reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 5 - Chiropractor › Rule 23-203-5.4 - Dual Eligibles

Current through June 25, 2024
A. For
				beneficiaries covered under Medicare and Mississippi Medicaid (dual eligibles),
				chiropractic providers must not file a claim with Medicaid for the manipulation
				of the spine procedures not covered by Medicare. Mississippi Medicaid benefits
				are not available for services that do not satisfy Medicare's medical necessity
				criteria.
B. For beneficiaries
				covered under Medicare and Medicaid (dual eligibles), chiropractic providers
				may file a claim with Medicaid for those specified codes not covered by
				Medicare.
C. The six (6) month
				timely filing limitation for filing crossover claims is applicable with no
				exceptions.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 5 - Chiropractor › Rule 23-203-5.5 - Documentation Requirements

Current through June 25, 2024
The chiropractor must maintain auditable records that
				  substantiate the services provided. At a minimum, the records must contain the
				  following on each patient:
A. The dates
				of services provided.
B. The
				patient's presenting complaint.
C.
				Date of the x-ray which must be within twelve (12) months of the date of
				service.
D. Expected date of
				delivery if the patient is pregnant.
E. Date of last menstrual period if a
				pregnancy is suspected but not confirmed.
F. Child's date of birth when the child is
				twelve (12) years of age or less. (The x-ray is at the discretion of the
				chiropractor).
G. The
				results/findings of all diagnostic studies.
H. The patient's history and physical
				findings.
I. The treatment
				rendered, including:
1. Frequency,
2. Proposed length,
3. Progress, and
4. Prognosis.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 5 - Chiropractor › Rule 23-203-5.6 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Current through June 25, 2024
The Division of Medicaid pays for all medically necessary
				  services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title
				  23, without regard to service limitations and with prior
				  authorization.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 6 - Podiatry › Rule 23-203-6.1 - Covered Services

Current through June 25, 2024
Medicaid covers the following podiatry services:
A. Laboratory services required for care of a
				systemic condition are covered only to the MD/DO supervising the systemic
				condition or to a laboratory to which the MD/DO has referred the
				specimen.
B. Physical therapy
				services that are medically necessary and appropriate for the treatment of the
				foot condition.
C. Radiology
				services provided in an office setting that are medically necessary and include
				both the technical and professional components of the service if
				provided.
D. Foot care required as
				a result of or associated with systemic conditions limited to once every sixty
				(60) days.
E. Surgical treatment of
				ingrown toenails. Localized pathology of the soft tissue surrounding the nail
				must demonstrate that it is severe enough to require professional
				intervention.
F. Debridement if
				gross contamination requires prolonged cleansing.
G. Surgical debridement of mycotic nails with
				a manual or electric grinder method if the following conditions exists:
1. Clinical evidence of mycosis of the
				toenail.
2. Documentation of the
				severity of the condition and if patient ambulatory have marked limitation of
				ambulation, pain or secondary infection resulting from the thickening and
				dystrophy of the infected toenail plate and for non-ambulatory patients must
				suffer pain or secondary infection resulting from the thickening and dystrophy
				of the infected toenail plate.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 6 - Podiatry › Rule 23-203-6.2 - Non-covered services

Current through June 25, 2024
Medicaid does not cover the following:
A. Identification of culture of fungi in the
				toenail clippings is not covered.
A. Local anesthesia, digital blocks, or
				topical anesthesia done with a specific surgical procedure.
C. Cast applications/strapping/splinting
				charged separately from the initial surgery or fracture care on same day as
				initial surgery or fracture care.
D. Removal of casts/straps/splints.
E. Ultrasound on patients with
				diabetes.
F. Foot
				massage.
G. Whirlpool for mycotic
				nail treatment. H. Surgical trays.
I. Supplies.
J. Biopsies performed in conjunction with a
				surgical procedure.
K. Services for
				treatment of flat foot.
L. Services
				not medically necessary for the diagnosis and treatment of the condition of the
				foot.
M. Laboratory services
				performed by the DPM (Doctor of Podiatric Medicine) or referred to an
				independent laboratory by the DPM.
N. Services performed for conditions above
				the ankle unless within the scope of the podiatrist license.
O. Office visits with routine foot care
				procedures.
P. Routine foot
				examinations on all patients in a skilled nursing facility on a routine basis
				for screening purposes.
Q.
				Orthopedic shoes, any other type shoe, and/or supportive devices.
R. Routine foot care with debridement of
				nails on same date of service. Routine foot care may not be substituted for
				debridement of nails when the once every sixty day limit has been
				utilized.
S. Doppler (other than
				hand held Doppler), non-vascular diagnostic testing pertaining to a systemic
				disease.
T. Evaluation and advice
				for proper care of feet when the only service rendered for the management of
				paronychia. Debridement and avulsion may not be done on the same date of
				service.
U. Surgical or nonsurgical
				treatments provided for the sole purpose of correcting a subluxated structure
				in the foot as an isolate entity.
V. Palliative treatment of viral or plantar
				warts.
W. Routine foot care, in the
				absence of systemic conditions, including the following:
1. The cutting or removal or corns or
				calluses,
2. The trimming of nails,
				including the cutting, clipping, or debridement of ingrown toenails, club
				nails, or mycotic nails,
3. Fungal
				infections of the nail plates or mycotic nails with little or no
				symptomatology,
4. Avulsing small
				chips after trimming of the thickened/elongated nails that are painful, under
				the diagnosis of ingrown toenail,
5. Other hygienic and preventive maintenance
				care and any other service provided in the absence of localized illness,
				injury, or symptoms involving the foot, or
6. Routine soaking and application of topical
				medication.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 6 - Podiatry › Rule 23-203-6.3 - Anesthesia

Current through June 25, 2024
A. Medicaid does not cover local
				infiltration, metacarpal/ metatarsal/ digital blocks, or topical anesthesia
				outside the specific surgical procedure performed.
B. Medicaid covers the cost of drugs used for
				IV sedation and must be billed with the appropriate HCPCS code
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 6 - Podiatry › Rule 23-203-6.5 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Current through June 25, 2024
The Division of Medicaid pays for all medically necessary
				  services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title
				  23, without regard to service limitations and with prior
				  authorization.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 7 - Nurse Practitioner › Rule 23-203-7.1 - Provider Enrollment

Current through June 25, 2024
A. Advanced
				Practice Registered Nurses (APRNs), also referred to as Nurse Practitioners
				(NPs), certified by the state in which they practice may participate in the
				Mississippi Medicaid Program upon compliance with provider enrollment
				requirements outlined in Part 200, Chapter 4, Rule
				4.8 in addition to providing the
				following:
1. National Provider Identifier
				(NPI), verification from National Plan and Provider Enumeration System (NPPES),
2. Copy of current licensure card,
3. Verification of social security
				number using a social security card, driver's license if it notes the social
				security number, military ID or a notarized statement signed by the provider
				noting the social security number. The name noted on verification must match
				the name noted on the W-9,
4. Copy
				of the NP's approved protocol and practice setting or the regulation allowing
				independent practice if the state in which the NP practices does not require
				physician collaboration or supervision,
5. The name and Medicaid number of the NP's
				collaborating physician, and
6.
				Copy of specialty certificate(s), if applicable.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 7 - Nurse Practitioner › Rule 23-203-7.2 - Nurse Practitioner Services and Reimbursement

Current through June 25, 2024
A.
				The Division of Medicaid covers services provided by Advanced Practice
				Registered Nurses (APRNs), also referred to as Nurse Practitioners (NPs),
				certified by the state in which they practice, for services rendered within the
				scope of practice allowed by their protocol.
B. NPs must bill the appropriate Current
				Procedure Terminology (CPT) code for services rendered and follow the same
				rules and guidelines as physician services.
C. The Division of Medicaid reimburses NPs at
				ninety percent (90%) of the physician fee for the service.
D. The Division of Medicaid does not
				reimburse for:
1. An NP as an assistant
				surgeon,
2. Multiple providers
				when a service is performed simultaneously with another provider, or
3. NP services if the collaborating physician
				is not a Mississippi Medicaid enrolled provider or an Ordering, Referring or
				Prescribing (ORP) physician.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 7 - Nurse Practitioner › Rule 23-203-7.3 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Current through June 25, 2024
The Division of Medicaid pays for all medically necessary
				  services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title
				  23, without regard to service limitations and with prior
				  authorization.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 8 - Physician Assistant › Rule 23-203-8.1 - Physician Assistant Enrollment Requirements

Current through June 25, 2024
A. Physician
				assistants (PAs), who are licensed by the Mississippi State Board of Medical
				Licensure, and are practicing with physician supervision under regulations
				adopted by the board, may participate in the Mississippi Medicaid Program upon
				compliance with provider enrollment requirements outlined in Part 200, Chapter
				4, Rule
				4.8 in addition to providing the
				following:
1. National Provider Identifier
				(NPI), verification from National Plan and Provider Enumeration System (NPPES),
2. Copy of current licensure card,
3. Verification of social security
				number using a social security card or driver's license if it notes the social
				security number, military ID or a notarized statement signed by the provider
				noting the social security number. The name noted on verification must match
				the name noted on the W-9,
4. Copy
				of approved protocol and practice setting,
5. The name and Mississippi Medicaid provider
				number of the PA's supervising physician, and
6. Copy of specialty certificate(s), if
				applicable.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 8 - Physician Assistant › Rule 23-203-8.2 - Physician Assistant Services and Reimbursement

Current through June 25, 2024
A.
				Physician assistants (PAs) may bill the Division of Medicaid for the covered
				services within the scope of practice allowed by their protocol.
B. PAs must bill the appropriate Current
				Procedure Terminology (CPT) code for services rendered and follow the same
				rules and guidelines as physician services.
C. The Division of Medicaid reimburses PAs at
				ninety percent (90%) of the physician fee for the service.
D. The Division of Medicaid does not
				reimburse for:
1. A PA as an assistant
				surgeon,
2. Multiple providers
				when a service(s) is (are) performed simultaneously with another provider, or
3. PA services if the supervising
				physician is not a Mississippi Medicaid enrolled provider or an Ordering,
				Referring or Prescribing (ORP) physician.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 8 - Physician Assistant › Rule 23-203-8.3 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Current through June 25, 2024
The Division of Medicaid pays for all medically necessary
				  services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title
				  23, without regard to service limitations and with prior
				  authorization.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 9 - Psychiatric Services › Rule 23-203-9.1 - Provider Qualifications

Current through June 25, 2024
Psychiatric services described in this chapter must be
				  provided by a licensed physician (medical doctor or doctor of osteopathy) who
				  is board-certified in psychiatry or by a licensed Psychiatric Mental Health
				  Nurse Practitioner (PMHNP). Rules included in this chapter do not apply to
				  psychologists.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 9 - Psychiatric Services › Rule 23-203-9.2 - General Requirements

Current through June 25, 2024
A. All services
				must be personally and directly provided by the psychiatrist or PMHNP who
				requests reimbursement for the service.
B. Services must be based on beneficiary need
				and not the convenience of the beneficiary, the beneficiary's family or the
				provider.
C. A provider may bill
				only for the actual time spent in service delivery.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 9 - Psychiatric Services › Rule 23-203-9.3 - Covered Services

Current through June 25, 2024
The following psychiatric services are eligible for
				  reimbursement by Medicaid only when they have been personally and directly
				  provided by a licensed physician (medical doctor or doctor of osteopathy) who
				  is board-certified in psychiatry or by a licensed Psychiatric Mental Health
				  Nurse Practitioner (PMHNP):
A.
				Evaluative Services which include a psychiatric interview ok an interactive
				psychiatric interview.
B.
				Therapeutic Services which include individual, family, and group
				psychotherapy.
C. Other psychiatric
				services/procedures including
1. Medication
				evaluation, and
2.
				Electroconvulsive therapy.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 9 - Psychiatric Services › Rule 23-203-9.4 - Non-Covered Services

Current through June 25, 2024
A. Services are not
				eligible for reimbursement unless they are personally and directly provided by
				the servicing provider.
B.
				Educational interventions of an academic nature are not eligible for Medicaid
				reimbursement.
C. Medicaid will not
				reimburse more than once for the same service provided to any beneficiary on
				any given date, regardless of the setting(s) in which the service was provided.
				It is the provider's responsibility to coordinate services with the beneficiary
				and/or his/her family member to insure that services are not
				duplicated.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 9 - Psychiatric Services › Rule 23-203-9.5 - Service Limits

Current through June 25, 2024
A. The Division of
				Medicaid defines service limits as the maximum quantity of services per
				beneficiary that are eligible for reimbursement by the Division of Medicaid
				within a given time frame, either daily or yearly.
B. Daily service limits apply to
				beneficiaries, regardless of the setting, hospital/residential or
				community-based, in which the services are provided.
C. The following yearly service limits apply
				to non-EPSDT-eligible beneficiaries:
1. The
				Division of Medicaid covers a combined total of sixteen (16) psychiatric
				physician office and hospital outpatient department visits per state fiscal
				year (July 1-June 30). [Refer to Miss. Admin. Code, Part 200, Rule 9.5 for
				non-psychiatric physician office and hospital outpatient department
				visits.]
2. Hospital Inpatient
				Services
a) Inpatient hospital psychiatric
				services are reimbursed under the APR-DRG methodology and are available only if
				the services are determined to be medically necessary by the Utilization
				Management/Quality Improvement Organization (UM/QIO). Day outlier payments may
				be made for mental health long lengths of stay for exceptionally expensive
				cases.
b) Prior authorization is
				required upon admission and for lengths of stay greater than nineteen (19)
				days.
c) One (1) covered
				psychiatric service/procedure is eligible for reimbursement per beneficiary per
				certified day in a general hospital or acute freestanding psychiatric
				facility.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 9 - Psychiatric Services › Rule 23-203-9.6 - Documentation

Current through June 25, 2024
A. Physicians are required to maintain
				auditable records that will verify any or all services provided and billed
				under the Medicaid program.
1. Records must,
				be made available to representatives of the Division of Medicaid or Office of
				the Attorney General in substantiation of claims.
2. Records must be maintained for a minimum
				of five (5) years in order to comply with all state and federal regulations and
				laws. Refer to Maintenance of Records Part 200, Chapter 1, Rule 1.3.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 9 - Psychiatric Services › Rule 23-203-9.7 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Current through June 25, 2024
The Division of Medicaid pays for all medically necessary
				  services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title
				  23, without regard to service limitations and with prior
				  authorization.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 203 - Physician Services › Chapter 10 - Implantable Medical Devices › Rule 23-203-10.1 - Skin and Soft Tissue Substitutes

Current through June 25, 2024
A. The Division of
				Medicaid defines skin and soft tissue substitutes as types of wound coverage
				materials composed of human tissue, non-human tissue, synthetic materials, or a
				composite of these materials which mimic or substitute for some aspect of the
				skin's structure, either permanently or temporarily, for the treatment of acute
				and chronic non-healing wounds and soft tissue grafting.
B. The Division of Medicaid covers skin and
				soft tissue substitute procedures, products, and services for medically
				accepted conditions and indications approved by the Food and Drug
				Administration (FDA) when medically necessary and when the procedures,
				products, and services are:
1. Individualized,
				specific, and consistent with symptoms or confirmed diagnosis of the illness or
				injury under treatment, and not in excess of the beneficiary's needs,
2. Safely applied within the scope of FDA
				indications and according to manufacturer's instructions, and
3. No equally effective or more conservative
				or less costly treatment is available statewide.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.1 - Dental Programs

Current through June 25, 2024
The Division of Medicaid is authorized to furnish:
A. Dental care that is an adjunct to
				treatment of an acute medical or surgical condition,
B. Services of oral surgeons and dentists in
				connection with surgery related to the jaw or any structure contiguous to the
				jaw or the reduction of any fracture of the jaw or any facial bone,
				and
C. Emergency dental extractions
				and treatment related thereto. Medicaid defines a dental emergency as a
				condition that requires treatment and that causes pain and/or infection of the
				dental apparatus and/or contiguous structures.
Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.2 - Provider Enrollment

Current through June 25, 2024
A. Dentists must
				comply with all requirements set forth in Miss. Admin. Code Part 200, Chapter
				4, 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, driver's
				license if it notes the social security number, 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 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.3 - Covered Services

Current through June 25, 2024
A. Covered dental
				services include:
1. Limited oral evaluation,
				problem-focused,
2.
				Radiographs,
3. Gingivectomy and/or
				gingivoplasty for Dilantin therapy only,
4. Oral surgery,
5. Extractions, and
6. Alveoloplasty.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.4 - Non-covered Services

Current through June 25, 2024
A. Non-covered
				dental services include, but not limited to, the following:
1. Comprehensive oral evaluation,
2. Preventive services,
3. Amalgams, composites, and
				crowns,
4. Endodontics,
5. Dentures, and
6. Orthodontia.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.5 - Dental Benefit Limits

Current through June 25, 2024
A. The Division of
				Medicaid covers dental expenditures, excluding orthodontia-related services, up
				to twenty five hundred dollars ($2,500.00) per beneficiary per state fiscal
				year.
B. All American Dental
				Association (ADA) dental procedure codes, except orthodontia-related services,
				are applied to the $2,500 annual limit.
Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.6 - Prior Authorization

Current through June 25, 2024
A. The Division of
				Medicaid requires prior authorization, except for emergencies, from the
				Utilization Management/Quality Improvement Organization (UM/QIO) of the
				following dental services:
1. Surgical access
				of an unerupted tooth,
2. Radical
				resection of mandible with tooth bone graft,
3. Arthrotomy,
4. Complicated suture greater than five (5)
				cm,
5. Osteoplasty - for
				orthognathic deformities,
6.
				Osteotomy - mandibular rami,
7.
				Osteotomy - mandibular rami with bone graft, includes obtaining the
				graft,
8. Osteotomy - segmented or
				subapical - per sextant or quadrant,
9. Osteotomy - body of mandible,
10. Lefort I (maxilla - total),
11. Lefort I (maxilla - segmented),
12. Lefort II or Lefort III (osteoplasty of
				facial bones for midface hypoplasia),
13. Repair of maxillofacial soft and hard
				tissue defect,
14. Closure of
				salivary fistula,
15.
				Coronoidectomy,
16. All procedures
				billed under unspecified dental procedure codes, and
17. The following types of analgesia and
				sedation for dental office-based procedures:
a. Analgesia, anxiolysis, inhalation of
				nitrous oxide,
b. Non-Intravenous
				conscious sedation,
c. Deep
				sedation/general anesthesia, and
d.
				Intravenous conscious sedation/analgesia.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.7 - Laboratory Services, Diagnostic Casts and Photographs

Current through June 25, 2024
The Division of Medicaid covers lab and pathology services if
				  the provider performs the service in their office and must have a Clinical
				  Laboratory Improvement Amendment (CLIA) certificate number on file with
				  Medicaid.
Miss. Code Ann.
				  §§ 43-13-171,
				  43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.8 - Radiographs

Current through June 25, 2024
A. The Division of Medicaid covers the
				following types of dental radiographs:
1.
				Intraoral - complete series, including bitewings,
2. Intraoral - periapical,
3. Bitewings, and
4. Panoramic film.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.9 - Periodontic Procedures

Current through June 25, 2024
The Division of Medicaid covers gingivectomy or gingivoplasty
				  for beneficiaries only if the beneficiary is on Dilantin therapy. Documentation
				  relating to the beneficiary's Dilantin therapy must be retained in the dental
				  record.
Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.11 - Dental Services Provided in the Hospital or Ambulatory Surgical Center (ASC) Setting

Current through June 25, 2024
A. The Division of
				Medicaid covers medically necessary dental treatment in the outpatient hospital
				or Ambulatory Surgical Center (ASC) setting when all the following are met:
1. Quality, safe, and effective treatment
				cannot be provided in an office setting,
2. Inpatient hospitalization is not medically
				necessary, [Refer to Miss. Admin. Code Part 204, Rule 1.11.B.] and
3. Certain dental procedures have been prior
				authorized by the Division of Medicaid or designee.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.12 - Oral Evaluations

Current through June 25, 2024
The Division of Medicaid defines a limited oral evaluation as
				  an evaluation or re-evaluation limited to a specific oral health
				  problem.
A. The Division of Medicaid
				covers limited oral evaluations four (4) times per state fiscal year.
B. This may require interpretation of
				information acquired through additional diagnostic procedures.
C. The Division of Medicaid covers definitive
				procedures to be performed on the same date as the evaluation according to this
				rule.
Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.13 - Consultations

Current through June 25, 2024
The Division of Medicaid covers consultation services for
				  dentists or dental specialists.
A. The
				Division of Medicaid does not cover the visit or exam on the same day as the
				initial consultation by the consulting dentist or dental specialist.
B. The Division of Medicaid covers diagnostic
				and therapeutic procedures on the same or different dates of services as the
				consultation.
C. The appropriate
				dental procedure code is required for reimbursement.
Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.14 - Anesthesia

Current through June 25, 2024
A. The Division of Medicaid defines a topical
				anesthetic as an agent used to temporarily anesthetize or numb the tiny nerve
				endings located on the surfaces of the oral mucosa. The Division of Medicaid
				does not cover the cost of the topical anesthetic and the application of the
				topical anesthetic separately from the procedure performed.
B. The Division of Medicaid defines a local
				anesthetic as an agent used to temporarily prevent the conduction of sensory
				impulses such as pain, touch, and thermal change from a body part along nerve
				pathways to the brain. The Division of Medicaid does not cover local anesthesia
				separately from the procedure performed.
C. The Division of Medicaid defines conscious
				sedation as an anesthetic, including oral, intravenous and intramuscular,
				administered to place the beneficiary in a relaxed state, which helps control
				fear and anxiety, but the beneficiary can still respond to speech or touch. The
				Division of Medicaid covers conscious sedation for dental and oral procedures
				using the appropriate dental procedure code.
D. The Division of Medicaid defines deep
				sedation/general anesthesia as a controlled state of depressed consciousness
				induced by an anesthetic and accompanied by a partial or complete loss of
				protective reflexes, including the inability of the beneficiary to maintain an
				airway without assistance or support. The Division of Medicaid covers deep
				sedation/general anesthesia for dental and oral procedures using the
				appropriate dental code.
E. All
				forms of sedation and anesthesia administered in a dental office-based setting
				must comply pursuant to Miss. Code Ann. §
									73-9-13
				to insure that beneficiaries are provided with the benefits of anxiety and pain
				control in a safe and efficacious manner.
Miss. Code Ann.
				  §§
										43-13-117,
				  43-13-121,
				  73-9-13;
				  MS State Board of Dental Examiners, Board Regulation
				  29.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.15 - Bone Replacement Graft

Current through June 25, 2024
A. The Division of
				Medicaid defines a bone replacement graft as a procedure which involves the use
				of osseous autografts, osseous allografts, or non-osseous grafts to stimulate
				bone formation or periodontal regeneration when the disease process has led to
				a deformity of the bone. This procedure does not include flap entry and
				closure. The Division of Medicaid defines the following as:
1. Osseous autograft as a graft taken from
				one part of the body and placed in another site on the same
				individual.
2. Osseous allograft as
				a graft between two or more individuals allogenic at one or more
				loci.
3. Non-osseous as a graft not
				composed of bone such as tendon or ligament tissue, and the material can be
				artificial, synthetic or natural.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.16 - Documentation Requirements

Current through June 25, 2024
Dental providers must maintain auditable records containing
				  documentation that substantiate the services provided in accordance with
				  requirements set forth in Miss. Admin. Code Part 200, Chapter 1, Rule 1.3.
				  including, but not limited to:
A. Date
				of service,
B. History taken on
				initial visit,
C. Chief complaint
				on each visit,
D. Test, radiographs
				and results must have the beneficiary's name, the date, must be legible, and
				must be maintained on file with the beneficiary's dental records.
E. Diagnosis,
F. Treatment, including
				prescriptions,
G. Signature or
				initials of dentist after each visit, and
H. Copies of hospital and/or emergency room
				records if available.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.17 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Current through June 25, 2024
The Division of Medicaid pays for all medically necessary
				  services for EPSDT-eligible beneficiaries in accordance with Miss. Admin. Code
				  Part 223, without regard to service limitations and with prior
				  authorization.
Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 1 - General › Rule 23-204-1.18 - Dental Reimbursement

Current through June 25, 2024
A. The Division of
				Medicaid reimburses dental providers based on a statewide uniform fee
				schedule.
B. Dental providers must
				bill the procedure code that accurately reflects the services rendered as
				follows:
1. Dental procedures performed by a
				Mississippi licensed dentist must be billed with a Code on Dental Procedures
				and Nomenclature (CDT).
2. Dental
				procedures performed by a Mississippi licensed dentist who is also a
				Mississippi licensed physician can bill either a CDT code or a Current
				Procedural Terminology (CPT) code.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 2 - Oral Surgery › Rule 23-204-2.1 - Simple Extractions

Current through June 25, 2024
Medicaid covers for simple extractions and the fee includes
				  local anesthesia and routine postoperative care.
A. Medicaid covers for alveoloplasties with
				the simple extraction of three (3) or more adjacent teeth in the same
				quadrant.
B. Medicaid requires for
				an alveolopasty by quadrant to be covered, a minimum of five (5) teeth in the
				quadrant must be done.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 2 - Oral Surgery › Rule 23-204-2.3 - Surgical Extractions

Current through June 25, 2024
A. The Division of
				Medicaid defines an impacted tooth as one where its eruption is partially or
				wholly obstructed by bone, soft tissue or other teeth.
B. The Division of Medicaid covers surgical
				extractions and removal of impacted teeth.
C. The Division of Medicaid does not cover
				for the extraction of an unerupted third molar unless medically necessary
				including, but not limited to:
1.
				Radiographic evidence that a third molar will be severely impacted, or
2. Evidence of infection.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 2 - Oral Surgery › Rule 23-204-2.4 - Alveoloplasty

Current through June 25, 2024
The Division of Medicaid covers alveoloplasty as a separate
				  procedure from extractions or in conjunction with extractions when there is a
				  need for significant bone re-contouring in the quadrant to prepare the ridge
				  for a prosthetic appliance if there:
A.
				Are three (3) or more tooth spaces present per quadrant, or three (3) or more
				teeth extracted per quadrant, or
B.
				Are less than three (3) tooth spaces present per quadrant, or less than three
				(3) teeth extracted per quadrant if prior authorized as medically necessary by
				the Utilization Management/Quality Improvement Organization (UM/QIO), or
				designee.
Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 2 - Oral Surgery › Rule 23-204-2.5 - Root Tips

Current through June 25, 2024
Medicaid does not cover for the surgical removal of residual
				  tooth roots with an extraction separately. The appropriate code for surgical
				  removal of residual tooth roots (cutting procedures) must be used to bill the
				  surgical removal of residual roots when a tooth has been broken off by natural
				  means or when the beneficiary seeks follow-up care from a practitioner other
				  than the dentist or oral surgeon who performed the original
				  extraction.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 2 - Oral Surgery › Rule 23-204-2.6 - Complicated Sutures

Current through June 25, 2024
Medicaid covers complicated suturing only in instances of
				  trauma where simple sutures cannot be placed or simple suturing is not
				  possible. Medicaid does not pay separately when done with extractions of
				  unerupted teeth or when the dentist creates the flap or incision. Medicaid
				  requires detailed documentation of the traumatic event in the dental
				  record.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 204 - Dental Services › Chapter 2 - Oral Surgery › Rule 23-204-2.7 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

Current through June 25, 2024
The Division of Medicaid pays for all medically necessary
				  services for EPSDT-eligible beneficiaries in accordance with Part 223 of Title
				  23, without regard to service limitations and with prior
				  authorization.
Miss. Code Ann. §
										43-13-121
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 205 - Hospice Services › Chapter 1 - Program Overview › Rule 23-205-1.1 - General Provisions and Definitions

Current through June 25, 2024
A. Admission to
				hospice and subsequent election periods must be prior authorized through a
				Utilization Management/Quality Improvement Organization (UM/QIO), the Division
				of Medicaid, or designated entity.
B. The hospice provider must provide all
				required services to meet the needs of the beneficiary related to the terminal
				illness and related conditions.
C.
				The Division of Medicaid covers medically necessary hospice services for
				beneficiaries when the following criteria are met:
1. A written certification specifying the
				beneficiary's medical prognosis is for a life expectancy of six (6) months or
				less if the terminal illness runs its normal course and the written
				certification is in accordance with
				42 C.F.R. §
											418.22 and the Mississippi State Department
				of Health (MSDH) Minimum Standards of Operation for Hospice,
2. A beneficiary or a beneficiary's
				guardian/legal representative has elected hospice care services for the
				palliation and management of a beneficiary's terminal illness and related
				conditions,
3. Services are
				reasonable and necessary for the palliation and management of a beneficiary's
				terminal illness and related conditions,
4. A plan of care (POC) is established, prior
				to hospice care services beginning, which requires periodic review by the
				attending physician, if any, the medical director, and the interdisciplinary
				group of the hospice program, and
5. The hospice care services are consistent
				with the beneficiary's established plan of care.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 205 - Hospice Services › Chapter 1 - Program Overview › Rule 23-205-1.2 - Provider Enrollment Requirements

Current through June 25, 2024
Providers of hospice must comply with all federal, state,
				  and local laws and regulations related to the health and safety of
				  beneficiaries and:
A. Meet the
				conditions of participation set forth in 42 C.F.R. Part 418, Subpart D,
B. Be licensed and certified for
				participation by the Mississippi State Department of Health (MSDH), Division of
				Health Facilities Licensure and Certification (HFLC), and meet all requirements
				in accordance with the rules and regulations as defined in the Minimum
				Standards of Operation for Hospice per the MSDH,
C. Enter into a provider agreement with the
				Mississippi Division of Medicaid,
D. Satisfy all requirements set forth in Part
				200, Rule 4.8 and must provide to the Division of Medicaid:
1. A 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. An Explanation of Medicare Benefits (EOMB) is not
				acceptable, and
4. A copy of the
				provider's current license or certification letter from the state of the
				servicing location.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 205 - Hospice Services › Chapter 1 - Program Overview › Rule 23-205-1.4 - Hospice Eligibility, Election, Transfer, Revocation, and Discharge

Current through June 25, 2024
A. A beneficiary must meet eligibility
				requirements for hospice care services. For the duration of an election of
				hospice care services, a beneficiary waives all rights to Medicaid State Plan
				services for treatment related to the terminal illness and related conditions.
				In order to be eligible to elect hospice care services under Medicaid, a
				beneficiary must:
1. Be Medicaid eligible for
				full benefits,
2. Be certified by a
				physician as terminally ill in compliance with 42 C.F.R. §
				418.22,
3. Require medically
				necessary treatment for the palliation and management of a terminal illness and
				related conditions,
4. The
				beneficiary or legal guardian/representative must elect hospice care in
				accordance with 42 C.F.R. § 418.24.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 205 - Hospice Services › Chapter 1 - Program Overview › Rule 23-205-1.5 - Hospice Plan of Care (POC)

Current through June 25, 2024
A. The hospice
				provider must ensure each beneficiary has an individualized written plan of
				care (POC) established by the hospice interdisciplinary team/interdisciplinary
				group (IDT/IDG) in collaboration with the attending physician, if any,
				beneficiary, family and/or primary care giver that specifies the hospice care
				and services necessary to meet the beneficiary's and family's specific needs
				identified in the initial, comprehensive, and updated comprehensive
				assessments.
B. The hospice
				provider must ensure that each beneficiary and the primary care giver(s)
				receive education and training provided by the hospice as appropriate to their
				responsibilities for the care and services identified in the POC.
C. The IDT/IDG must be designated by the
				hospice and be composed of representatives from all the core services and
				include, at a minimum:
1. A doctor of
				medicine or osteopathy,
2. A
				registered nurse (RN) designated to provide coordination of care and to ensure
				continuous assessment of each beneficiary's and family's needs and
				implementation of the interdisciplinary POC,
3. A social worker, and
4. A pastoral or other counselor.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 205 - Hospice Services › Chapter 1 - Program Overview › Rule 23-205-1.6 - Covered Services

Current through June 25, 2024
The Division of Medicaid covers hospice services in
				  accordance with the hospice plan of care (POC), when prior authorized by a
				  Utilization Management/Quality Improvement Organization (UM/QIO), the Division
				  of Medicaid, or designated entity and provided in a manner that is consistent
				  with accepted standards of practice and complies with all federal and state
				  laws in addition to Medicare's Conditions of Participation and includes the
				  following:
A. Core services, with the
				exception of physician services, must be provided directly by hospice employees
				on a routine basis. The following are hospice core services:
1. Physician services,
2. Nursing services by a registered nurse
				(RN),
3. Medical social services by
				a licensed social worker who has at least a bachelor's degree from a school
				accredited or approved by the Council on Social Work Education, and who is
				working under the direction of a physician,
4. Counseling services which includes, but
				not limited to:
a) Bereavement counseling
				services provided to the beneficiary's family before and up to one (1) year
				after the beneficiary's death and the hospice provider must:
1) Have an organized program for the
				provision of bereavement services furnished under the supervision of a
				qualified professional with experience or education in grief or loss
				counseling.
2) Counsel residents of
				a skilled nursing facility/nursing facility (SNF/NF) or an intermediate care
				facility for individuals with intellectual disabilities (ICF/IID) when
				appropriate and identified in the bereavement plan of care (POC).
3) Ensure that bereavement services reflect
				the needs of the bereaved.
4)
				Develop a bereavement POC that notes the kind of bereavement services to be
				offered and the frequency of service delivery.
b) Spiritual counseling, and
c) Dietary counseling by a registered
				dietician, RN, or other qualified professionals.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 205 - Hospice Services › Chapter 1 - Program Overview › Rule 23-205-1.7 - Transportation

Current through June 25, 2024
A. The hospice provider must:
1. Provide transportation for medical
				services relating to the terminal illness and related conditions after the
				admission to the hospice,
2.
				Provide transportation from the hospital to the beneficiary's residence or to a
				freestanding hospice facility during a period of hospitalization after election
				of the hospice benefit.
3. Arrange
				for non-emergency transportation through the non-emergency transportation (NET)
				broker program when the hospice beneficiary requires or requests transportation
				for services that are not palliative in nature or for transportation services
				unrelated to the terminal illness and related conditions.