Division of Medicaid

A. Reimbursement for AL Waiver provider services cannot be requested earlier than the first (1st) day of the month following the month in which services were rendered. B. Reimbursement for AL Waiver provider services is only for those services provided within the facility. The Di…

A. Decisions made by the Division of Medicaid that result in services being denied, reduced or terminated, may be appealed in accordance with Part 300 of the Miss. Admin. Code. B. The waiver participant/legal representative has thirty (30) days from the date of the notice regardi…

A. All AL Waiver providers must have policies and procedures assuring safeguards to protect the safety, health and well-being of all waiver participants which must include: 1. Definitions of abuse, neglect and exploitation, 2. Education for employees in detection of abuse, neglec…

AL Waiver providers must: A. Conduct a search of the Mississippi Nurse Aide abuse registry prior to hiring an individual who will provide care to waiver participants including, but not limited to: 1. Any individual providing direct care or supervision to the residents, 2. Owners,…

A. AL Waiver providers must have disaster preparedness and management procedures to ensure that waiver participant's care, safety, and well- being are maintained during and following instances of natural disasters, disease outbreaks, or similar situations. B. In the event of term…

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. To be eligible for the Assisted Living Waiver Program a waiver participant must: 1. Be twenty-one (21) years of age or older, 2. Require nursing facility level of care as determined by a standardized comprehensive preadmission screening, and 3. Be in the Supplemental Security …

To become an HCBS/AL Waiver provider, the prospective provider must: A. Submit a provider enrollment packet complete with all necessary information. B. Submit a copy of the current and active license/certification to function as a Personal Care Home Assisted Living Facility (PCH-…

A. Medicaid beneficiaries have the right to freedom of choice of approved Medicaid providers for services as outlined in Miss. Admin. Code Part 200, Chapter 3, Rule 3.6 B. The person and/or guardian or legal representative must be informed of setting options based on the person's…

A. Prior approval must be obtained from the Division of Medicaid before an individual can receive services through the Home and Community-Based Waiver Program. B. Functional eligibility for waiver services is determined through a comprehensive PreAdmission Screening. 1. The physi…

A. The Assisted Living (AL) Waiver covers Case Management Services provided by a social worker licensed to practice in the State of Mississippi with at least two (2) years of full-time experience in direct services to elderly and disabled individuals. B. AL Services include the f…

A. AL Waiver providers must meet applicable service specifications. Refer to the Miss. Admin. Code, Part 208, Chapter 1. B. AL Waiver providers must report changes in contact information, staffing, and licensure within ten (10) calendar days to Division of Medicaid. C. Providers …

A. Providers participating in the HCBS/AL Waiver program are required to: 1. Maintain legible, accurate, and complete records. 2. Document the services rendered and billed under the program including when a participant is out of the facility and the reason why. 3. Make records av…

Notes 23 Miss. Code. R. 208-3.9 Social Security Act 1902 (a)(14); 42 CFR §447.50447.59; Miss. Code Ann. § 43-13-121. Reserved 9/1/2023

A. The Division of Medicaid covers certain Home and Community-Based Services (HCBS) as an alternative to institutionalization in a nursing facility through its Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver. Waiver services are available statewide. 1. Persons enrolled…

Whenever the service amounts, frequencies, duration, and scope are reduced, denied, or terminated, the beneficiary must be provided written notice of recourse/appeal procedures within ten (10) calendar days of the effective reduction or termination of services or within ten (10) …

A. Decisions made by the Division of Medicaid that result in services being denied, terminated, or reduced may be appealed.1. The beneficiary/legal representative has thirty (30) days from the date of the notice regarding services to appeal the decision. 2. All appeals must be in…

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. Eligibility is limited to individuals with the following disease(s) or condition(s): 1. Traumatic brain injury which the Division of Medicaid defines as an insult to the skull, brain, or its covering resulting from external trauma, which produces an altered state of consciousn…

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. Personal care services may be furnished by family members provided they are not legally responsible for the individual. 1. The Divi…

A. Waiver providers must meet applicable quality assurance standards. B. Only the Division of Medicaid can initiate, in writing, any interpretation or exception to Medicaid rules or regulations. Notes 23 Miss. Code. R. 208-4.4 Miss. Code Ann. § 43-13-121; § 43-13-117; §1915(c) of…

A. The Division of Medicaid covers the following traumatic brain injury/spinal cord injury (TBI/SCI) Waiver services: 1. Case Management services are defined as services assisting beneficiaries in accessing needed waiver and other services, as well as needed medical, social, educ…

A. Prior approval must be obtained from the Division of Medicaid before a beneficiary can receive services through the Home and Community-Based Waiver program. Prior Approval is based on clinical eligibility. B. Clinical eligibility for waiver services is determined through the u…

A. Documentation/record maintenance for reimbursement purposes must, at a minimum, reflect procedures set forth for applicable waiver quality assurance standards. Refer to Maintenance of Records Part 200, Ch.1, Rule 1.3. B. Waiver providers must submit copies of all service logs/…

Notes 23 Miss. Code. R. 208-4.8 Miss. Code Ann. § 43-13-121; Social Security Act 1902 (a)(14) Reserved 9/1/2023

Reimbursement for waiver services can be requested no earlier than the first day of the month following the month in which services were rendered. Notes 23 Miss. Code. R. 208-4.9 Miss. Code Ann. § 43-13-121

A. Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver services are services covered by the Division of Medicaid as an alternative to institutionalization in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) which: 1. Are opera…

A. Documentation of each Intellectual Disabilities/Developmental Disabilities (ID/DD) service provided must be in the case record. [Refer to Miss. Admin. Code, Part 200, Rule 1.3.] B. The entry or clinical note must include all of the following documentation: 1. Date of service, …

Notes 23 Miss. Code. R. 208-5.11 42 USC § 1396 a; 42 CFR §§447.50 -.52; Miss. Code Ann. § 43-13-121. Revised to reflect changes with ID/DD Waiver renewal (eff. 07/01/2013) eff. 09/01/2015; Amended 9/1/2015 Reserved 9/1/2023

A. The Department of Mental Health (DMH) is responsible for investigating and documenting all grievances/complaints regarding all programs operated and/or certified by DMH. Grievances may be made via phone, written letter format or email. B. Personnel issues are not within the pu…

A. If it is determined that an applicant does not meet Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) level of care (LOC) at the completion of an initial evaluation by the Diagnostic and Evaluation (D&E) team, the applicant and/or guardian or …

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. The Division of Medicaid Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver providers must be certified by the Department of Mental Health (DMH) except for the providers listed below: 1. Occupational therapists, 2. Speech-language pathologists, 3. Physical the…

A. Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver persons have the right to freedom of choice of providers for Medicaid covered services. [Refer to Miss. Admin. Code Part 200, Rule 3.6] B. The person and/or guardian or legal representative must be informed of…

A. A participant's level of care (LOC) is determined by an initial evaluation and required reevaluations to assess the needs for services through the Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver. 1. All LOC initial evaluations and required reevaluations mus…

A. Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver services must only be provided to persons when approved by the Department of Mental Health (DMH) and authorized by the ID/DD Waiver support coordinator as part of the approved Plan of Services and Supports (PS…

Notes 23 Miss. Code. R. 208-5.6 Miss. Code Ann. § 43-13-121; Social Security Act 1915(b)(c); 42 CFR 441.302 Reserved 9/1/2015

A. Providers cannot bill the Division of Medicaid for Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver services until the first (1 st) day of the month after the services were rendered for the following services: 1. Support Coordination, 2. Community Respite, 3…

A. Department of Mental Health (DMH) certified providers must receive training at least annually regarding Mississippi's Vulnerable Persons Act and the following: 1. Education as to what constitutes possible abuse/neglect/exploitation, 2. Abuse/neglect/exploitation reporting requ…

A. Nurses employed by an agency enrolled as an Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver provider must practice within the current guidelines outlined in the Mississippi Nurse Practice Act and applicable state and federal laws and regulations, regardless…

A. Bridge to Independence (B2I), Mississippi's Money Follows the Person (MFP) initiative, is a six (6) year federal demonstration grant that was awarded to the Division of Medicaid on April 1, 2011, and is funded by the United States Department of Health and Human Services (DHHS)…

A. To participate in the Bridge to Independence (B2I) demonstration project, the person: 1. Must reside in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) or a nursing facility for at least ninety (90) consecutive days with at least one (1) …

The following services are available to B2I persons as documented in the Plan of Services and Supports (PSS): A. Transition Care Management, defined as transition care planning occurring for up to one-hundred eighty (180) days pre-discharge from the institution and post-transitio…

B2I providers must maintain quality control measures to ensure the health, safety, and welfare of individuals including, but not limited to: A. A twenty-four (24) hours a day, seven (7) days a week crisis and response system, B. A critical incident reporting system, and C. A syst…

A. Decisions made by B2I staff or representatives resulting in reduced, suspended or terminated services of the Division of Medicaid may be appealed. [Refer to Miss. Admin. Code Part 300: Appeals, Chapter 1: Appeals] Notes 23 Miss. Code. R. 208-6.5 Olmstead v. L.C., 119 S. Ct. 21…

A. The Division of Medicaid covers certain 1915(i) Home and Community-Based Services (HCBS) as an alternative to institutionalization in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) through its State Plan. The State Plan services:1. Offer…

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 …