Division of Medicaid

The Division of Medicaid reimburses personal care services (PCS) for a certified nursing assistant (CNA) by adding the Federal Insurance Contributions Act (FICA) percentage of 7.65% and an administrative allowance of 21.35% to the May 2018 National Bureau of Labor Statistics (BLS…

A. Certified Nursing Assistants (CNAs) providing personal care services (PCS) must document all care rendered during each shift including, but not limited to: 1. Assistance with activities of daily living (ADL), and 2. Any significant changes in the beneficiary's condition. B. We…

A. The Division of Medicaid defines: 1. Clinical/medical case record as the central repository of all pertinent information about the beneficiary that provides an accurate chronological accounting of the treatment plan and progress. 2. Day treatment as a behavioral intervention a…

A. Providers of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Rehabilitative Services must comply with the provider requirements described in Miss. Admin. Code Title 23, Part 206, Rule 1.1. B. Providers employing any evidence-based practices (EBP) in the course of…

A. All State Plan services described in Miss. Admin. Code Part 206 and Part 223 are covered for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)-eligible beneficiaries without regard to service limits when prior authorized by the Utilization Management/Quality Impro…

A. The Division of Medicaid does not cover: 1. Educational interventions of an academic nature performed by the Department of Education, 2. Same service provided on the same date, regardless of the setting(s) in which the service was provided unless service specifically states ot…

A. The Division of Medicaid reimburses expanded rehabilitative services based on a statewide uniform fee schedule. B. The Division of Medicaid does not reimburse for the duplication of services. 1. Providers are responsible for coordinating services with the beneficiary and guard…

A. The medical record must be in compliance with Miss. Admin. Code Part 200, Rule 1.3 and include the following documentation:1. Consent for treatment obtained yearly, 2. Date of service, 3. Type of service provided, 4. Time session began and time session ended, 5. Length of time…

The Division of Medicaid defines: A. Centers for Disease Control and Prevention (CDC) as the nation's public health protection agency with the authority to implement regulations related to protecting America from health and safety threats, both foreign and within the United State…

A. Providers must satisfy all requirements set forth in Part 200, Rule 4.8 in addition to the following:1. National Provider Identifier (NPI), verification from National Plan and Provider Enumeration System (NPPES). 2. Written confirmation from the Internal Revenue Service (IRS) …

The Division of Medicaid covers vaccines according to the indications and guidelines of the Centers for Disease Control and Prevention (CDC) administered to beneficiaries: A. Eighteen (18) years of age and younger when administered by physician and non-physician practitioner prov…

The Division of Medicaid does not cover the administration of additional components in a combination vaccine separately if ACIP recommends a combination vaccine available through the VFC program. Notes 23 Miss. Code. R. 224-1.4 42 USC § 300aa-26; Miss. Code Ann. 43-13-121. Amende…

A. The Division of Medicaid reimburses the lessor of the provider's usual and customary charge or a fee from the Mississippi Medicaid fee schedule. 1. Physicians, nurse practitioners, and physician assistants: a For vaccines available through the VFC program administered to benef…

Providers administering vaccines must document the following in addition to other documentation required by other federal and state regulatory agencies: A. The date the beneficiary, or parent or legal representative if the beneficiary is a minor, received a current copy of the re…

A. The Division of Medicaid covers the following vaccines according to the indications and guidelines of the Centers for Disease Control and Prevention (CDC) for beneficiaries nineteen (19) years of age and older through the pharmacy program: 1. Influenza, 2. Pneumococcal, 3. Her…

The Division of Medicaid defines telemedicine as a method which uses electronic information and communication equipment to supply and support health care when remoteness disconnects patients and links primary care physicians, specialists, providers, and beneficiaries which includ…

A. Providers of telehealth services must comply with all requirements set forth in Miss. Admin. Code Part 200, Rule 4.8 for all providers in addition to the provider specific requirements below:1. National Provider Identifier (NPI), verification from National Plan and Provider En…

A. The Division of Medicaid covers medically necessary telehealth services as a substitution for an in-person visit for consultations, office visits, and/or outpatient visits when all the required medically appropriate criteria is met which aligns with the description of the Curr…

The Division of Medicaid does not: A. Cover a telehealth service if that same service is not covered in an in-person setting. B. Cover a separate reimbursement for the installation or maintenance of telehealth hardware, software and/or equipment, videotapes, and transmissions. C.…

A. The Division of Medicaid reimburses the provider at the originating site the Mississippi Medicaid telehealth originating site facility fee for telehealth services per completed transmission, in addition to a separately identifiable covered service if performed.1. The following…

The provider must document the same information as for a comparable in-person service and be maintained at both the originating and distant site of the telehealth services provided including, but not limited to: A. Signed consent for treatment using telehealth, B. Medically appro…

The Mississippi Division of Medicaid will allow additional coverage of telehealth services during a state of emergency as declared by either the Governor of Mississippi or the President of the United States. Details of enhanced services include the following that will terminate a…

A. The Division of Medicaid defines telemedicine as a method which uses electronic information and communication equipment to supply and support health care when remoteness disconnects patients and links primary care physicians, specialists, providers, and beneficiaries which inc…

A. Providers of remote patient monitoring services must comply with all requirements set forth in Miss. Admin. Code Part 200, Rule 4.8 for all providers in addition to the provider specific requirements below: 1. National Provider Identifier (NPI), verification from National Plan…

A. The Division of Medicaid covers remote patient monitoring of devices when medically necessary, ordered by a physician, physician assistant or nurse practitioner which includes, but not limited to:1. Implantable pacemakers, 2. Defibrillators, 3. Cardiac monitors, 4. Loop record…

The Division of Medicaid does not cover remote patient monitoring for disease management as outlined in Miss. Admin. Code Part 225, Rule 2.3.B. for a beneficiary who is a resident of an institution that meets the basic definition of a hospital or long-term care facility. Notes 23…

A. The Division of Medicaid reimburses for remote patient monitoring: 1. Of devices when billed with the appropriate code, and 2. For disease management: a) A daily monitoring rate for days the beneficiary's information is reviewed. b) Only one (1) unit per day is allowed, not to…

The provider must document the remote patient monitoring service the same as for a comparable in person service which includes, but is not limited to: A. The monitoring equipment meets all of the following requirements: 1. Capable of monitoring any data parameters included in the…

The Division of Medicaid defines telemedicine as a method which uses electronic information and communication equipment to supply and support health care when remoteness disconnects patients and links primary care physicians, specialists, providers, and beneficiaries which includ…

A. Providers of teleradiology services must comply with all requirements set forth in Miss. Admin. Code Part 200, Rule 4.8 for all providers in addition to the provider specific requirements below: 1. National Provider Identifier (NPI), verification from National Plan and Provide…

The Division of Medicaid covers: A. One (1) technical and one (1) professional component for each teleradiology procedure only for providers enrolled as a Mississippi Medicaid provider and when there are no geographically local radiologist providers to interpret the images. B. Th…

The Division of Medicaid does not cover: A. The transmission cost or any other associated cost of teleradiology, B. Both the technical and professional component of teleradiology services for one (1) provider, or C. One (1) provider billing for services performed by another provi…

A. The Division of Medicaid reimburses for: 1. The technical component of the radiological service at the originating site for only providers enrolled as a Mississippi Medicaid provider. 2. The professional component of the radiological service at the distant site only for provid…

A. Teleradiology documentation must include, but not limited to: 1. At the originating site: a) The reason teleradiology was utilized to deliver the service including there was no local radiologists to interpret the images, b) Date(s) of service, c) Beneficiary demographic inform…

A.The Division of Medicaid defines telemedicine as a method which uses electronic information and communication equipment to supply and support health care when remoteness disconnects patients and links primary care physicians, specialists, providers, and beneficiaries which incl…

A. Providers of continuous glucose monitoring services must comply with all requirements set forth in Miss. Admin. Code Part 200, Rule 4.8 for all providers in addition to the provider specific requirements below: 1. National Provider Identifier (NPI), verification from National …

A. The Division of Medicaid covers:1. A continuous glucose monitoring (CGM) service when medically necessary, prior authorized by the UM/QIO, Division of Medicaid or designee, ordered by the physician who is actively managing the beneficiary's diabetes and the beneficiary meets a…

The Division of Medicaid does not cover continuous glucose monitoring for: A. Non-diagnostic or personal use at home, or B. Beneficiaries with type II diabetes mellitus. Notes 23 Miss. Code. R. 225-4.4 Adopted 7/1/2015

A. The Division of Medicaid reimburses for: 1. One (1) retrospective review and interpretation of blood glucose values per month, and 2. A one (1) time device hook-up which includes beneficiary education. B. The Division of Medicaid does not reimburse for a separate Evaluation an…

Continuous glucose monitoring (CGM) service documentation must include, but is not limited to: A. The beneficiary and/or care giver is capable of operating the continuous glucose monitoring system, B. The beneficiary: 1. Has an established diagnosis of type I or type II diabetes …

A. Pharmacists participating in the Medicaid program and providing disease management services must comply with the requirements outlined in Part 214, Chapter 1, Rule 1.1 in addition to the following requirements: 1. National Provider Identifier (NPI) verification from National P…

Title 23, Part 300 of the Mississippi Division of Medicaid's Administrative Code establishes procedures applicable to Appeals and Fair Hearings conducted by the Mississippi Division of Medicaid pursuant to 42 C.F.R. Part 431 Subpart E, 42 C.F.R. Part 438 Subpart F, 42 C.F.R. Part…

A. The Division of Medicaid provides an appeal process for applicants, beneficiaries, and providers. B. Appeals for Fee-for-Service (FFS) Applicants, Beneficiaries, and Providers 1. An applicant or beneficiary, or an applicant/beneficiary's representative wishing to appeal a Reco…

The Mississippi Medicaid Law governing the administration of medical assistance makes provision under Section 43-13-116 of the Mississippi Code of 1972, as amended, for fair and impartial hearings in full implementation of the Federal statutory and regulatory requirements. Any pe…

A. When a local hearing is requested, the regional office will notify the applicant/beneficiary or representative in writing of the time and date of the local hearing. B. When a state hearing is requested, the hearing officer assigned to the case will notify the applicant/benefic…

A. A state or local hearing is not open to the public. Persons attending the hearing will attend for the purpose of: 1. Giving information on behalf of the applicant or beneficiary, 2. Rendering the applicant or beneficiary assistance in some other way, or 3. To represent the Div…

A. Withdrawal of a request for hearing must be in writing and submitted by: 1. The applicant/beneficiary, or 2. The applicant/beneficiary's representative, and 3. Bear the applicant/beneficiary's signature or the representative's signature. B. A state or local hearing request may…