Mississippi Administrative Code

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 …

D. Division of Medicaid 1915(i) providers must be certified by the Mississippi Department of Mental Health (DMH), Bureau of Quality Management, Operations and Standards (BQMOS). DMH Certification is dependent upon compliance with the Mississippi Department of Mental Health Operat…

A. Medicaid 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. Targeted Case Managers must facilitate individual choice regarding services and supports and who provides them. Targeted Case Man…

A. Level of care (LOC) evaluations and reevaluations for eligibility must be conducted by one (1) of the five (5) Diagnostic and Evaluation (D&E) Teams housed at the DMH's five (5) comprehensive regional programs.1. Re-evaluations are only required if the beneficiary has a signif…

A. A person can receive: 1. 1915(i) services if not eligible for services available: a) For Prevocational Services under a program funded under Section 110 of the Rehabilitation Act of 1973 or Sections 602(16) and (17) of the Individuals with Disabilities Education Act, 20 U.S.C.…

A. All Department of Mental Health (DMH) providers, including support coordinators and targeted case managers, must receive training at least annually regarding Mississippi's Vulnerable Persons Act and the following: 1. Education as to what constitutes possible abuse/neglect/expl…

C. Documentation of each service provided must be in the case record. Refer to Maintenance of Records Part 200, Ch.1, Rule 1.3. D. The entry or service note must include all of the following documentation:1. Date of service, 2. Type of service provide, 3. Time service began and t…

A. The Department of Mental Health (DMH), Office of Consumer Support (OCS) is responsible for investigating and documenting all grievances/complaints regarding all programs operated and/or certified by DMH. The DMH, Quality Management Workgroup assists the OCS in development of p…

A. If it is determined that a person does not meet 1915(i) eligibility criteria or if decisions made by the Department of Mental Health (DMH) result in services being denied, terminated, or reduced the /legal representative has the right to request an appeal from the DMH. B. If t…

In order to participate as a Durable Medical Equipment (DME) supplier in the Medicaid program, a provider must: A. Be certified to participate as a DME supplier under Title XVII (Medicare) of the Social Security Act and provide current documentation of their authorization to part…

A. Medicaid defines an apnea monitor as a device used to monitor respiratory movements. This may be accomplished by use of an apnea alarm mattress or by use of alarm sensitive devices to measure thoracic and abdominal movement and heart rate. B. Medicaid covers apnea monitors for…

A. The Division of Medicaid defines an augmentative, or alternative, communication device (ACD) as any type of system that allows beneficiaries with severe, expressive communication disorders, or speech-language impairments, to overcome the disabling effects of communication impa…

A. The Division of Medicaid defines a bath bench or shower chair as durable medical equipment (DME) enabling a beneficiary to bathe or shower safely. B. The Division of Medicaid covers a bath bench or shower chair when: 1. [Reserved], 2. Prior authorized by the Utilization Manage…

A. The Division of Medicaid defines the following:1. Battery is a device for generating electric current by chemical action. 2. Battery charger is a device that adds electrical energy to a battery. B. The Division of Medicaid covers a sealed battery and single mode battery charge…

A. Medicaid defines a bi-level positive airway pressure (BiPAP) device as a non-continuous, bi-level airway management device that cycles between the inspiratory and expiratory pressure levels in response to the patient's respiratory effort. The rise in pressure, during inspirati…

A. The Division of Medicaid defines a breast pump as a device used to extract breast milk from a lactating mother. B. The Division of Medicaid covers the following types of breast pumps for nursing mother beneficiaries when medically necessary, prior authorized by the Utilization…

A. Medicaid defines a cane as an assistive device held in the hand and used for support during ambulation. This includes canes of all materials, single, quad or three pronged, adjustable or fixed. B. Medicaid covers canes for all beneficiaries when prior authorized by the Utiliza…

A. The Division of Medicaid defines a combination positive expiratory pressure, airway oscillation, and intermittent flow acceleration device as a unit for mobilizing respiratory tract secretions in a beneficiary with chronic lung conditions such as, but not limited to: 1. Chroni…

A. The Division of Medicaid defines commode chairs as toileting aids used to assist beneficiaries who are not able to use regular toilet facilities due to their physical condition. B. The Division of Medicaid covers commode chairs and raised toilet seats for all beneficiaries whe…

A. Medicaid defines compressors as machines that compress air into storage tanks for use by air driven equipment. B. Medicaid covers for all beneficiaries when prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid o…

DME providers must satisfy all requirements set forth in 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 Provider Enumeration System (NPPES), B. Provide writ…

A. The Division of Medicaid defines continuous positive airway pressure (CPAP) with or without an in-line heated humidifier as a non-invasive provision of air pressure through nasal administration and a flow generator system to prevent collapse of the oropharyngeal walls during s…

A. Medicaid defines crutches as assistive devices used for support during ambulation. 1. Crutches may provide underarm or forearm support. 2. Crutches may be made of wood or metal, fixed or adjustable in height and must be supplied with tips. B. Medicaid covers crutches for all b…

Refer to Part 209, Chapter 2: Medical Supplies, Rule 2.2.AA. Notes 23 Miss. Code. R. 209-1.22 History: Revised 01/01/2013 Amended 5/1/2021 Amended 7/1/2021

A. Medicaid defines an electromyography (EMG) biofeedback device as a device that uses recording equipment to detect, amplify and display a physiological response. 1. EMG uses surface electrodes that are attached to the skin over a specific muscle or group of muscles. 2. The EMG …

A. The Division of Medicaid covers repairs and external replacement parts for cochlear implant devices when medically necessary, prior authorized by a Utilization Management/Quality Improvement Organization (UM/QIO), the Division of Medicaid, or designee, and ordered by an audiol…

A. The Division of Medicaid defines a gait trainer as a device similar to a walker and consists of a wide based steel frame with four (4) casters/wheels and may include a seat or support accessories. The user has difficulty with balance and control of the trunk, has an unsteady g…

A. The Division of Medicaid defines glucose monitoring devices as durable medical equipment (DME) for home use to measure glucose levels which includes a: 1. Blood glucose monitor (BGM) defined as a portable battery-operated meter used to determine the beneficiary's blood glucose…

A. Medicaid defines a hip abductor pillow wedge as a foam triangular shaped device placed between the beneficiary's thighs and secured with straps. The device maintains constant abduction. B. Medicaid covers hip abductor pillow wedges for all beneficiaries when prior authorized b…

A. The Division of Medicaid defines a hospital bed as a medical device with: 1. An articulating frame allowing adjustment of the head and foot of the bed, 2. A headboard, 3. A footboard, 4. A mattress, and 5. Side rails. B. The Division of Medicaid covers hospital beds when medic…

A. The Division of Medicaid defines a patient hydraulic lift as a device used to transfer a beneficiary between a bed, a chair, wheelchair or portable commode chair but not solely for use in the bathroom. B. The Division of Medicaid covers hydraulic lifts for all beneficiaries wh…

The Division of Medicaid defines: A. Durable Medical Equipment (DME) and/or medical appliance as an item meeting all five (5) criteria below: 1. It can withstand repeated use, 2. Is reusable or removable, 3. Is primarily and customarily used to serve a medical purpose, 4. Is gene…

A. Medicaid defines an enteral pump as a device used to deliver nutritional requirements to the stomach or small bowel via a tube, including nasogastric, gastrostomy, jejunostomy and PEG tubes. B. Medicaid covers enteral pumps for all beneficiaries when prior authorized by the Ut…

A. Medicaid defines an insulin pump as a small battery-driven pump that delivers insulin subcutaneously. The pump can be programmed to deliver varying doses of insulin in accordance with changes in need for insulin during different conditions such as eating, exercise, sleep, or a…

A. Medicaid defines an IV pole as a device to suspend fluid to be administered by gravity or pump. B. Medicaid covers IV poles for all beneficiaries when prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or desi…

A. Medicaid defines a nebulizer as an apparatus for producing a fine spray or mist primarily for use in administering drugs by inhalation. 1. This may be accomplished by rapidly passing air through a liquid or by vibrating a liquid at a high frequency so that the particles produc…

A. Medicaid defines a neuromuscular electrical stimulator (NMES) as a device that transmits an electrical impulse to the skin over selected muscle groups by way of electrodes to treat disuse atrophy where the nerve supply to the muscle is intact. B. Medicaid covers for all benefi…

A. The Division of Medicaid covers oxygen and oxygen related equipment that allows for the safe delivery of oxygen as durable medical equipment (DME) and includes: 1. Stationary gaseous oxygen systems which include container, contents, regulator, flow meter, humidifier, nebulizer…

A. Medicaid defines a pacemaker monitor as a self-contained device used in the evaluation of a pacemaker by trans-telephonic monitoring of the transmission of the generator's pulse rate. 1. By means of special equipment, the sound tone of the patient's pacemaker is transmitted ov…

A. Medicaid defines pulse oximeter as a photoelectric apparatus for determining the amount of oxygen in the blood. This is usually done by measuring the amount of light transmitted through a translucent part of the skin. B. Medicaid covers pulse oximeters for all beneficiaries wh…

A. Medicaid defines a spacer/aerosol-holding chamber as a cylinder shaped device usually four (4) to eight (8) inches long with a one (1) way valve. 1. The device is attached to a metered dose inhaler (MDI). 2. Use of the spacer/aerosol-holding chamber slows the delivery of medic…

A. Medicaid defines a mobile or stationary home model suction pump as a lightweight, compact, electric aspirator designed for upper respiratory oral, pharyngeal and tracheal suction for use in the home. A suction device must be appropriate for home use without technical or profes…

A. The Division of Medicaid reimburses for durable medical equipment (DME) and/or medical appliances when ordered by a physician or through the use of a collaborative practice agreement between the non-physician practitioner and the physician, and within the practitioner's scope …

A. Medicaid defines traction equipment as encompassing a variety of equipment used to apply a pulling force to a part of the body. It may be used to minimize muscle spasms, to reduce, align, and immobilize fractures, to lessen deformity or to increase space between opposing surfa…