Division of Medicaid

A. Providers of Family Planning Waiver (FPW) services must comply with the requirements for maintenance of records outlined in Miss. Admin. Code Part 200, Rule 1.3. B. FPW services documentation must include, but is not limited to: 1. Date of service, 2. Reason for visit, 3. Phys…

A. The Division of Medicaid covers maternity services which include: 1. Antepartum services defined by the Division of Medicaid as the care of a pregnant woman during the time in the maternity cycle that begins with conception and ends with labor. 2. Delivery services defined by …

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. Notes 23 Miss. Code. R. 222-1.10 Miss. Code Ann. § 43-13-121

A. The Division of Medicaid defines Screening, Brief Intervention, and Referral to Treatment (SBIRT) as an early intervention approach that targets pregnant women with nondependent substance use to provide effective strategies for intervention prior to the need for more extensive…

A. The Division of Medicaid covers one (1) face-to-face counseling session per quit attempt with mandatory referral to the Mississippi (MS) Tobacco Quit Line for pregnant women who use tobacco. B. Face-to-Face sessions must be provided by: 1. Or under supervision of a physician, …

Notes 23 Miss. Code. R. 222-1.2 Amended 1/2/2015

A. For a fetal biophysical profile, the physician may bill one (1) unit for each fetus being evaluated in cases of multiple gestations. B. For an ultrasound during hospitalization, Medicaid reimburses the physician submitting a claim for a visit and a review of an ultrasound on t…

A. Medicaid covers a maternity epidural for all pregnant Medicaid beneficiaries. Medicaid considers maternity epidurals as a medically necessary service for treatment of labor pain and does not consider it an elective procedure. B. A physician who is participating in the Medicaid…

Notes 23 Miss. Code. R. 222-1.5 Amended 1/2/2015

A delivery, cesarean section or vaginal, and a tubal ligation performed at the same setting will be reimbursed at one hundred percent (100¢) of the fee schedule for each procedure. Notes 23 Miss. Code. R. 222-1.6 Miss. Code Ann. § 43-13-121

Medicaid reimburses covered sterilization procedures when the criteria for covered sterilization are satisfied in accordance with Part 202, Chapter 1, Rule 1.8. Notes 23 Miss. Code. R. 222-1.7 Miss. Code Ann. § 43-13-121; 42 CFR 441, Subpart F

Terbutaline pump therapy with uterine activity monitoring for beneficiaries who are at risk for preterm labor is not covered by Medicaid. Notes 23 Miss. Code. R. 222-1.8 Miss. Code Ann. § 43-13-121

Notes 23 Miss. Code. R. 222-1.9 Miss. Code Ann. § 43-13-121 Reserved 9/1/2023

A. The provider, agency, or entity of Targeted Case Management (TCM) services for high-risk women who are pregnant and up to sixty (60) days postpartum or high-risk infants through one (1) year of age must comply with the requirements to enroll as a Mississippi Medicaid Early and…

A. A medical risk screen must be conducted to determine the need to refer an individual for Targeted Case Management (TCM) services. Referrals for TCM services must be initiated during the pregnancy for the woman, or birth through one (1) year of age for the infant. The medical r…

A. To qualify for reimbursement, a case file with adequate documentation must be maintained for each participant receiving Targeted Case Management (TCM) through the Perinatal High-Risk Management/Infant Services System (PHRM/ISS) program. Each TCM case file must, at a minimum, c…

A. Medicaid beneficiaries have the right to freedom of choice of providers for Medicaid covered services. Refer to Part 200, Chapter 3, Rule 3.6. B. Perinatal High-Risk Management/Infant Services System (PHRM/ISS) Targeted Case Management (TCM) services will not restrict an indiv…

A. The provider must bill the appropriate HCPCs code and modifier HD for maternity and infant services to be reimbursed under the PHRM/ISS program. B. Payments under the plan must not duplicate payments made to public agencies or private entities under other program authorities f…

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. Notes 23 Miss. Code. R. 222-2.6 Miss. Code Ann. § 43-13-121. Amended 7/…

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. Notes 23 Miss. Code. R. 222-2.7 Miss. Code Ann. § 43-13-121

A. The Division of Medicaid has established a program of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) which provides screenings, preventive and comprehensive health services for certain beneficiaries who are eligible for full Medicaid benefits. EPSDT services ar…

A. Physicians, physician assistants or nurse practitioners who wish to provide EPSDT screenings must meet the Mississippi Medicaid enrollment requirements, complete and sign an EPSDT specific provider agreement and pass an onsite clinic inspection performed by the Division of Med…

A. Enrolled Mississippi Medicaid providers who have signed an Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) specific provider agreement must conduct periodic screenings and medically necessary inter periodic visits for all EPSDT-eligible beneficiaries in accordan…

A. EPSDT providers must adhere to the current American Academy of Pediatrics (AAP) Bright Futures Periodicity Schedule. B. EPSDT providers must schedule all health assessment screening appointments for the EPSDT-eligible beneficiary according to the AAP Bright Futures Periodicity…

A. An initial or established age-appropriate medical screening which must include at a minimum: 1. A comprehensive health and developmental history including assessment of both physical and mental health development and family history, 2. A comprehensive unclothed physical examin…

A. The medical record must include, at a minimum, documentation of the specific age appropriate screening requirements according to the American Academy of Pediatrics (AAP) Bright Futures Periodicity Schedule including the date the test or procedure was performed, the specific te…

The Division of Medicaid covers any medically necessary Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) diagnostic and treatment services required to correct or ameliorate physical, mental, psychosocial, and/or behavioral health conditions discovered by a screening…

A. The Division of Medicaid reimburses a separate fee in addition to the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) periodic screenings and medically necessary interperiodic visits for each of the following when documented in accordance with Miss. Admin. Code …

The Division of Medicaid defines: A. Early and Periodic Screening, Diagnosis and Treatment (EPSDT)-eligible beneficiaries as beneficiaries who qualify for the federally mandated EPSDT program according to 42 U.S.C. § 1396 d and 42 C.F.R. Part 441. B. Prescribed pediatric extended…

A. Prescribed pediatric extended care (PPEC) providers, including out-of-state providers, must satisfy all requirements set forth in Miss. Admin Code Title 23, Part 200, Rule 4.8 in addition to the following provider type specific requirements: 1. National Provider Identifier (NP…

A. The Division of Medicaid covers up to twelve (12) hours per day of medically necessary prescribed pediatric extended care (PPEC) services for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) eligible beneficiaries when: 1. Ordered by the beneficiary's attending ph…

The Division of Medicaid does not cover the following as prescribed pediatric extended care (PPEC) services: A. Services that are not part of a written plan of care, B. Services that have not been ordered by a physician, C. Educational services, D. Services provided to beneficiar…

A. The Division of Medicaid reimburses up to twelve (12) hours per day of medically necessary prescribed pediatric extended care (PPEC) services for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) eligible beneficiaries when: 1. Ordered by the beneficiary's attendin…

A. Providers must maintain required documentation in accordance with Miss. Admin. Code Part 200, Rule 1.3, and must maintain auditable records to substantiate claims submitted to the Division of Medicaid or designated entity. B. Documentation must include, but is not limited to: …

The Division of Medicaid defines: A. A medically necessary early and periodic screening, diagnosis and treatment (EPSDT) service as a service necessary to correct or ameliorate the individual child's physical or mental condition with the determination made on a case-by-case basis…

A. Private duty nursing (PDN) providers must:1. Have a Division of Medicaid approved PDN proposal package. 1. Establish a provider agreement with the Mississippi Division of Medicaid. 2. Satisfy all requirements in accordance with Part 200, Rule 4.8 and must provide to the Divisi…

A. The Division of Medicaid covers medically necessary private duty nursing (PDN) services only for early and periodic screening, diagnosis and treatment (EPSDT)-eligible beneficiaries when:1. Ordered and directed by the beneficiary's primary physician or appropriate physician sp…

A. Private duty nursing (PDN) providers must submit a prior authorization request to the Division of Medicaid or designee prior to the initiation of PDN services which must include, at a minimum, the following: 1. A signed physician or specialist's order for PDN and a signed init…

Private duty nursing (PDN) services will be discontinued when one (1) or more of the following is met: A. When all of the following exist: 1. Beneficiary's condition is clinically stable, 2. The licensed nurses' skills are not required to provide ongoing nursing assessment and/or…

A. The Division of Medicaid does not cover private duty nursing (PDN) services solely for the convenience of the child, the parents or the caregiver. B. Non-covered PDN services include, but are not limited to: 1. PDN services solely for: a) Nasogastric or gastrostomy feedings, b…

A. The Division of Medicaid or designee will issue a written denial to the private duty nursing (PDN) provider providing PDN services when the beneficiary no longer meets the medical and/or home environment criteria for PDN services. B. The denial of services is effective thirty …

A. The Division of Medicaid reimburses private duty nursing (PDN) services for a registered nurse (RN) by adding the Federal Insurance Contributions Act (FICA) percentage of 7.65% and an administrative allowance of 0.53% to the May 2018 National Bureau of Labor Statistics (BLS) H…

A. Nurses providing private duty nursing (PDN) services must document all nursing care rendered during each shift including, but not limited to: 1. Current physician's orders, 2. Medications administered and response, 3. Treatments administered and response, 4. Any other professi…

The Division of Medicaid defines: A. A medically necessary early and periodic screening, diagnosis and treatment (EPSDT) service as a service necessary to correct or ameliorate the individual child's physical or mental condition with the determination made on a case-by-case basis…

A. Certified Nursing Assistants (CNAs) providing personal care services (PCS) must be hired and managed by private duty nursing (PDN) providers. PDN providers employing CNAs must:1. Enter into a provider agreement with the Mississippi Division of Medicaid. 2. Satisfy all requirem…

A. The Division of Medicaid covers medically necessary personal care services (PCS) only for early and periodic screening, diagnosis and treatment (EPSDT)-eligible beneficiaries when:1. Ordered and directed by the beneficiary's primary physician or appropriate physician specialis…

A. Private duty nursing (PDN) providers employing Certified Nursing Assistants (CNAs) must submit a prior authorization request to the Division of Medicaid or designee at least two (2) weeks prior to the initiation of personal care services (PCS) that must include, at a minimum, …