reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 5 - The Hearing Process › Rule 23-100-5.17 - Continuation of Benefits

Current through June 25, 2024
A. If a client or
				representative requests a hearing within the advance notice period, benefits
				must be continued or reinstated to the benefit level in effect prior to the
				planned adverse action.
1. Timely Request for
				Continuation of Benefits. To determine if the request for continuation of
				benefits is timely, the request must be received by the regional office within
				twelve (12) days from the notice date. This twelve (12) day period includes the
				ten (10) day adverse action period plus two (2) days mailing time. If a hearing
				is requested by telephone, the client must be advised to put the request in
				writing prior to the end of the specified period. Any hearing requested or
				dated after this period will not be accepted as a timely request for
				continuation of benefits.
2.
				Continuation of Benefits When Local Decision is Adverse. The client may request
				a state hearing if the local hearing is adverse. If benefits have been
				continued pending the local hearing, then benefits will continue pending a
				state hearing decision provided the request for the state hearing is made
				within fifteen (15) days of the date on the Notice of Local Hearing
				Decision.
3. Agency Action Upheld
				in Final Hearing Decision. When the final hearing decision is adverse to the
				client, the specialist will terminate or reduce the continued benefits using
				the original reason for the adverse action. A second
				(2nd) Notice of Adverse Action is not
				required.
4. The Division of
				Medicaid has the right to initiate recovery procedures against the client to
				recoup the cost of any medical services furnished the client under Medicaid and
				CHIP premiums paid by the Division of Medicaid on behalf of CHIP children, to
				the extent they were furnished solely based on the provision for continuation
				of benefits.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 5 - The Hearing Process › Rule 23-100-5.18 - Local Hearings

Current through June 25, 2024
A. The regional
				office is responsible for completing a supervisory review of the action under
				appeal and for preparing the state hearing record. The office is responsible
				for all activities involved in the local hearing process and for taking
				appropriate action on the case at the end of the hearing process. The purpose
				of a local hearing is to provide an informal proceeding to allow the client or
				representative to:
1. Present new or
				additional information;
2. Question
				the action taken on the clients case, and
3. Hear an explanation of eligibility
				requirements as they pertain to the clients situation.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 5 - The Hearing Process › Rule 23-100-5.19 - State Hearing After Adverse Local Decision

Current through June 25, 2024
A. The client has
				the right to appeal a local hearing decision by requesting a state hearing;
				however, the state hearing request must be made in writing within fifteen (15)
				days of the mailing date of the local hearing decision. This means the state
				hearing request must be received by the regional office or state office on or
				before the fifteenth (15th) day after the local
				hearing notice is mailed.
B. If the
				state hearing request is made orally, then the claimant must be informed that
				the request must be put into writing and received within the allotted fifteen
				(15) day time period. If benefits have been continued pending the local hearing
				decision, then benefits will continue throughout the fifteen (15) day advance
				notice period when the local hearing decision is adverse.
C. If a state hearing is requested timely
				within the fifteen (15) day period, then benefits will continue pending the
				outcome of the state hearing. State hearings requested after the fifteen (15)
				day advance notice period for the local hearing will not be accepted unless the
				thirty (30) day period for filing a hearing request has not expired because the
				local hearing was held early in the thirty (30) day period and there is time
				remaining.
Miss. Code Ann. §
				  43-13-116.3 (Rev. 2000).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 5 - The Hearing Process › Rule 23-100-5.20 - State Hearings

Current through June 25, 2024
A. A state hearing
				is assigned to an impartial hearing officer. Impartial means the hearing
				officer has not been involved in any way with the action or decision under
				appeal who
1. Reviews the local offices
				action;
2. Schedules the
				hearing;
3. Holds the hearing and
				provides the following explanations to those in attendance:
a) The hearing will be recorded and a copy of
				the recording made available to the client upon request.
b) The reason for the hearing, i.e., the
				action taken by the regional office which prompted the appeal.
c) The clients rights and the purpose of the
				hearing.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 5 - The Hearing Process › Rule 23-100-5.21 - CHIP Agency Errors

Current through June 25, 2024
A. The Division of
				Medicaid is responsible for ensuring payment for eligible beneficiaries.
				Providing timely CHIP benefits is a special concern because, unlike Medicaid,
				the CHIP effective dates are determined relative to monthly processing
				deadlines which do not allow the regional office to take retroactive or
				corrective action when an error is discovered for a prior month.
B. When CHIP agency errors occur, resolution
				comes through a local or state hearing request.
C. If a fair hearing is requested on a CHIP
				termination or denial and agency error was not involved, the procedures
				described previously in this section will be followed based on the type of
				hearing requested, i.e., local or state.
MS Code Ann. §
				  41-86-3.4 (Rev. 2002).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 6 - Improper Payments (Transferred) › Rule 23-100-6.1 - Types of Improper Payments (Transferred)

Current through June 25, 2024
Rule 23-100-6.1 Refer to Part 305.
MS Code Ann. §
				  43-13-121.1 (Rev. 2001).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 6 - Improper Payments (Transferred) › Rule 23-100-6.2 - Reporting an Improper Payment (Transferred)

Current through June 25, 2024
Rule 23-100-6.2 Refer to Part 305.
MS Code Ann. §
				  43-13-121.1 (Rev. 2005).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 6 - Improper Payments (Transferred) › Rule 23-100-6.3 - Claims Against Estates (Transferred)

Current through June 25, 2024
Rule 23-100-6.3 Refer to Part 305.
MS Code Ann. §
				  43-13-317.1 (Rev. 2005).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 7 - Quality Control (Transferred) › Rule 23-100-7.1 - Quality Control Reviews (Transferred)

Current through June 25, 2024
Rule 23-100-7.1 Refer to Part 305.
CFR §431.810 et.
				  seq. (Rev. 1990).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.1 - Coverage of Mandatory and Optional Categorically Needy Individuals

Current through June 25, 2024
A. The federal government, through passage of
				federal laws, defines and describes categorically needy groups that either must
				be covered by individual state Medicaid programs or that may be covered by
				individual state Medicaid programs at their option.
B. All individual state Medicaid programs
				must provide coverage to specified categories of needy individuals that
				include: children, pregnant women, parents or caretaker relatives of dependent
				children, aged individuals and disabled or blind individuals. Within these
				broad categories of coverage, the specific groups covered are either mandatory
				or optional.
C. Coverage of
				optional categorically needy groups is authorized by the passage of state laws.
42 CFR §
											435.2; Miss. Code Ann. §
										43-13-115.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.2 - Application of Modified Adjusted Gross Income (MAGI) to Specified Categories of Coverage

Current through June 25, 2024
A. The Affordable
				Care Act (ACA) requires that certain mandatory and optional categorically needy
				groups are subject to the application of Modified Adjusted Gross Income (MAGI)
				standards, which are financial methodologies used to determine eligibility.
				Generally, the groups subject to MAGI rules are those that cover children,
				pregnant women and parents and caretaker relatives. Groups that are not subject
				to MAGI requirements are groups that cover the aged, blind and disabled.
B. MAGI affects income eligibility
				standards that are used for MAGI-related coverage groups in that net income
				eligibility thresholds in effect prior to the implementation of the ACA must be
				converted to equivalent MAGI levels to account for any income disregards used
				prior to the ACA. Income standards for these programs are expressed as
				MAGI-equivalent standards after the required conversion.
42 CFR §
											435.603.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.3 - Mandatory Coverage of Parents and Other Caretaker Relatives

Current through June 25, 2024
A. Coverage is mandatory for parents and
				other caretaker relatives who have a dependent child or children under the age
				of eighteen (18) living in the home whose household income is below the
				applicable limit established by the state for coverage. The limit established
				by the state is required by the Affordable Care Act (ACA) to convert to a
				Modified Adjusted Gross Income (MAGI)-equivalent standard. The Division of
				Medicaid certifies eligibility for this group.
B. Extended Medicaid coverage for twelve (12)
				months is mandatory for a family whose eligibility is based on family coverage
				if the family loses Medicaid coverage solely due to increased income from
				employment or increased hours of employment provided the family received
				Medicaid in any three (3) or more months during the six (6) month period prior
				to becoming ineligible, as determined by the Division of Medicaid.
C. Extended Medicaid for a maximum of four
				(4) months is required if a new collection or increased collection of child
				support (prior to January, 2014) or spousal support under title IV-D of the
				Social Security Act results in the termination of Medicaid for a family whose
				eligibility is based on family coverage described above, as determined by the
				Division of Medicaid. Effective with the implementation of the ACA, child
				support no longer counts as income.
42 CFR §
				  435.110-115.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.4 - Mandatory Coverage of Pregnant Women

Current through June 25, 2024
A. Coverage is
				mandatory for pregnant woman whose household income is at or below the income
				standard established by the state, not to exceed one hundred eighty-five
				percent (185%) of the federal poverty level converted to a Modified Adjusted
				Gross Income (MAGI)-equivalent standard. The Division of Medicaid certifies
				eligibility for this group.
B. The
				agency must provide categorically needy Medicaid eligibility for an extended
				period following termination of pregnancy to women who, while pregnant, applied
				for, were eligible for, and received Medicaid services on the day that their
				pregnancy ends. This period extends from the last day of pregnancy through the
				end of the month in which a sixty (60)-day period, beginning on the last day of
				the pregnancy, ends. Eligibility must be provided regardless of changes in the
				woman's financial circumstances that may occur within this extended
				period.
42 CFR §§
											435.116,
				  435.170.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.5 - Mandatory Coverage of Newborns

Current through June 25, 2024
A. Coverage is
				mandatory for infants born to Medicaid eligible mothers. The infant is deemed
				eligible for one (1) year from the date of birth. This provision applies in
				instances where the labor and delivery services were furnished prior to the
				date of application and covered by Medicaid based on retroactive eligibility.
				The Division of Medicaid is responsible for certifying eligibility for deemed
				eligible newborns.
B. Coverage is
				mandatory for infants born to qualified or non-qualified alien mothers who
				qualify for Medicaid on all factors other than alien status who receive
				Medicaid on the basis of emergency medical services, provided an application
				for emergency services is timely filed with the Division of Medicaid.
42USC§
											1396 a;
				  42 CFR §
											435.117; Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.6 - Mandatory Coverage of Infants and Children under Age Nineteen (19)

Current through June 25, 2024
A. Coverage is mandatory for infants to age
				one (1) in households whose income is at or below one hundred eighty-five
				percent (185%) of the federal poverty level converted to a Modified Adjusted
				Gross Income (MAGI)-equivalent standard.
B. Coverage is mandatory for children age one
				(1) to age six (6) whose household income is at or below one hundred
				thirty-three percent (133%) of the federal poverty level converted to a
				MAGI-equivalent standard. Children age six (6) to age nineteen (19) are
				eligible for Medicaid if household income is at or below one hundred
				thirty-three percent (133%) of the federal poverty level, as required by the
				Affordable Care Act (ACA).
C. The
				Division of Medicaid certifies eligibility for these age-specific groups of
				children.
42 CFR §
											435.118.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.7 - Mandatory Coverage of Adoption Assistance and Foster Care Children

Current through June 25, 2024
A. Coverage is mandatory for children for
				whom adoption assistance or foster care maintenance payments are made under
				title IV-E of the Social Security Act, as determined by the Department of Human
				Services (DHS) who certifies eligibility for this group of children.
B. Coverage is mandatory for former foster
				care children who are under age twenty-six (26) if the child was in foster care
				and enrolled in Medicaid upon reaching the age of eighteen (18) or prior to age
				twenty-one (21) when released from foster care by DHS. Continued Medicaid
				coverage is certified by the Division of Medicaid in coordination with
				DHS.
42 USC
				  1396 a;
				  42
				  CFR §
											435.145.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.8 - Mandatory Coverage of the Aged, Blind and Disabled

Current through June 25, 2024
A.
				Coverage is mandatory for individuals receiving Supplemental Security Income
				(SSI). This includes individuals receiving SSI pending a final determination of
				blindness or disability, those receiving SSI under an agreement to dispose of
				resources that exceed the SSI resource limit, and those receiving benefits
				under section 1619(a) or considered to be receiving SSI under 1619(b) of the
				Social Security Act. Coverage also includes those who would be eligible for SSI
				except for an eligibility requirement used in the SSI program that is
				specifically prohibited under title XIX. Eligibility for SSI is determined by
				the Social Security Administration. No separate application for Medicaid is
				required unless the individual needs to apply for retroactive Medicaid for up
				to three (3) months prior to the month of the SSI application, in which case
				the individual must apply with the Division of Medicaid for the retroactive
				period of eligibility.
B.
				Individuals who become ineligible for SSI cash assistance as a result of a
				cost-of-living increase in title II benefits received after April, 1977, must
				be granted Medicaid coverage if the sole reason for the loss of SSI was an
				increase in Retirement, Survivor, Disability Insurance (RSDI) benefits received
				by the individual and/or his or her financially responsible spouse. The
				Division of Medicaid certifies eligibility for this group.
C. Coverage is mandatory for certain disabled
				widows and widowers and certain disabled adult children who would be eligible
				for SSI except for receipt of title II benefits. Specified conditions apply in
				order to have Medicaid coverage continued as a former SSI cash assistance
				recipient under these protected groups, as determined by the Division of
				Medicaid.
42 CFR §
											435.120 -
				  138.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.9 - Mandatory Coverage of Certain Medicare Cost-Sharing Groups

Current through June 25, 2024
A. Qualified Medicare Beneficiaries (QMB)
				must be entitled to Medicare Part A and have income that does not exceed one
				hundred percent (100%) of the federal poverty level. Medical assistance is
				limited to payment of Medicare cost-sharing expenses that includes premiums,
				co-insurance and deductible charges.
B. Specified Low-Income Medicare
				Beneficiaries (SLMB) must be entitled to Medicare Part A and have income
				greater than one hundred percent (100%) of the federal poverty level but less
				than one hundred twenty percent (120%) of the federal poverty level. Medical
				assistance for this group is limited to payment of Medicare Part B premiums.
C. Qualifying Individuals (QI)
				must be entitled to Medicare Part A and have income that is at least one
				hundred twenty percent (120%) of the federal poverty level but less than one
				hundred thirty-five percent (135%) of the federal poverty level. Medical
				assistance for this group is limited to payment of Medicare Part B premiums
				under a federal allotment of funds. Eligibility for coverage as a QI is
				dependent on the availability of federal funds.
D. Qualified Disabled and Working Individuals
				must be entitled to Medicare Part A and have income that does not exceed two
				hundred percent (200%) of the federal poverty level whose return to work
				results in the loss of coverage for Medicare. Medical assistance is limited to
				payment of the Part A premium.
E.
				The Division of Medicaid certifies eligibility for all of the Medicare
				cost-sharing groups.
42USC
				  §§
											1395w-114,
				  1396
				  a, 1396d.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.10 - Mandatory Coverage of Certain Aliens for Emergency Services

Current through June 25, 2024
A. Emergency services, including labor and
				delivery services, must be provided to aliens who meet all eligibility
				requirements for Medicaid coverage except for their alien status who are in
				need of treatment of an emergency medical condition.
B. Coverage is limited to treatment of the
				emergency condition only. Transplant services are prohibited.
C. The Division of Medicaid certifies
				Medicaid coverage for Emergency Services.
42 CFR §
											435.139.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.11 - Mandatory Presumptive Eligibility Determined by Qualified Hospitals

Current through June 25, 2024
A. As required by the Affordable Care Act
				(ACA), qualified hospitals must be allowed to determine presumptive eligibility
				for individuals eligible for Medicaid in certain Medicaid coverage groups,
				referred to as Hospital Presumptive Eligibility (HPE).
B. HPE affords qualified hospitals the
				opportunity to immediately enroll patients in Medicaid who are determined
				eligible for Medicaid by authorized hospital staff.
C. HPE provides temporary Medicaid
				eligibility but also allows access to continuing Medicaid coverage provided the
				HPE decision includes filing a full Medicaid application.
D. Medicaid populations eligible for HPE
				decisions include children up to age nineteen (19), pregnant women, low income
				parents or caretaker relative(s), former foster children and certain women with
				breast or cervical cancer.
E. The
				Division of Medicaid certifies HPE Medicaid eligibility.
42 CFR §
											435.1110.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.12 - Optional Coverage of Children Elected to be Covered by Mississippi

Current through June 25, 2024
A. Children under the age of twenty-one (21)
				for whom the Department of Human Services (DHS) assumes full or partial
				financial responsibility who are in foster homes or private institutions are
				certified for Medicaid coverage by DHS if the child's income is within state
				established standards, converted to a Modified Adjusted Gross Income
				(MAGI)-equivalent standard. Children under age twenty-one (21) in adoptions
				subsidized in full or part by DHS and children in adoption assistance who
				cannot be placed for adoption without medical assistance due to special needs
				of the child are eligible for Medicaid regardless of the child's income, as
				determined by DHS.
B. Independent
				foster care adolescents who are in foster care under the responsibility of DHS
				on their eighteenth (18th) birthday have Medicaid
				coverage continued until age twenty-one (21) without regard to any change in
				circumstances such as income or resources. As required by the Affordable Care
				Act (ACA), former foster children receive Medicaid on a mandatory basis to age
				twenty-six (26); however, the optional coverage of former foster children to
				age twenty-one (21) was in place prior to the ACA. The Division of Medicaid, in
				coordination with DHS, certifies Medicaid coverage for this group.
C. Uninsured children under age nineteen (19)
				whose household income is at or below two hundred percent (200%) of the federal
				poverty level converted to a MAGI-equivalent standard are covered by the
				Children's Health Insurance Program (CHIP), which is a separate health plan.
				Covered children include: infants to age one (1) whose household income is
				above the MAGI-equivalent standard of one hundred eighty-five percent (185%)
				but does not exceed the MAGI-equivalent standard of two hundred percent (200%)
				of the federal poverty level; children age one (1) to age six (6) whose
				household income is above the MAGI-equivalent standard of one hundred
				thirty-three percent (133%) but does not exceed the MAGI-equivalent standard of
				two hundred percent (200%) of the federal poverty level and children age six
				(6) to age nineteen (19) whose household income is above one hundred
				thirty-three percent (133%) of the federal poverty level but does not exceed
				the MAGI-equivalent standard of two hundred percent (200%).
42 USC §
											1396 a;
				  42 CFR §
											435.201; Miss. Code Ann. §
										41-86-15.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.13 - Optional Coverage of the Aged, Blind and Disabled Considered to be in an Institution Elected to be Covered by Mississippi

Current through June 25, 2024
A.
				Individuals who would be eligible for cash assistance if not institutionalized.
				The individual must be in a title XIX nursing facility or hospital and meet
				income, resource and other non-financial factors of eligibility, as determined
				by the Division of Medicaid.
B.
				Individuals in institutions who are eligible under a special income test. The
				individual must be in a title XIX nursing facility or hospital and meet income,
				resource and other non-financial factors of eligibility, as determined by the
				Division of Medicaid.
C.
				Individuals receiving home and community-based services who would be Medicaid
				eligible if institutionalized who are eligible under an approved waiver and
				receive waivered services. The individual must meet income, resource and other
				non-financial factors of eligibility, as determined by the Division of
				Medicaid.
D. Certain disabled
				children age eighteen (18) or under who are living at home, who would be
				eligible for Medicaid if in a medical institution and for whom the Division of
				Medicaid has made a determination as required under section 1902(e)(3)(B) of
				the Social Security Act. The cost-effectiveness of care at home compared to
				care provided in a medical institution must be considered, as determined by the
				Division of Medicaid.
42 USC §
											1396 a;
				  42
				  CFR §§
											435.211,
				  435.217,
				  435.236.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.14 - Optional Coverage of the Aged, Blind and Disabled Living At-Home Elected to be Covered by Mississippi

Current through June 25, 2024
A. Disabled
				individuals who work in excess of an established number of hours each month
				whose net family earned income is at or below two hundred fifty percent (250%)
				of the federal poverty level and whose unearned income is at or below one
				hundred thirty-five percent (135%) of the federal poverty level. Resource
				limits and other non-financial factors of eligibility are required. Premiums
				are payable for households with earnings that exceed one hundred fifty percent
				(150%) of the poverty level. The Division of Medicaid certifies eligibility and
				premiums payable for this group.
B.
				Women who have been screened for breast or cervical cancer under the Centers
				for Disease Control (CDC) and Prevention Breast and Cervical Cancer Early
				Detection Program established under title XV of the Public Health Service Act
				in accordance with the requirements of section 1504 of that Act and need
				treatment for breast or cervical cancer, including a precancerous condition of
				the breast or cervix. Coverage is limited to women who are otherwise uninsured
				and are not eligible for Medicaid under any other mandatory coverage group and
				have not attained age sixty-five (65). The MS State Department of Health (MSDH)
				is responsible for the screening, diagnosis and financial eligibility
				decisions. The Division of Medicaid is responsible for the non-financial
				eligibility decisions and for certifying Medicaid eligibility during the course
				of the woman's active treatment.
42 USC §
											1396 a.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.15 - Optional Waiver Coverage of Non-Medicare Aged, Blind and Disabled Individuals

Current through June 25, 2024
Section 1115(a) waiver coverage is granted to certain
				  non-Medicare entitled individuals who are aged, blind or disabled and have
				  income at or below one hundred thirty-five percent (135%) of the federal
				  poverty level. Coverage under the waiver is subject to an enrollment cap.
				  Resource limits and other factors of eligibility apply, as determined by the
				  Division of Medicaid.
42 USC §
											1315; Healthier Mississippi Waiver
				  (HMW).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.16 - Optional Waiver Coverage- Family Planning

Current through June 25, 2024
Section 1115(a) waiver coverage provides family planning and
				  family planning related services to women of child bearing age who have family
				  incomes at or below one hundred eighty-five percent (185%) of the federal
				  poverty level converted to a Modified Adjusted Gross Income (MAGI)-equivalent
				  standard who are not otherwise eligible for Medicare, Medicaid, Children's
				  Health Insurance Program (CHIP) or other health insurance that includes
				  coverage of family planning services. Effective January 1, 2015, the family
				  planning waiver includes the coverage of men. All individuals qualifying for
				  coverage of family planning services under the waiver must be within the age
				  and income limits, as determined by the Division of Medicaid.
42 USC §
											1315; Family Planning Waiver
				  (FPW).
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 8 - Coverage of the Categorically Needy in Mississippi › Rule 23-100-8.17 - Optional Waiver Coverage - 1915(c) Home and Community-Based Waivers

Current through June 25, 2024
Section 1915(c) Home and Community-Based Services (HCBS)
				  waiver coverage includes the following :
A. Elderly and Disabled (E&D) Waiver
				[Refer to Miss. Admin. Code Part 208, Chapter 1],
B. Independent Living (IL) Waiver [Refer to
				Miss. Admin. Code Part 208, Chapter 2],
C. Assisted Living (AL) Waiver [Refer to
				Miss. Admin. Code Part 208, Chapter 3],
D. Traumatic Brain Injury/Spinal Cord Injury
				(TBI/SCI) Waiver [Refer to Miss. Admin. Code Part 208, Chapter 4], and
E. Intellectual
				Disabilities/Developmental Disabilities (ID/DD) Waiver [Refer to Miss. Admin.
				Code Part 208, Chapter 5].
42 USC §
											1315; Miss. Code Ann.
				  43-13-117.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 9 - Administrative Rules › Rule 23-100-9.1 - Public Notice

Current through June 25, 2024
The Division of Medicaid provides public notice of any:
A. Significant proposed change in
				methods and standards for setting payment rates for State Plan services, except
				when a change is:
1. Being made to conform to
				Medicare methods or levels of reimbursement,
2. Required by a court order, or
3. Based on changes in wholesalers' or
				manufactures' prices of drugs or materials, if the Division of Medicaid's
				reimbursement system is based on material cost plus a professional fee.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 9 - Administrative Rules › Rule 23-100-9.2 - Public Records

Current through June 25, 2024
A. The Division of
				Medicaid defines "public records" as all books, records, papers, accounts,
				letters, maps, photographs, films, cards, tapes, recordings or reproductions
				thereof, and any other documentary materials, regardless of physical form or
				characteristics, having been used, being in use, or prepared, possessed or
				retained for use in the conduct, transaction or performance of any business,
				transaction, work, duty or function of the Division of Medicaid or required to
				be maintained by the Division of Medicaid.
B. The Division of Medicaid allows any person
				the right to inspect, copy, mechanically reproduce or obtain a reproduction of
				any public record of the Division of Medicaid, unless the record is exempt from
				public inspection as specified by federal and/or state law, during the Division
				of Medicaid's normal business hours, Monday through Friday, 8:00 a.m. to 5:00
				p.m., excluding legal holidays.
1. Public
				records must be inspected or reproduced at the central or regional office(s) of
				the Division of Medicaid, depending on the type of public records
				requested.
2. The Division of
				Medicaid may have a staff member observe the inspection or reproduction of
				public records by the requestor.
3.
				The Division of Medicaid will provide reasonable space for the inspection
				and/or reproduction of public records.
4. Requested public records and/or
				information will be provided by a Division of Medicaid staff member.
5. Public records subject to inspection
				and/or reproduction may not be destroyed, altered, marked upon, or disassembled
				in any manner by the requestor.
6.
				The time, place and manner of inspection and/or reproduction of public records
				cannot interfere with other essential duties or unreasonably disrupt operations
				of the Division of Medicaid.
7.
				The time, place and manner of inspection and/or reproduction of public records
				must be mutually agreed upon by the Division of Medicaid and the
				requestor.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 9 - Administrative Rules › Rule 23-100-9.3 - Declaratory Opinions

Current through June 25, 2024
A. This rule sets
				forth the Mississippi Division of Medicaid's rules governing the form, content,
				and filing of requests for declaratory opinions, the procedural rights of
				persons in relation to the written requests, and the Mississippi Division of
				Medicaid's procedures regarding the disposition of requests as required by
				Miss. Code Ann. §
									25-43-2.103.
B. The Mississippi Division of Medicaid will
				issue declaratory opinions regarding the applicability to specified facts of:
1. A statute administered or enforceable by
				the Mississippi Division of Medicaid;
2. A rule promulgated by the Mississippi
				Division of Medicaid; or
3. An
				order issued by the Mississippi Division of Medicaid.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 9 - Administrative Rules › Rule 23-100-9.4 - Oral Proceedings

Current through June 25, 2024
A. This rule
				applies to all oral proceedings held for the purpose of providing the public
				with an opportunity to make oral presentations or written input on proposed new
				rules, amendments to rules, and proposed repeal of existing rules before the
				Mississippi Division of Medicaid pursuant to the Administrative Procedures Act,
				specifically Miss. Code Ann. §
									25-43-3.104.
B. When a political subdivision, an agency,
				or ten (10) persons request an oral proceeding in regards to a proposed rule
				adoption, the requestor must submit a printed, typewritten, or legibly
				handwritten request.
1. Each request must be
				submitted on 8-1/2" x 11" white paper.
2. The request may be in the form of a letter
				addressed to the Executive Director of the Mississippi Division of Medicaid or
				in the form of a pleading as if filed with a court.
3. Each request must include the full name,
				telephone numbers, and mailing address of the requestor(s).
4. All requests shall be signed by the person
				filing the request, unless represented by an attorney, in which case the
				attorney may sign the request.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 100 - General Provisions › Chapter 9 - Administrative Rules › Rule 23-100-9.5 - Public Hearings

Current through June 25, 2024
A. This rule applies
				to all public hearings held for the purpose of providing the public with an
				opportunity for input on the Division of Medicaid's submissions to the Centers
				for Medicare and Medicaid Services (CMS).
B. The date, time, and place of a public
				hearing will be published as part of a public notice.
C. Public hearings held by the Division of
				Medicaid will allow for a reasonable time for the public to provide input.
D. The presiding officer may place
				time limitations on individual presentations when necessary to assure the
				orderly and expeditious administration of the public hearing.
E. The Division of Medicaid is not required
				to respond to public comments or questions during a public hearing.
F. Physical and documentary submissions
				presented by participants of a public hearing are to be submitted to the
				presiding officer and become property of the Division of Medicaid, subject to
				the public records request procedure.
G. The Division of Medicaid may record public
				hearings by stenographic or electronic means.
42 CFR §447.205;
				  Miss. Code Ann. §
										43-13-121.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.1 - Certification Responsibilities

Current through June 25, 2024
Medicaid eligibility is certified or authorized by the
				  following entities:
A. The Social
				Security Administration (SSA),
B.
				The Mississippi Department of Child Protection Services (DCPS),
C. The Mississippi Division of Medicaid, and
D. Qualified Hospitals that
				certify Hospital Presumptive Eligibility (HPE).
42 C.F.R. §
											435.1110; Miss. Code Ann. §
										43-13-115.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.2 - Coverage of Mandatory and Optional Categorically Needy Individuals

Current through June 25, 2024
A. The Division of Medicaid covers the
				following categorically needy individuals as mandated by federal law listed in
				Miss. Admin. Code Part 101, Rules 1.2 - 1.11.
B. The Division of Medicaid covers the
				following optional categorically needy groups as authorized by state law listed
				in Miss. Admin. Code Part 101, Rules 1.12 - 1.18.
42 C.F.R. §
											435.2; Miss. Code Ann. §
										43-13-115.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.3 - Modified Adjusted Gross Income (MAGI) Related Coverage and Aged, Blind and Disabled (ABD) Coverage

Current through June 25, 2024
A. Coverage for
				children, pregnant women, parents and caretaker relatives are referred to as
				MAGI-related coverage due to the application of Modified Adjusted Gross Income
				or MAGI standards to these groups.
1. Income
				standards for MAGI-related coverage are referred to as MAGI-equivalent
				standards.
2. Effective January 1,
				2014, the Affordable Care Act (ACA) required that net income thresholds in
				effect prior to the ACA be converted to equivalent MAGI levels to account for
				income disregards eliminated by the ACA.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.4 - Rule Mandatory Coverage of Parents and Other Caretaker Relatives

Current through June 25, 2024
A. Coverage is mandatory for parents and
				other caretaker relatives who have a dependent child or children under the age
				of eighteen (18) living in the home whose household income is below the
				applicable limit established by the state for coverage.
1. The limit established by the state is a
				modified adjusted gross income (MAGI) equivalent standard based on household
				size.
2. The Division of Medicaid
				certifies eligibility for this group.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.5 - Mandatory Coverage of Pregnant Women

Current through June 25, 2024
A. Coverage is mandatory for pregnant woman
				whose household income is at or below the income standard established by the
				state, not to exceed one hundred eighty-five percent (185%) of the federal
				poverty level (FPL) converted to a modified adjusted gross income (MAGI)
				equivalent standard. The Division of Medicaid certifies eligibility for this
				group.
B. The Division of Medicaid
				extends eligibility to the postpartum period for women who applied and were
				eligible for Medicaid services on the day their pregnancy ended.
1. This period extends through the last day
				of the month in which the twelve (12) month postpartum period ends.
2. Eligibility is met regardless of changes
				in the woman's financial circumstances that may occur within this extended
				period.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.6 - Mandatory Coverage of Newborns

Current through June 25, 2024
A. Coverage is
				mandatory for infants born to Medicaid eligible mothers.
1. The infant is deemed eligible for one (1)
				year from the date of birth.
2.
				Retroactive eligibility for coverage applies in instances where the labor and
				delivery services were furnished prior to the date of Medicaid application
				provided the Medicaid application is filed by the end of the third (3 
				rd) month following the birth month of
				the infant.
3. The Division of
				Medicaid is responsible for certifying eligibility for deemed eligible
				newborns.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.7 - Mandatory Coverage of Infants and Children under Age Nineteen (19)

Current through June 25, 2024
A. Coverage is mandatory for infants to age
				one (1) in households whose income is at or below one hundred eighty-five
				percent (185%) of the federal poverty level (FPL) converted to a modified
				adjusted gross income (MAGI) equivalent standard.
B. Coverage is mandatory for children age one
				(1) to age six (6) whose household income is at or below one hundred
				thirty-three percent (133%) of the FPL converted to a MAGI-equivalent standard.
C. Children age six (6) to age
				nineteen (19) are eligible for Medicaid if household income is at or below one
				hundred thirty-three percent (133%) of the FPL. This limit is not converted to
				a MAGI-equivalent standard since federal law specifies that one hundred
				thirty-three percent (133%) is the maximum limit.
D. The Division of Medicaid certifies
				eligibility for these age-specific groups of children.
42 C.F.R. §
											435.118.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.8 - Mandatory Coverage of Adoption Assistance and Foster Care Children

Current through June 25, 2024
A. Coverage is mandatory for children for
				whom adoption assistance or foster care maintenance payments are made under
				Title IV-E of the Social Security Act, as determined by the Mississippi
				Department of Child Protection Services (DCPS) who certifies eligibility for
				this group of children
B. Coverage
				is mandatory for former foster care children who are under age twenty-six (26)
				if the child was in foster care and enrolled in Medicaid upon reaching age
				eighteen (18) or prior to age twenty-one (21) when released from foster care.
				Continued Medicaid coverage is certified by the Division of Medicaid in
				coordination with DCPS.
42 USC §
											1396a; 42 C.F.R §
				  435.145.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.9 - Mandatory Coverage of the Aged, Blind and Disabled (ABD)

Current through June 25, 2024
A.
				Coverage is mandatory for individuals receiving Supplemental Security Income
				(SSI) in Mississippi.
1. This includes
				individuals:
a) Receiving Supplemental
				Security Income (SSI) pending a final determination of blindness or disability,
				those receiving SSI under an agreement to dispose of resources that exceed the
				SSI resource limit, and those receiving benefits under section 1619(a) or
				considered to be receiving SSI under 1619(b) of the Social Security
				Act.
b) Who would be eligible for
				SSI except for an eligibility requirement used in the SSI program that is
				specifically prohibited under Title XIX.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.10 - Mandatory Coverage of Certain Medicare Cost-Sharing Groups

Current through June 25, 2024
The Division of Medicaid covers the following Medicare
				  cost-sharing groups.
A. Qualified
				Medicare Beneficiaries (QMB) must be entitled to Medicare Part A and have
				income that does not exceed one hundred percent (100%) of the federal poverty
				level (FPL). Medical assistance is limited to payment of Medicare cost-sharing
				expenses that includes premiums, co-insurance and deductible charges.
B. Specified Low-Income Medicare
				Beneficiaries (SLMB) must be entitled to Medicare Part A and have income that
				exceeds one hundred percent (100%) of the FPL but does not exceed one hundred
				twenty percent (120%) of the FPL. Medical assistance for this group is limited
				to payment of Medicare Part B premiums.
C. Qualifying Individuals (QI) must be
				entitled to Medicare Part A and have income that exceeds one hundred twenty
				percent (120%) of the federal poverty level but does not exceed one hundred
				thirty-five percent (135%) of the FPL.
1.
				Medical assistance for this group is limited to payment of Medicare Part B
				premiums under a federal allotment of funds.
2. Eligibility for coverage as a QI is
				dependent on the availability of federal funds.
Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes › Chapter 1 - Coverage of the Categorically Needy in Mississippi › Rule 23-101-1.11 - Mandatory Coverage of Certain Aliens for Emergency Services

Current through June 25, 2024
A. Coverage is limited to emergency services,
				including labor and delivery services, for aliens who are in need of treatment
				of an emergency medical condition who meet all eligibility requirements for
				Medicaid coverage except for their alien status.
1. Coverage is limited to treatment of the
				emergency condition only.
2.
				Transplant services are prohibited.