reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 3 - Prescribed Pediatric Extended Care (PPEC) Services › Rule 23-223-3.2 - Provider Requirements

Current through June 25, 2024
A. Prescribed
				pediatric extended care (PPEC) providers, including out-of-state providers,
				must satisfy all requirements set forth in Miss. Admin Code Title 23, Part 200,
				Rule 4.8 in addition to the following provider type specific requirements:
1. National Provider Identifier (NPI)
				verification from National Plan and Provider Enumeration System (NPPES).
2. Written confirmation from the
				Internal Revenue Service (IRS) confirming the provider's tax identification
				number and legal business name.
3.
				A copy of the provider's current Medicare certification or Tie-In Notice from
				the Medicare Administrative Contractor. An Explanation of Medicare Benefits
				(EOMB) is not acceptable.
4. A copy
				of License from the Mississippi State Department of Health, Health Facilities
				Licensure and Certification. If parent entity is an out-of-state facility with
				a servicing location in Mississippi, a copy of the respective State's license
				is required.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 3 - Prescribed Pediatric Extended Care (PPEC) Services › Rule 23-223-3.3 - Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid covers up to twelve (12) hours per day of medically necessary
				prescribed pediatric extended care (PPEC) services for Early and Periodic
				Screening, Diagnosis and Treatment (EPSDT) eligible beneficiaries when:
1. Ordered by the beneficiary's attending
				physician,
2. Provided by a
				Mississippi licensed and Medicaid enrolled PPEC center, and
3. Prior authorized by the Division of
				Medicaid or designee:
a) Prior authorizations
				must be submitted every six (6) months, and
b) The ordering physician must perform an
				in-person evaluation of the beneficiary a minimum of every six (6) months to
				review and update the plan of care (POC) as necessary.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 3 - Prescribed Pediatric Extended Care (PPEC) Services › Rule 23-223-3.4 - Non-covered Services

Current through June 25, 2024
The Division of Medicaid does not cover the following as
				  prescribed pediatric extended care (PPEC) services:
A. Services that are not part of a written
				plan of care,
B. Services that have
				not been ordered by a physician,
C.
				Educational services,
D. Services
				provided to beneficiaries that are related to the owner or operator by blood,
				marriage or adoption, and
E.
				Services that do not meet the Mississippi Department of Health's (MSDH's)
				minimum standards.
42 U.S.C §
											1396 d; Miss. Code Ann. §§
										41-125-19,
				  43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 3 - Prescribed Pediatric Extended Care (PPEC) Services › Rule 23-223-3.5 - Reimbursement

Current through June 25, 2024
A. The Division of Medicaid reimburses up to
				twelve (12) hours per day of medically necessary prescribed pediatric extended
				care (PPEC) services for Early and Periodic Screening, Diagnosis and Treatment
				(EPSDT) eligible beneficiaries when:
1.
				Ordered by the beneficiary's attending physician,
2. Provided by a Mississippi licensed and
				Medicaid enrolled PPEC center, and
3. Prior authorized by the Division of
				Medicaid or designee every six (6) months.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 3 - Prescribed Pediatric Extended Care (PPEC) Services › Rule 23-223-3.6 - Documentation

Current through June 25, 2024
A. Providers must maintain required
				documentation in accordance with Miss. Admin. Code Part 200, Rule
				1.3, and must maintain auditable
				records to substantiate claims submitted to the Division of Medicaid or
				designated entity.
B. Documentation
				must include, but is not limited to:
1. The
				physician's orders and any changes in physician orders,
2. Progress notes,
3. Prior authorization,
4. The plan of care and quarterly
				updates,
5. Immunization records,
6. Dates and times of all services
				provided including, but not limited to:
a)
				Medication administration record,
b) Treatment administration record, and
c) Respiratory treatment
				record
7. Dates and times
				of educational services,
8. Dietary
				orders,
9. Pick-up and drop-off
				times,
10. Accident
				reports,
11. Incident Reports,
				and
12. Emergency contact
				information.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 4 - Private Duty Nursing › Rule 23-223-4.1 - Definitions

Current through June 25, 2024
The Division of Medicaid defines:
A. A medically necessary early and periodic
				screening, diagnosis and treatment (EPSDT) service as a service necessary to
				correct or ameliorate the individual child's physical or mental condition with
				the determination made on a case-by-case basis taking into account the
				particular needs of the child.
B.
				EPSDT-eligible beneficiary as a beneficiary who meets the requirements of the
				federally mandated EPSDT program.
C. Private duty nursing (PDN) as skilled
				nursing care services for EPSDT-eligible beneficiaries who require more
				individual and continuous care than is available from a visiting nurse or
				routinely provided by the nursing staff of a hospital or skilled nursing
				facility.
D. Skilled nursing care
				as a service requiring high-level skills of a registered nurse (RN) or licensed
				practical nurse (LPN) to provide curative, restorative, and preventative care.
				These services are rendered under the supervision of an RN and according to a
				plan of care and treatment created in consultation with the beneficiary's care
				team and approved by the beneficiary's physician.
42
				  U.S.C. §
											1396d; 42 C.F.R. Part 441;
				  42 C.F.R. §
											440.80; Miss. Code Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 4 - Private Duty Nursing › Rule 23-223-4.2 - Provider Requirements

Current through June 25, 2024
A. Private duty
				nursing (PDN) providers must:
1. Have a
				Division of Medicaid approved PDN proposal package.
1. Establish a provider agreement with the
				Mississippi Division of Medicaid.
2. Satisfy all requirements in accordance
				with Part 200, Rule
				4.8 and must provide to the Division
				of Medicaid:
a) A National Provider
				Identifier (NPI) verification from National Plan and Provider Enumeration
				System (NPPES), and
b) Written
				confirmation from the Internal Revenue Service (IRS) confirming the provider's
				tax identification number and legal business name,
3. Demonstrate prior successful health care
				delivery for at least one (1) year,
4. Operate from a business office that is a
				dedicated professional location and not part of a residence,
5. Disclose ownership information,
6. Maintain auditable medical records on each
				beneficiary in the provider's business location, and
7. Maintain the highest level of ethical
				standard in its business practices and adopt written standard of ethical
				practice, which must include:
a) Neither the
				owner nor any PDN provider employee shall knowingly mislead a patient, family
				member or caretaker concerning services, charges, or use of
				equipment.
b) Neither the owner nor
				any PDN provider employee shall misuse or misappropriate any property-real or
				personal-belonging to any patient, family member or caretaker.
c) Neither the owner nor any PDN provider
				employee shall knowingly and actively recruit a patient under the care of
				another PDN provider.
d) No
				employee or patient of a PDN provider shall be coerced into participating in
				provider fund raising activities.
e) The PDN provider shall accept patient
				referrals in a professional manner with no remuneration provided to the
				referring party.
f) Patient
				clinical records, administrative records, and financial records shall not be
				falsified by any individual for any reason.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 4 - Private Duty Nursing › Rule 23-223-4.3 - Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid covers medically necessary private duty nursing (PDN) services only
				for early and periodic screening, diagnosis and treatment (EPSDT)-eligible
				beneficiaries when:
1. Ordered and directed by
				the beneficiary's primary physician or appropriate physician
				specialist.
2. Prior authorized by
				the Division of Medicaid or designee.
3. The required service(s) exceed the level
				of services provided through the home health benefit.
4. Post-acute inpatient skilled nursing care
				is not appropriate, does not meet the beneficiary's care needs, or is not
				available.
5. Provided in a setting
				in which the beneficiary's normal life activities take place.
6. All medical and home environment criteria
				are met.
7. Are directly related to
				the beneficiary's illness or disability.
8. Services can be safely provided by only
				one (1) nurse and do not require the assistance of a second
				(2nd) nurse.
9. The plan of care (POC) includes multiple
				skilled nursing functions and is not limited to just one (1) skilled nursing
				function, such as for the administration of a nasogastric or gastrostomy
				feeding.
10. The beneficiary:
a) Is medically stable to receive nursing
				care managed safely in a non-institutional setting where normal life activities
				take place,
b) Has a documented
				illness or disability of such severity and/or complexity that it requires
				prescribed care that can only be provided by an RN or LPN, and
c) Requires more individual and continuous
				care than is available from a visiting nurse through intermittent home health
				care or custodial care.
11. The home environment is conducive to
				appropriate growth and development for the beneficiary's age group and is
				conducive to the provision of appropriate medical care.
12. There must be at least one (1) parent or
				other caregiver capable of and willing to be trained to assist in the provision
				of care for the beneficiary and the parent or caregiver must:
a) Provide evidence of parental or family
				involvement, and an appropriate home situation including, but not limited to, a
				physical environment and geographic location for the beneficiary's medical
				safety.
b) Have a reasonable plan
				for an emergency situation including, but not limited to:
1) Power and equipment backup for those with
				a life-support device,
2) Access to
				a working telephone, and
3)
				Available transportation adequate to safely transport the
				beneficiary.
c) Comply
				with the plan of care, physician office appointments and/or other ancillary
				services.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 4 - Private Duty Nursing › Rule 23-223-4.4 - Prior Authorization and Concurrent Reviews

Current through June 25, 2024
A. Private
				duty nursing (PDN) providers must submit a prior authorization request to the
				Division of Medicaid or designee prior to the initiation of PDN services which
				must include, at a minimum, the following:
1.
				A signed physician or specialist's order for PDN and a signed initial Plan of
				Care (POC),
2. Beneficiary
				diagnosis(es),
3. Skilled
				teaching/instructions to be provided to a family member or
				caregiver(s),
4. Treatment
				plan/physician orders specifying each skill to be performed including whether
				the service(s) require a registered nurse (RN) or a licensed practical nurse
				(LPN),
5. Expected duration of
				service,
6. Identification of any
				other home care services, including the hours, days, and times of these
				services being provided, including, but limited to:
a) Case management,
b) Physical therapy,
c) Speech therapy,
d) Occupational therapy,
e) Respiratory therapy,
f) Respite,
g) Hospice, and/or
h) Personal care attendant.
7. When PDN medical necessity
				criteria are no longer met, a plan:
a) For
				reducing and discontinuing PDN hours, and
b) To transition the beneficiary to the most
				appropriate setting.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 4 - Private Duty Nursing › Rule 23-223-4.5 - Discontinuation of Private Duty Nursing (PDN) Services

Current through June 25, 2024
Private duty nursing (PDN) services will be discontinued when
				  one (1) or more of the following is met:
A. When all of the following exist:
1. Beneficiary's condition is clinically
				stable,
2. The licensed nurses'
				skills are not required to provide ongoing nursing assessment and/or
				treatment,
3. Beneficiary
				demonstrates the ability to carry out self-management,
4. Caregiver(s) demonstrates the ability to
				carry out management of the beneficiary's condition, and
5. When the transition is
				complete.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 4 - Private Duty Nursing › Rule 23-223-4.6 - Non-Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid does not cover private duty nursing (PDN) services solely for the
				convenience of the child, the parents or the caregiver.
B. Non-covered PDN services include, but are
				not limited to:
1. PDN services solely for:
a) Nasogastric or gastrostomy
				feedings,
b) Apnea
				monitoring,
c) Home
				dialysis,
d) Intravenous (IV)
				infusion of total parenteral nutrition (TPN) or hyperalimentation,
e) IV infusion of fluids for hydration
				or,
f) Therapy
				maintenance.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 4 - Private Duty Nursing › Rule 23-223-4.7 - Denial of Services and Appeals

Current through June 25, 2024
A. The Division of
				Medicaid or designee will issue a written denial to the private duty nursing
				(PDN) provider providing PDN services when the beneficiary no longer meets the
				medical and/or home environment criteria for PDN services.
B. The denial of services is effective thirty
				(30) days following the date the provider receives the written
				decision.
C. The beneficiary has
				the right to request an administrative hearing if he/she disagrees with the
				denial. [Refer to Miss. Admin. Code Part 300, Rule
				1.3 ]
42 C.F.R. §
											440.80; Miss. Code Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 4 - Private Duty Nursing › Rule 23-223-4.8 - Reimbursement

Current through June 25, 2024
A. The Division of Medicaid reimburses
				private duty nursing (PDN) services for a registered nurse (RN) by adding the
				Federal Insurance Contributions Act (FICA) percentage of 7.65% and an
				administrative allowance of 0.53% to the May 2018 National Bureau of Labor
				Statistics (BLS) Highest Median Hourly rate for an RN in the Memphis, TN-MS-AR
				area. An additional $17.00 per hour is added to the rate calculation for RN PDN
				ventilator services. Effective May 12, 2023, the fifteen percent (15%) increase
				previously added to the rates for Private Duty Nursing Services will remain in
				place.
B. The Division of Medicaid
				reimburses private duty nursing (PDN) services for a licensed practical nurse
				(LPN) by adding the Federal Insurance Contributions Act (FICA) percentage of
				7.65% and an administrative allowance of 16.51% to the May 2018 National Bureau
				of Labor Statistics (BLS) Highest Median Hourly rate for an LPN in the Memphis,
				TN-MS-AR area. Effective May 12, 2023, the fifteen percent (15%) increase
				previously added to the rates for Private Duty Nursing Services will remain in
				place.
C. The Division of Medicaid
				reimburses one hundred percent (100%) of the maximum allowable rate for the
				first beneficiary and fifty percent (50%) of the maximum allowable rate for the
				second beneficiary when a private duty nurse is caring for two (2)
				beneficiaries simultaneously in the same home.
Miss. Code. Ann.
				  §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 4 - Private Duty Nursing › Rule 23-223-4.9 - Documentation Requirements

Current through June 25, 2024
A. Nurses providing
				private duty nursing (PDN) services must document all nursing care rendered
				during each shift including, but not limited to:
1. Current physician's orders,
2. Medications administered and
				response,
3. Treatments
				administered and response,
4. Any
				other professional nursing skills provided during the shift,
5. Narrative skilled nursing services notes
				including accurate dates and times of services and documentation that a copy
				was given to parent and/or legal guardian or caregiver, and
6. Any significant changes in the
				beneficiary's condition,
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 5 - Personal Care Services › Rule 23-223-5.1 - Definitions

Current through June 25, 2024
The Division of Medicaid defines:
A. A medically necessary early and periodic
				screening, diagnosis and treatment (EPSDT) service as a service necessary to
				correct or ameliorate the individual child's physical or mental condition with
				the determination made on a case-by-case basis taking into account the
				particular needs of the child.
B.
				EPSDT-eligible beneficiary as a beneficiary who meets the requirements of the
				federally mandated EPSDT program.
C. Personal care services (PCS) as medically
				necessary personal care services for EPSDT-eligible beneficiaries who require
				assistance in order to safely perform the activities of daily living (ADLs) due
				to a diagnosed condition, disability, or injury. The delivery and receipt of
				these services must be medically necessary for the treatment of the
				beneficiary's condition, disability, or injury and exceed the level of care
				available through the home health benefit..
D. Certified Nurse Assistant (CNA) as an
				individual who obtained certification through a program approved by the
				Mississippi Department of Health, Licensure and Certification. CNAs are the
				only individuals who may render personal care services. These services must be
				delivered under the supervision of a registered nurse (RN) pursuant to the plan
				of treatment established in consultation with appropriate members of the care
				team under the direction of the beneficiary's physician.
42
				  U.S.C. §
											1396d; 42 C.F.R. Part 441;
				  42 C.F.R. §
											440.167; Miss. Code Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 5 - Personal Care Services › Rule 23-223-5.2 - Provider Requirements

Current through June 25, 2024
A. Certified
				Nursing Assistants (CNAs) providing personal care services (PCS) must be hired
				and managed by private duty nursing (PDN) providers. PDN providers employing
				CNAs must:
1. Enter into a provider agreement
				with the Mississippi Division of Medicaid.
2. Satisfy all requirements set forth in Part
				200, Rule
				4.8 and must provide to the Division
				of Medicaid:
a) A National Provider
				Identifier (NPI) verification from National Plan and Provider Enumeration
				System (NPPES), and
b) Written
				confirmation from the Internal Revenue Service (IRS) confirming the provider's
				tax identification number and legal business name,
3. Demonstrate prior successful health care
				delivery for at least one (1) year,
4. Operate from a business office that is a
				dedicated professional location and not part of a residence,
5. Disclose ownership information,
				and
6. Maintain auditable medical
				records on each beneficiary in the provider's business location.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 5 - Personal Care Services › Rule 23-223-5.3 - Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid covers medically necessary personal care services (PCS) only for early
				and periodic screening, diagnosis and treatment (EPSDT)-eligible beneficiaries
				when:
1. Ordered and directed by the
				beneficiary's primary physician or appropriate physician specialist.
2. Prior authorized by the Division of
				Medicaid or designee.
3. The
				required service(s) exceed the level of services provided through the home
				health benefit.
4. Provided in a
				setting in which the beneficiary's normal life activities take place.
5. All medical and home environment criteria
				are met.
6. Are directly related to
				the beneficiary's illness or disability.
7. Services can be safely provided by only
				one (1) Certified Nursing Assistant (CNA) and do not require the assistance of
				a second (2nd) CNA.
8. The beneficiary:
a) Is medically stable to receive PCS managed
				safely in a non-institutional setting where normal life activities take
				place,
b) Has a documented illness
				or disability that requires the assistance of a CNA in order to safely perform
				activities of daily living, and
c)
				Requires more individual and continuous care than is available from a visiting
				CNA through intermittent home health care.
9. The home environment is conducive to
				appropriate growth and development for the beneficiary's age group and be
				conducive to the provision of appropriate medical care.
10. There must be at least one (1) parent or
				other caregiver capable of and willing to be trained to assist in the provision
				of care for the beneficiary and the parent or caregiver must:
a) Provide evidence of parental or family
				involvement and an appropriate home situation including, but not limited to, a
				physical environment and geographic location for the beneficiary's medical
				safety.
b) Have a reasonable plan
				for an emergency situation including, but not limited to:
1) Power and equipment backup for equipment
				necessary to the medical care of the beneficiary,
2) Access to a working telephone,
				and
3) Available transportation
				adequate to safely transport the beneficiary.
c) Comply with the plan of care, physician
				office appointments and/or other ancillary services.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 5 - Personal Care Services › Rule 23-223-5.4 - Prior Authorization and Concurrent Reviews

Current through June 25, 2024
A. Private
				duty nursing (PDN) providers employing Certified Nursing Assistants (CNAs) must
				submit a prior authorization request to the Division of Medicaid or designee at
				least two (2) weeks prior to the initiation of personal care services (PCS)
				that must include, at a minimum, the following:
1. A signed physician or specialist's order
				for PCS and a signed initial Plan of Care (POC),
2. Beneficiary diagnosis(es),
3. Skilled teaching/instructions to be
				provided to a family member or caregiver(s),
4. Treatment plan/physician orders specifying
				each skill to be performed,
5.
				Expected duration of service,
6.
				Identification of any other home care services, including the hours, days, and
				times of these services being provided, including, but limited to:
a) Case management,
b) Physical therapy,
c) Speech therapy,
d) Occupational therapy,
e) Respiratory therapy,
f) Respite,
g) Hospice, and/or
h) Private duty nursing.
7. When PCS medical necessity criteria are no
				longer met, a plan:
a) For reducing and
				discontinuing PCS hours, and
b) To
				transition the beneficiary to the most appropriate setting.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 5 - Personal Care Services › Rule 23-223-5.5 - Discontinuation of Personal Care Services (PCS)

Current through June 25, 2024
Personal care services (PCS) will be discontinued when one
				  (1) or more of the following is met:
A. When all of the following exist:
1. Beneficiary's condition is clinically
				stable,
2. The Certified Nursing
				Assistant (CNA) skills are not required to provide assistance with activities
				of daily living,
3. Beneficiary
				demonstrates the ability to carry out self-management,
4. Caregiver(s) demonstrates the ability to
				carry out management of the beneficiary's condition, and
5. When the transition is complete.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 5 - Personal Care Services › Rule 23-223-5.6 - Non-Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid does not cover personal care services (PCS) solely for the convenience
				of the child, the parents or the caregiver.
B. Non-covered PCS include, but are not
				limited to:
1. Skilled nursing services
				including, but not limited to:
a) Nasogastric
				or gastrostomy feedings,
b) Apnea
				monitoring,
c) Home
				dialysis,
d) Intravenous (IV)
				infusion of total parenteral nutrition (TPN) or hyperalimentation,
e) IV infusion of fluids for
				hydration
f) Medication
				administration, and/or
g)
				Tracheostomy care.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 5 - Personal Care Services › Rule 23-223-5.7 - Denial of Services and Appeals

Current through June 25, 2024
A. The Division of
				Medicaid or designee will issue a written denial to the private duty nursing
				(PDN) provider employing the Certified Nursing Assistant (CNA) when the
				beneficiary no longer meets the medical and/or home environment criteria for
				personal care services.
B. The
				denial of services is effective thirty (30) days following the date the
				provider receives the written decision.
C. The beneficiary has the right to request
				an administrative hearing if he/she disagrees with the denial. [Refer to Miss.
				Admin. Code Part 300, Rule
				1.3 ]
Miss. Code Ann.
				  §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 5 - Personal Care Services › Rule 23-223-5.8 - Reimbursement

Current through June 25, 2024
The Division of Medicaid reimburses personal care services
				  (PCS) for a certified nursing assistant (CNA) by adding the Federal Insurance
				  Contributions Act (FICA) percentage of 7.65% and an administrative allowance of
				  21.35% to the May 2018 National Bureau of Labor Statistics (BLS) Mean Hourly
				  rate for a CNA in the Memphis, TN-MS-AR.
Miss. Code.
				  Ann. §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 5 - Personal Care Services › Rule 23-223-5.9 - Documentation Requirements

Current through June 25, 2024
A. Certified
				Nursing Assistants (CNAs) providing personal care services (PCS) must document
				all care rendered during each shift including, but not limited to:
1. Assistance with activities of daily living
				(ADL), and
2. Any significant
				changes in the beneficiary's condition.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 6 - Expanded Rehabilitative Services › Rule 23-223-6.1 - Definitions

Current through June 25, 2024
A. The Division of Medicaid defines:
1. Clinical/medical case record as the
				central repository of all pertinent information about the beneficiary that
				provides an accurate chronological accounting of the treatment plan and
				progress.
2. Day treatment as a
				behavioral intervention and strengths-based program, provided in the context of
				a therapeutic milieu, which enables beneficiaries between the ages of three (3)
				and twenty-one (21) with serious emotional disturbances or autism/Asperger's
				syndrome to live in the community.
3. A developmental evaluation as an
				assessment by a licensed practitioner utilizing standardized developmental
				instruments of the current cognitive, social and motor function of
				beneficiaries younger than three (3) years of age or beneficiaries with such
				severe mental or physical disabilities that a standardized intellectual
				assessment is not possible.
4.
				Duplication of services as the provision of the same service to the same
				beneficiary by the same or different provider on the same day.
5. A neuropsychological evaluation as a
				performance-based method to assess cognitive functioning which includes the
				collection of diagnostic information, differential diagnostic information,
				assessment of treatment response, and prediction of functional potential and
				recovery potential.
6. Wraparound
				facilitation as a targeted case management program that includes the creation
				and facilitation of a child/youth and family team for the purpose of developing
				a single care plan to address the needs of children/youth who require the level
				of care provided in a Psychiatric Residential Treatment Facility
				(PRTF).
7. Mississippi Youth
				Programs Around the Clock (MYPAC) Therapeutic services as a community
				psychiatric support treatment program provided in the home or community, to
				Early and Periodic Screening, Diagnosis and Treatment (EPSDT) eligible
				beneficiaries that require the level of care provided in a psychiatric
				residential treatment facility (PRTF), for family stabilization to empower the
				beneficiary to achieve the highest level of functioning. These are a group of
				therapeutic interventions designed to diffuse the current crisis, evaluate its
				cause, and intervene to reduce the likelihood of a recurrence.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 6 - Expanded Rehabilitative Services › Rule 23-223-6.2 - Provider Requirements

Current through June 25, 2024
A. Providers of Early and Periodic Screening,
				Diagnosis and Treatment (EPSDT) Rehabilitative Services must comply with the
				provider requirements described in Miss. Admin. Code Title 23, Part 206, Rule
				1.1.
B. Providers employing any evidence-based
				practices (EBP) in the course of treatment must have completed the appropriate
				training for the specific EBP.
C.
				Wraparound facilitators must be certified by the Mississippi Department of
				Mental Health (DMH) and comply with the DMH Operational Standards for Mental
				Health, Intellectual/Developmental Disabilities and Substance Use Community
				Service Providers established for Wraparound service provision.
D. MYPAC therapeutic services must be
				provided by a Mississippi Department of Mental Health certified provider within
				the scope of their license and/or certification and comply with the DMH
				Operational Standards for Mental Health, Intellectual/Development Disabilities,
				and Substance Use Community Service Providers established for MYPAC service
				provision.
42 C.F.R. §§
											440.130,
				  441.57; Miss. Code Ann.
				  §§
										43-13-117,
				  43-13-121; SPA
				  20-0022.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 6 - Expanded Rehabilitative Services › Rule 23-223-6.3 - Covered Services

Current through June 25, 2024
A. All State Plan services described in Miss.
				Admin. Code Part 206 and Part 223 are covered for Early and Periodic Screening,
				Diagnosis, and Treatment (EPSDT)-eligible beneficiaries without regard to
				service limits when prior authorized by the Utilization Management/Quality
				Improvement Organization (UM/QIO).
B. The Division of Medicaid covers
				neuropsychological evaluations for EPSDT-eligible beneficiaries when medically
				necessary, prior authorized by a UM/QIO, the Division of Medicaid or designee
				and conducted by a psychologist trained to administer, score and interpret
				neuropsychological instruments, and one (1) or more of the following apply:
1. Other interventions have been unsuccessful
				with the beneficiary,
2. Previous
				psychological evaluation indicates neuropsychological deficits and supports
				justification,
3. The beneficiary
				displays evidence of cognitive deficits or brain injury, or
4. Results are used in treatment planning and
				placement decisions.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 6 - Expanded Rehabilitative Services › Rule 23-223-6.4 - Non-Covered Services

Current through June 25, 2024
A. The Division of Medicaid does not cover:
1. Educational interventions of an academic
				nature performed by the Department of Education,
2. Same service provided on the same date,
				regardless of the setting(s) in which the service was provided unless service
				specifically states otherwise.
3.
				Community-based mental health services when a beneficiary is an inpatient of a
				Medicaid-covered facility except for targeted case management services,
				including wraparound services, provided up to thirty (30) days of a covered
				stay in a medical institution for EPSDT-eligible beneficiaries with a serious
				emotional disturbance (SED) that meet the level of care provided in a
				psychiatric residential treatment facility (PRTF),
4. Time spent on documentation, unless
				completed during the session and relevant to the treatment goals,
5. Time spent completing a care plan form or
				prior authorization request online via web portal,
6. Staff travel time,
7. Field trips and routine recreational
				activities,
8. Beneficiary travel
				time to and from any service, or
9.
				Services provided to more than one (1) beneficiary at a time, unless
				specifically allowed in the service definition.
10. Wraparound facilitation for more than one
				family member at a time.
11. Case
				management components provided or billed as part of a direct care service,
				including but not limited to:
a) Assisting a
				person in accessing needed services such as medical, social, educational,
				transportation, housing, substance use, personal care, employment and other
				services that may be identified in the Recovery Support Plan as components of
				Health, Home, Purpose and Community,
b) Assisting the person and natural supports
				in implementation of therapeutic interventions outlined in the Individual
				Service Plan, or
c) Psychoeducation
				and training of family, unpaid caregivers, and/or others who have a legitimate
				role in addressing the needs of the person.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 6 - Expanded Rehabilitative Services › Rule 23-223-6.5 - Reimbursement

Current through June 25, 2024
A. The Division of Medicaid reimburses
				expanded rehabilitative services based on a statewide uniform fee
				schedule.
B. The Division of
				Medicaid does not reimburse for the duplication of services.
1. Providers are responsible for coordinating
				services with the beneficiary and guardian/legal representative to avoid
				service duplication when the beneficiary is receiving mental health services at
				more than one (1) location from more than one (1) provider.
2. When duplicate service claims are filed
				the provider billing the first claim is reimbursed.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) › Chapter 6 - Expanded Rehabilitative Services › Rule 23-223-6.6 - Documentation

Current through June 25, 2024
A. The medical record must be in compliance
				with Miss. Admin. Code Part 200, Rule
				1.3 and include the following
				documentation:
1. Consent for treatment
				obtained yearly,
2. Date of
				service,
3. Type of service
				provided,
4. Time session began and
				time session ended,
5. Length of
				time spent delivering the service,
6. Identification of individual(s) receiving
				or participating in the service,
7.
				Summary of what transpired in the session,
8. Treatment Plan reviewed and revised as
				needed every six (6) months or as medically indicated,
9. Evidence that the session relates to the
				goals and objectives established in the treatment plan,
10. Name, title, and signature of the
				servicing provider providing the service,
11. Name, title, and signature of the
				individual who documented the services, and
12. All documentation must be legible, easily
				read and clearly understood.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 224 - Immunizations › Chapter 1 - General › Rule 23-224-1.1 - Definitions

Current through June 25, 2024
The Division of Medicaid defines:
A. Centers for Disease Control and Prevention
				(CDC) as the nation's public health protection agency with the authority to
				implement regulations related to protecting America from health and safety
				threats, both foreign and within the United States, and increasing public
				health security.
B. The Advisory
				Committee for Immunization Practices (ACIP) as a committee of medical and
				public health experts who develop recommendations on the use of vaccines in the
				civilian population of the United States whose recommendations stand as public
				health guidance for safe use of vaccines and related biological
				products.
C. The Vaccines for
				Children (VFC) Program as a federally funded program that provides vaccines at
				no cost to Mississippi Medicaid providers enrolled as VFC providers. The
				Mississippi State Department of Health (MSDH) is the lead agency in
				administering the VFC Program and distributing the vaccines to VFC enrolled
				providers allowing for eligible children eighteen (18) years of age and younger
				to receive free vaccines.
42 U.S.C.
				  §§
											1396 s, 300aa-26; Miss. Code
				  Ann. §§
										41-23-37,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 224 - Immunizations › Chapter 1 - General › Rule 23-224-1.2 - Provider Requirements

Current through June 25, 2024
A. Providers must
				satisfy all requirements set forth in Part 200, Rule 4.8 in addition to the
				following:
1. National Provider Identifier
				(NPI), verification from National Plan and Provider Enumeration System
				(NPPES).
2. Written confirmation
				from the Internal Revenue Service (IRS) confirming the provider's tax
				identification number and legal business name.
3. A copy of the provider's current Medicare
				certification or Tie-In Notice from the Medicare Intermediary, if applicable.
				An Explanation of Medicare Benefits (EOMB) is not acceptable.
4. A copy of the provider's current license,
				permit or certification.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 224 - Immunizations › Chapter 1 - General › Rule 23-224-1.3 - Covered Services

Current through June 25, 2024
The Division of Medicaid covers vaccines according to the
				  indications and guidelines of the Centers for Disease Control and Prevention
				  (CDC) administered to beneficiaries:
A.
				Eighteen (18) years of age and younger when administered by physician and
				non-physician practitioner providers enrolled as a Vaccine for Children (VFC)
				provider through the medical benefit.
B. Eighteen (18) years of age and younger who
				are pregnant or postpartum receiving the Tdap vaccine when administered by an
				obstetrician regardless of VFC enrollment through the medical
				benefit.
C. Ten (10) to eighteen
				(18) years of age when administered by a pharmacist employed by a pharmacy
				provider enrolled as a VFC provider through the point-of-sale pharmacy billing
				venue.
D. Nineteen (19) years of
				age and older when administered by a physician or non-physician practitioner or
				a pharmacist who is employed by a pharmacy provider through the medical and
				point-of-sale pharmacy billing venue.
E. Of any age, for vaccines not listed on the
				CDC recommended Immunization Schedules required for travel outside of the
				United States, with prior authorization.
42 USC §§
											1396 s, 300aa-26; Miss. Code Ann.
				  §§
										41-23-37,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 224 - Immunizations › Chapter 1 - General › Rule 23-224-1.4 - Non-Covered Services

Current through June 25, 2024
The Division of Medicaid does not cover the administration of
				  additional components in a combination vaccine separately if ACIP recommends a
				  combination vaccine available through the VFC program.
42 USC §
											300aa-26; Miss. Code Ann.
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 224 - Immunizations › Chapter 1 - General › Rule 23-224-1.5 - Reimbursement

Current through June 25, 2024
A. The Division of Medicaid reimburses the
				lessor of the provider's usual and customary charge or a fee from the
				Mississippi Medicaid fee schedule.
1.
				Physicians, nurse practitioners, and physician assistants:
a For vaccines available through the VFC
				program administered to beneficiaries eighteen (18) years of age and younger by
				VFC enrolled providers:
(1) The administration
				fee for each single or combination vaccine administered.
(2) No additional reimbursement for the cost
				of the vaccine.
(3) An
				administration fee in addition to an Early and Periodic Screening, Diagnosis
				and Treatment (EPSDT) visit or physician office visit only when a separately
				identifiable service is provided at the time of the vaccine
				administration.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 224 - Immunizations › Chapter 1 - General › Rule 23-224-1.6 - Documentation

Current through June 25, 2024
Providers administering vaccines must document the following
				  in addition to other documentation required by other federal and state
				  regulatory agencies:
A. The date the
				beneficiary, or parent or legal representative if the beneficiary is a minor,
				received a current copy of the relevant federal Vaccine Information Statement
				(VIS) for each vaccine prior to the administration and confirmation that the
				beneficiary was given an opportunity to discuss concerns,
B. The date of publication of the
				VIS,
C. The date the vaccination
				was given,
D. The vaccine
				manufacturer and lot number of the vaccine administered,
E. The signature and title of the individual
				who administered the vaccine, and
F. Any adverse events that occurred after
				vaccination.
42 USC §§
											1396 s, 300aa-26; Miss. Code Ann.
				  §§
										43-13-117,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 224 - Immunizations › Chapter 1 - General › Rule 23-224-1.7 - Vaccines Available Through the Pharmacy Venue

Current through June 25, 2024
A. The
				Division of Medicaid covers the following vaccines according to the indications
				and guidelines of the Centers for Disease Control and Prevention (CDC) for
				beneficiaries nineteen (19) years of age and older through the pharmacy
				program:
1. Influenza,
2. Pneumococcal,
3. Herpes Zoster, and
4. Varicella.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 225 - Telemedicine › Chapter 1 - Telehealth Services › Rule 23-225-1.1 - Definitions

Current through June 25, 2024
The Division of Medicaid defines telemedicine as a method
				  which uses electronic information and communication equipment to supply and
				  support health care when remoteness disconnects patients and links primary care
				  physicians, specialists, providers, and beneficiaries which includes, but is
				  not limited to, telehealth services, remote patient monitoring services,
				  teleradiology services, store-and-forward and continuous glucose monitoring
				  services.
A. The Division of Medicaid
				defines telehealth services as the delivery of health care by an enrolled
				Mississippi Medicaid provider, through a real-time communication method, to a
				beneficiary who is located at a different site. The interaction must be:
1. Live,
2. Interactive, and
3. Audiovisual.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 225 - Telemedicine › Chapter 1 - Telehealth Services › Rule 23-225-1.2 - Provider Enrollment

Current through June 25, 2024
A. Providers of
				telehealth services must comply with all requirements set forth in Miss. Admin.
				Code Part 200, Rule 4.8 for all providers in addition to the provider specific
				requirements below:
1. National Provider
				Identifier (NPI), verification from National Plan and Provider Enumeration
				System (NPPES),
2. Copy of current
				licensure card or permit, and
3.
				Verification of social security number using a social security card, military
				ID or a notarized statement signed by the provider noting the social security
				number. The name noted on the verification must match the name noted on the
				W-9.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 225 - Telemedicine › Chapter 1 - Telehealth Services › Rule 23-225-1.3 - Covered Services

Current through June 25, 2024
A. The Division of
				Medicaid covers medically necessary telehealth services as a substitution for
				an in-person visit for consultations, office visits, and/or outpatient visits
				when all the required medically appropriate criteria is met which aligns with
				the description of the Current Procedural Terminology (CPT) evaluation and
				management (E&M) and Healthcare Common Procedure Coding System (HCPCS)
				guidelines.
B. The Division of
				Medicaid covers telehealth services at the following locations:
1. At the following originating sites:
a) Office of a physician or
				practitioner,
b) Outpatient
				Hospital (including a Critical Access Hospital (CAH)),
c) Rural Health Clinic (RHC),
d) Federally Qualified Health Center
				(FQHC),
e) Community Mental
				Health/Private Mental Health Centers,
f) Therapeutic Group Homes,
g) Indian Health Service Clinic,
h) School-based clinic,
i) School which employs a school
				nurse,
j) Inpatient hospital
				setting, or
k) Beneficiary's
				home.