and/or medical appliances as an item that (1) can withstand
				repeated use, (2) 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 nursing
				facility.
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. Ventilators. [Refer to Miss. Admin. Code
				Part 207, Rule
				2.15.]
15. The nursing facility must provide
				non-emergency transportation unless the resident chooses to be transported by a
				family member or friend.
16. The
				nursing facility cannot use the Non-Emergency Transportation (NET) Broker to
				arrange transportation for residents. Nursing facilities may use NET providers
				that also provide NET services for the NET Broker if:
a) The nursing facility arranges the
				transportation, and
b) Pays the NET
				provider directly.