Mississippi Administrative Code › Title 32 - Rehabilitation And Disabilities › Part 1 - Office of Special Disability Programs Policy Manual › PROCEDURE MANUAL › Section 32-1-16.9 - SPECIALIZED MEDICAL SUPPLIES FEE SCHEDULE/COST NEUTRALITY

Current through June 25, 2024
Specialized medical equipment and supplies include devices, controls or appliances that will enhance the client's ability to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live. This service also includes equipment and supplies necessary for life support, supplies and equipment necessary for the proper functioning of such items, and durable and nondurable medical equipment not available under the Medicaid State Plan. The need for/use of such items must be documented in the assessment/case file and approved on the plan of care.
Items reimbursed with waiver funds are in addition to medical equipment and supplies furnished under the Medicaid State Plan. Items not of direct medical or remedial benefit to the client are excluded.
Medicaid waiver funds are utilized as the payor of last resort. The Counselor must request payment from other sources (i.e., Medicare, private insurance, etc.) prior to submitting claims for reimbursement to the Division of Medicaid.
The maximum dollar amount of all approved services on the plan of care is limited to the latest CMS 372-372 Lag Report cost neutrality comparison threshold, i.e. annualized nursing home cost. In an attempt to ensure the client's plan of care does not exceed the annual nursing home cost, a list of medical supplies and a fee schedule is developed to indicate the maximum amount of supplies. See SMS Fee Schedule at end of section for a complete list of medical supplies and the maximum allowed by MDRS/OSDP.
Maximum Units
If a client is requesting supplies that exceed the maximum units, prior approval must be requested with accompanying documentation as to why the additional supplies are being requested.
A letter from the attending physician must be submitted to the District Manager to determine medical necessity. The letter must address the client's diagnosis, the effects of the condition, the period of time for which the approval is being requested and why the excessive number is medically necessary.
Catheters/Catheter Kits
* Intermittent Catheters are for urinary retention
* Foley Catheters are for urinary incontinence and retention
* Catheter Kits may be approved for a maximum of three months at a time. Chronic UTI's must be documented for intermittent kits to be covered.
Supply Name
Supply Code
Beginning Date
End Date
Maximum Units
Disposables
Briefs, Diapers, Pullups: (all sizes)
Not Covered
04/01/2010
12/31/9999
200/month Or 2 boxes
Under Pads
Blue Pads/disposal All sizes
Not covered
04/01/2010
12/31/9999
200/month Or 2 cases
Catheters
Catheters: Condom External (all sizes)
A4349
04/01/2010
12/31/9999
35/month
Catheter, Intermittent
A4351
04/01/2010
12/31/9999
200/month
Collection device
A4327
04/01/2010
12/31/9999
2/month
Collection pouch
A4328
04/01/2010
12/31/9999
2/month
Catheter-Urethral Foley
A4352
04/01/2010
12/31/9999
200/month
Leg strap Foley
A4334
04/01/2010
12/31/9999
1/month
Catheter Kit closed system
A4353
04/01/2010
12/31/9999
200/quarterly
Urinary Drainage leg bag
A4357
04/01/2010
12/31/9999
1/month
* Vinyl
A4358
04/01/2010
12/31/9999
1/moth
* Latex
A5112
04/01/2010
12/31/9999
1/month
Urinary Bed bag
04/01/2010
12/31/9999
Irrigation tubing set
A4355
04/01/2010
12/31/9999
3/month
Bedside Drainage Bottle
A5102
04/01/2010
12/31/9999
1 quarterly
Extension drainage tubing
A4331
04/01/2010
12/31/9999
5/month
Adhesive Catheter Anchoring Device
A4333
04/01/2010
12/31/9999
35/month
Gloves
* Non Sterile
A4927
04/01/2010
12/31/9999
2 boxes/50 pairs
* Sterile
A4930
04/01/2010
12/31/9999
2 boxes/50 pairs
Skin Sealants
Lantiseptic, Calmoseptine, Medisurge Cream
A6250
04/01/2010
12/31/9999
50 tubes
Gauze
Non impregnated, sterile pad 4x4 w/o adhesive border
A6216 A6402, etc.
04/01/2010
12/31/9999
200/pads
Tubes
Gastrostomy-Feeding Tubes, 14Fr-24Fr
B4087 B4088
04/01/2010
12/31/9999
1/month 1/month
Syringe
Syringes, 60cc pole bag
A4213
04/01/2010
12/31/9999
120/month
Skin cleaners
Alcohol prep pads
A4245
04/01/2010
12/31/9999
2 boxes/month
Irrigation Solutions
KY Jelly Lubricant
A4332
04/01/2010
12/31/9999
35/month
Tape
18 square inches Waterproof
A4450
04/01/2010
12/31/9999
2/month
18 square inches Non water proof
A4453
04/01/2010
12/31/9999
2/month
Ostomy Supplies
Ostomy Supplies can be requested if needed. The table below contains a few items on the list.
Supply name
Supply
Code
Quantity
Beginning Date
End Date
MDRS Cost
*Skin Barrier, solid
A4362
04/01/2010
12/31/9999
20/month
Adhesive liquid
A4364
04/01/2010
12/31/9999
4/month
Ostomy Belt
A4367
04/01/2010
12/31/9999
1/month
Ostomy Skin Barrier, liquid
A4369
04/01/2010
12/31/9999
1/month