Division of Medicaid

A. The intermediate care facility for individuals with intellectual disabilities (ICF/IID) must provide for all items and services required to meet the needs of a resident according to the comprehensive functional assessment and the individual program plan (IPP). B. Items and ser…

A. Participating Mississippi intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs) must prepare and submit a Long-term Care Medicaid cost report for reimbursement. 1. All cost reports are due by the end of the fifth (5th) calendar month following …

A. The Division of Medicaid defines temporary leave as a temporary absence for one (1) or more calendar days the resident is out of the intermediate care facility for individuals with intellectual disabilities (ICF/IID) for: 1. A home/therapeutic temporary leave. a) The temporary…

A. The intermediate care facility for individuals with intellectual disabilities (ICF/IID) must, upon written authorization by the resident, and/or guardian or legal representative accept responsibility for holding, safeguarding and accounting for the resident's personal funds. 1…

The Division of Medicaid's Utilization Management/Quality Improvement Organization (UM/QIO) is the organization designated to conduct utilization reviews (UR) in intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), as required by the Division of…

A. The purpose of these regulations is to set forth the minimum requirements for providers who provide described mental health services to Medicaid beneficiaries in a Psychiatric Residential Treatment Facility (PRTF). B. The regulations have been prepared for the information and …

A. Psychotherapy is defined as the intentional, face to face interaction between a mental health professional and a client, either an individual, family, or group, in which a therapeutic relationship is established to help resolve symptoms of the resident's mental and/or emotiona…

A. The Division of Medicaid covers medically necessary Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services for EPSDT-eligible beneficiaries in accordance with Miss. Admin. Code Part 223, without regard to service limitations and with prior authorization. B. A …

A. The Division of Medicaid defines special procedures as seclusion and restraint and must be used as an immediate response only in emergency safety situations when needed to help a resident regain control of his/her behavior. At all times, the least restrictive effective interve…

A. Documents pertaining to medication must be accurate and readily located. When medication is a prescribed intervention for a problem identified in the resident's treatment plan, it must be noted as such in the treatment plan. Medication changes must be made during treatment pla…

A. No later than seven (7) days prior to the resident's projected discharge date, the treatment team must develop a provisional aftercare plan for the resident. The plan's content must include, but not be limited to: 1. The planned discharge date, 2. The date of the resident's ad…

A. The PRTF must keep the Division of Medicaid informed of serious occurrences involving residents of the PRTF.1. The death of any resident or a serious incident involving any resident, regardless of whether or not those involved were Medicaid beneficiaries, must be reported to t…

Refer to Maintenance of Records Part 200, Ch.1, Rule 1.3. Notes 23 Miss. Code. R. 207-4.16 Miss. Code Ann. § 43-13-121; 43-21-353

Enrollment into the Medicaid program requires each provider to comply with the requirements outlined Part 200, Chapter 4, Rule 4.8, in addition to the following provider type specific requirements: A. National Provider Identifier (NPI), verification from National Plan and Provide…

The Division of Medicaid requires Psychiatric Residential Treatment Facilities (PRTF) have the following staff: A. The governing body of the PRTF must appoint an administrator to be responsible for the overall management of the facility. The administrator must have appropriate ac…

The Division of Medicaid covers PRTF services when a child does not require emergency or acute psychiatric care but does require supervision and treatment on a twenty-four (24) hour basis. A. A board-certified child/adolescent psychiatrist or a psychiatrist who has successfully c…

Division of Medicaid does not cover: A. Admissions on the weekends. The Division of Medicaid defines weekend admissions as admission after 5:00 p.m. on a Friday. Covered days will not begin until the following Monday. B. Non-covered days of stay. C. Any days of stay not certified…

A. Participating Mississippi facilities must prepare and submit a Medicaid cost report for reimbursement of long term care facilities.1. All cost reports are due by the end of the fifth (5th) calendar month following the reporting period. 2. Failure to file a cost report by the d…

The use of the term "treatment' refers to the active treatment of the resident. The Division of Medicaid defines active treatment as a process comprising of the following: A. Multi-disciplinary diagnostic assessment, B. Interdisciplinary treatment planning, C. Therapeutic interve…

A. The diagnostic evaluation must document the need for the PRTF level of care. B. Diagnostic evaluations must be completed within the first fourteen (14) days of admission. The assessment process must include, but is not limited to, the following: 1. A psychiatric evaluation. 2.…

A. Treatment planning is defined by the Division of Medicaid as a collaborative venture which the members of various disciplines jointly develop a comprehensive, individualized plan of care for each individual. 1. The treatment plan must be designed to achieve the individual's di…

A. The Division of Medicaid covers certain home and community-based services as an alternative to institutionalization in a nursing facility through the Elderly and Disabled Waiver (E&D). B. Beneficiaries enrolled in the E&D Waiver must reside in a private residence that is fully…

A. Claims must be based on services that have been rendered to beneficiaries as authorized by the Plan of Services and Supports (PSS), accurately billed by qualified waiver providers, and in accordance with the approved waiver. B. The Division of Medicaid conducts financial audit…

A. The Division of Medicaid and the case management agencies are responsible for operating a dispute resolution process separate from a fair hearing process. The Division of Medicaid has the final authority over any dispute. 1. The types of disputes addressed by an informal dispu…

Decisions made by the Division of Medicaid that result in services being denied, terminated, or reduced may be appealed in accordance with Miss. Admin. Code Part 300. Notes 23 Miss. Code. R. 208-1.12 42 C.F.R. 431, Subpart E; 42 C.F.R. §§ 440.180, 441.308; Miss. Code Ann. §§ 43-1…

A. Person-Centered Planning (PCP) is an ongoing process used to identify a beneficiary's desired outcomes based on their personal needs, goals, desires, interests, strengths, and abilities. The PCP process helps determine the services and supports the beneficiary requires in orde…

A. The Division of Medicaid is responsible for investigating and documenting all grievances/complaints regarding all E&D Waiver programs operated and/or certified by the Division of Medicaid. Grievances may be made via phone, written letter format or email. B. Personnel issues ar…

A. In order to qualify as a beneficiary of the Elderly & Disabled (E&D) Waiver Program, individuals must meet the following criteria: 1. Must be twenty-one (21) years of age or older. 2. Must require nursing facility level of care as determined by a comprehensive long-term servic…

A. Providers of Elderly and Disabled (E&D) Waiver services must satisfy all requirements set forth in Title 23 Miss. Admin. Code Part 200, Chapter 4 in addition to the listed provider-type specific requirements as set forth in sections B. and C. below and provide to the Division …

A. Beneficiaries enrolled in a Medicaid Waiver have the right to Freedom of Choice of Medicaid providers for Medicaid covered services. [Refer to Miss. Admin. Code Part 200, Rule 3.6] B. Freedom of Choice is required of all providers and is monitored by the Division of Medicaid. …

A. Waiver providers must follow applicable service specifications as referenced in the Elderly and Disabled (E&D) Waiver approved by the Centers for Medicare and Medicaid Services (CMS). The Waiver is available on the Division of Medicaid's website, www.medicaid.ms.gov. B. Provid…

A. The Division of Medicaid covers the following services through the Elderly and Disabled (E&D) Waiver:1. Case Management services include the identification of resources as well as the coordination and monitoring of resources and services by case managers to ensure the health, …

A. Prior approval must be obtained from the Division of Medicaid before a beneficiary can receive any services through the Elderly and Disabled (E&D) Waiver Program. To obtain approval, the waiver case management provider must complete and submit the current Division of Medicaid …

A. Documentation and record maintenance for reimbursement purposes must, at a minimum, meet requirements set forth in the Elderly and Disabled (E&D) Waiver. [Refer to Miss. Admin. Code Part 200, Rule 1.3.] B. All staff records should include, at a minimum, the following required …

Notes 23 Miss. Code. R. 208-1.9 42 U.S.C. 1396(a); 42 C.F.R. §§ 440.180, 447.50 - 447.59; Miss. Code Ann. §§ 43-13-117, 43-13-121. Revised - 01/01/2013 Amended 12/1/2018 Reserved 6/1/2025

A. The Division of Medicaid covers certain Home and Community-Based Services (HCBS) as an alternative to institutionalization in a nursing facility through the Independent Living (IL) Waiver. B. Waiver participants must reside in a private residence which is fully integrated with…

A. Claims must be based on services that have been rendered to waiver persons as authorized by the Plan of Services and Supports (PSS), accurately billed by qualified waiver providers, and in accordance with the approved waiver. B. The Division of Medicaid conducts financial audi…

A. The Division of Medicaid and Mississippi Department of Rehabilitation Services (MDRS) are responsible for operating the dispute mechanism separate from a fair hearing process. The Division of Medicaid has the final authority over any dispute. 1. The types of disputes addressed…

A. The waiver person or his/her representative may request to present an appeal through a local-level hearing, a state-level hearing, or both. The request for a local or state hearing must be made in writing by the person or his/her legal representative. B. The waiver person may …

A. The Division of Medicaid defines Person-Centered Planning (PCP) as an ongoing process used to identify a person's desired outcomes based on their personal needs, goals, desires, interests, strengths, and abilities. The PCP process helps determine the services and supports the …

A. Mississippi Department of Rehabilitation Services (MDRS) case managers are required to provide each individual with written information regarding their rights as a waiver person at the initial assessment. B. Case managers must provide the person's information at the initial as…

A. Eligibility requirements for the Independent Living (IL) Waiver Program include the following: 1. Persons must be age sixteen (16) or older. 2. Persons must require nursing facility level of care as determined by a comprehensive long-term services and supports (LTSS) assessmen…

A. The Mississippi Department of Rehabilitation Services (MDRS), as the provider of Independent Living (IL) Waiver services, must satisfy all requirements set forth in Title 23 Miss. Admin. Code Part 200, Rule 4.8 in addition to the listed provider-type specific requirements and …

A. Division of Medicaid beneficiaries have the right to freedom of choice of providers for Medicaid covered services as outlined in Part 200, Chapter 3, Rule 3.6. B. Adherence of Freedom of Choice is required of all qualified providers and is monitored by the operating agency and…

A. Waiver providers must meet applicable service specifications as referenced in the Independent Living Waiver document approved by the Centers for Medicare and Medicaid Services (CMS). B. Waiver providers and/or contractors must report changes in contact information, staffing, a…

A. The Division of Medicaid covers the following services through the Independent Living (IL) Waiver: 1. Case Management services are mandatory services provided by a Registered Nurse (RN) and/or a Case Manager and include the following activities: a) Must initiate and oversee th…

A. Prior approval must be obtained from the Division of Medicaid before a beneficiary can receive services through the Independent Living (IL) Home and Community-Based Waiver program. To obtain approval, the Mississippi Department of Rehabilitation Services (MDRS) must complete a…