Division of Medicaid

A. These payments are defined as follows:1. Payments to low-income families or to children with special needs for certain childcare activities, such as early childhood development, before and after school services and services designed to permit a parent to continue working. B. T…

A. These payments are defined as follows:1. Payments made under section 657 of the National Defense Authorization Act to an individual (or if deceased, to the surviving spouse or child of any age) captured and interned by the Democratic Republic of North Vietnam as a result of pa…

A. These payments are defined as follows:1. Lump sum payments for medical and other expenses associated with energy-related occupational illnesses. B. These payments are treated as follows: 1. Lump sum payments made under EEOICPA, including reimbursement for medical expenses, are…

A. These payments are defined as follows: 1. The American Recovery and Reinvestment Act signed February 17, 2009, established a one-time payment to eligible Filipino veterans (or surviving spouse) who aided American troops during World War II. Must file within one year of enactme…

A. These payments are defined as follows:1. SNAP; 2. School Lunch Program; 3. Child Nutrition Programs; and 4. Nutrition Programs for Older Americans. B. These payments are treated as follows:1. The value of food or assistance offered under these programs is excluded from income …

A. These gifts are defined as follows: 1. Any in-kind gift, not converted to cash, and cash gifts that do not exceed $2000 in any calendar year from a 501(c)(3) organization (e.g., Make-a-Wish Foundation, other charities or churches) for the benefit of a child under age 18 with a…

A. These payments are defined as follows: 1. Payments from Ricky Ray Hemophilia Relief Fund and Susan Walker v. Bayer Corporation, et al, settlement fund. B. These payments are treated as follows: 1. These payments are excluded from income and resources. 2. The interest earned on…

A. These payments are defined as follows: 1. Sick pay is a payment made to or on behalf of an employee by an employer or a private third party (such as a union or insurance company) for sickness or accident disability. Sick pay is either wages or unearned income. 2. Payments unde…

A. These payments are defined as follows:1. Wages are what an individual receives (before deductions) for working as someone else's employee. a) Under certain conditions, services performed as an employee are deemed self-employment rather than wages, e.g., ministers, real estate …

A. A Cafeteria Plan is defined as follows: 1. A written benefit plan offered by an employer in which: a) All participants are employees, and b) Participants choose cafeteria-style from a menu of two or more cash or qualified benefits. 1) A qualified benefit is not considered part…

A. These payments are defined as follows:1. Wage advances are payments by an employer to an individual for work to be done in the future. 2. Wages are considered "deferred" if they are received later than their normal payment date. a) Types of wage payments that may be deferred i…

A. NESE is defined as follows:1. NESE is the gross income from any trade or business, less allowable deductions for that trade or business. a) Any distributive share (whether distributed or not) of income or loss from a trade or business carried on by a partnership is included in…

A. These payments are defined as follows:1. Payment for services performed in a sheltered workshop or work activities center are what an individual receives for participating in a program designed to help him become self-supporting.a) A sheltered workshop is a nonprofit organizat…

A. These payments are defined as follows:1. Royalties include compensation paid to the owner for the use of property, usually copyrighted material (e.g., books, music, or art) or natural resources (like minerals, oil, gravel or timber). Royalty compensation may be expressed as a …

A. These types of income are broadly defined as follows: 1. Compensation to members of the Uniformed Services takes several forms, chiefly: a) Basic or Base Pay; b) Special and Incentive Pay; and c) Cash Allowances. B. These types of income are treated as follows:1. Cash payments…

A. This type of income is treated as follows:1. The existence of a vow of poverty is a factor in determining whether cash is considered wages or net earnings from self-employment. 2. The existence of a vow of poverty is also a factor in determining if payments made by a member to…

A. The Affordable Care Act (ACA) requires the use of MAGI-based budgeting rules for determining household size, household composition, household income and need standards which are all defined below. MAGI-based budgeting processes include rules for households that file federal in…

A. A tax filer's household includes the tax filer, spouse and all dependents that the tax filer claims or plans to claim in the tax year for which eligibility is requested. 1. Spouses whose tax filing status is married filing jointly are considered one household whether living to…

A. A tax dependent who is not the tax filer's spouse or child is treated as a non-filer, described in Rule 1.4. B. A tax dependent under age 19 who lives with two parents who do not expect to file a joint tax return is treated as a non-filer, described in Rule 1.4. C. A tax depen…

A. A non-filer is someone who neither files a federal tax return nor is claimed as a tax dependent. For individuals who are non-filers or exceptions to tax filer rules, budgeting rules depend on whether the individual is an adult or child under age 19 living in the same household…

A. Parent(s) or Caretaker Relatives that lose Medicaid due to increased hours or income from employment are eligible for extended Medicaid for up to twelve (12) consecutive months from the month of ineligibility provided the adult(s) received Medicaid as a parent or caretaker rel…

A. Parent(s), meaning a single parent or parent and step-parent family, that lose Medicaid in the parent/caretaker relative category of coverage due to new or increased spousal support under title IV-D of the Social Security Act must continue to receive Medicaid for four (4) cons…

A. Katie Beckett category of eligibility. A disabled child under the age of nineteen (19) must meet all of the following requirements:1. The child must be determined disabled using Supplemental Security Income (SSI) criteria as outlined in Miss. Admin Code, Title 23, Part 102, Ru…

A. Long Term Hospitalization 1. An individual can qualify for Medicaid using institutional rules after meeting the thirty (30) consecutive day requirement, as outlined in Miss. Admin. Code, Title 23, Part 105, Chapter 7, Rule 7.5. Individuals eligible in an at-home category of el…

After an individual has been determined eligible for Medicaid in a long term care facility, the amount the individual must pay toward the cost of their care must be determined. This payment, referred to as Medicaid Income or patient liability, is income that remains after allowab…

A. Records and information acquired in the administration of any part of the Social Security Act are confidential and may be disclosed only under the conditions prescribed in rules and regulations of the Department of Health and Human Services (DHHS) or when authorized by the Sec…

A. The Division of Medicaid defines an electronic signature (e-signature) as an electronic symbol attached to or logically associated with a document or communication to be transmitted or submitted to the Division of Medicaid. 1. The Division of Medicaid recognizes an electronic …

A. The Division of Medicaid allows providers' signatures on claims to be applied using one (1) of four (4) different methods: 1. Electronic signature [Refer to Miss. Admin. Code Part 200, Rule 1.10 ], 2. Typed signature, 3. Signature stamp bearing the signature of the provider, o…

A. The Division of Medicaid defines National Correct Coding Initiative (NCCI) edits as edits implemented in the Medicaid Management Information System (MMIS) to control improper coding leading to inappropriate payments which includes: 1. NCCI procedure to procedure (PTP) edits de…

A. The Division of Medicaid requires providers to adhere to Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) billing and coding guidelines when reporting timed-based services. 1. Providers are required to bill for services according to Me…

A. Public access to records maintained by the Division of Medicaid is described in Section 25-61-1 et seq. of the Mississippi Code of 1972, as amended. An exception to this public access for Medicaid purposes is beneficiary specific information which must be kept confidential in …

A. All professional, institutional, and contractual providers participating in the Medicaid program must: 1. Maintain all records substantiating services rendered and/or billed under the program, and 2. Upon request, make such records available to representatives of the Departmen…

A. Fundraising may only be used to obtain funds needed to pay for medical/treatment costs not normally covered by the Mississippi Medicaid program. Such costs include, but are not limited to the following:1. Transportation for family members, 2. Food and lodging for the beneficia…

For Division of Medicaid purposes, this plan is established to define the mandated compliance requirements pertinent to the provision of services to individuals with limited English proficiency (LEP), established procedures for requisitioning forms in Spanish and Vietnamese, and …

A. The Division of Medicaid requires providers to submit claims no later than three hundred sixty-five (365) calendar days from the date of service. B. Claims for services submitted by newly enrolled providers must be submitted within three hundred sixty-five (365) calendar days …

A. The Division of Medicaid defines a clean claim as a claim that can be processed without obtaining additional information from the provider of the service or from a third party. 1. Claims with errors originating in the Division of Medicaid's claims system are considered clean c…

A. Providers may request an Administrative Review regarding claims within ninety (90) calendar days of the denial of a claim when:1. The provider is unable to meet the timely filing requirement due to retroactive beneficiary eligibility and has:a) Received prior authorization, if…

The Division of Medicaid defines an authorized provider representative as an employee or agent of a provider designated by the provider to act for the provider with the provider's knowledge and written consent in order to manage and submit claims to the Division of Medicaid for p…

A. Federally Mandated Services - The following services are mandated for Mississippi Medicaid: 1. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) (Mississippi Cool Kids Program, 2. Expanded EPSDT, 3. Family Planning, 4. Federally Qualified Health Center (FQHC), 5. …

A. The Division of Medicaid does not cover certain items and services including, but not limited to, the following: 1. Items or services which are furnished gratuitously without regard to the beneficiary's ability to pay and without expectation of payment from any source, includi…

A. A state is not required to cover any Medicare cost sharing expenses related to payment for deductibles, coinsurance, or co-payments for dual eligibles which exceed what the state's Medicaid program would have paid for such service for a beneficiary who is not a dual eligible. …

A. Persons eligible for Full Medicaid Benefits1. Low-income families with children under age eighteen (18) who meet pre-reform Aid to Families with Dependent Children (AFDC) and income criteria, as certified by the Division of Medicaid. 2. Children in licensed foster family homes…

A. The Division of Medicaid covers an infant: 1. Whose mother was eligible for Medicaid in the child's birth month for the first year of life. a. Deemed newborn Medicaid eligibility begins with the birth month and continues through the month of the child's first (1 st) birthday u…

A. Retroactive eligibility is available to individuals during all or part of a three (3) month period before application for Medicaid. Applicants must meet financial and need requirements. B. Medicaid covered services paid for by a beneficiary during the three (3) month period ma…

Medicare is the primary payor for a beneficiary who is both Medicare and Medicaid eligible and has four (4) parts: A. Medicare Part A 1. The Division of Medicaid pays for the Medicare Part A premium through a "buy-in" process for individuals who have income that does not exceed 1…

A. It is the responsibility of the Medicaid provider to verify a Medicaid beneficiary's eligibility each time the beneficiary appears for a service. Evidence of eligibility is demonstrated by the Medicaid identification card issued to each Medicaid eligible member in a family. A …

A. Medicaid beneficiaries have the right to freedom of choice of providers for Medicaid covered services. Any individual eligible for medical assistance, including drugs, may obtain such assistance from any institution, agency, community pharmacy, or person qualified to perform t…