Mississippi Administrative Code

A. The Division of Medicaid will identify the cause of any improper payments due to an error in the beneficiary's eligibility information including, but not limited to, incorrect income or deductions, and take corrective action. B. All underpayments are corrected upon discovery: …

A. A beneficiary must cooperate with Medicaid Eligibility Quality Control (MEQC) reviews. B. If a beneficiary fails to cooperate with MEQC reviews and an investigator is unable to obtain information needed to complete a review, the case will be referred back to the regional offic…

The Division of Medicaid defines: A. Third party as any individual, entity or program that is, or maybe, liable to pay all, or part of the expenditures for medical assistance furnished under the State Plan. B. Cost Avoidance as a method of avoiding payment of Medicaid claims when…

A. Medicaid providers must:1. Identify and report any third party source to the Division of Medicaid. 2. Cooperate with the Division of Medicaid in the recovery of payments from the third party source. Providers will be held liable, to the extent of the Division of Medicaid's pay…

A. Providers must file a claim with the third party prior to billing Medicaid. Documentation of payment or denial must be submitted to the Division of Medicaid with the claim including but not limited to:1. The explanation of benefits (EOB), 2. Any amount paid by the third party,…

A. In the event a provider has knowledge that an individual is a Medicaid beneficiary and is receiving or has received health care services which may be covered by Medicaid as a result of the accident or incident, the provider is prohibited from: 1. Demanding any payment from the…

A. The Division of Medicaid must be billed as the payor of last resort. B. Providers are required to file a claim with the third party prior to filing with the Division of Medicaid except in the following circumstances: 1. Preventive pediatric service, including EPSDT services, c…

Third party sources that must be used to reduce Medicaid program cost include, but are not limited to the following: A. Medicare Parts A and B, B. Health Insurance: 1. Includes both reimbursement policies and indemnity policies that make payment because medical care and/or servic…

A. Coverage available through the Mississippi Medicaid program is secondary to any third party benefits to which a beneficiary may be entitled. If a beneficiary has other insurance, the primary insurance should be used before billing Medicaid. Benefits available from insurance or…

A. The Division of Medicaid is required to seek recovery of payments for nursing facility services and Home and Community-Based Services (HCBS) as well as related hospital and prescription drug services from the estates of deceased Medicaid recipients who were fifty-five (55) or …

Section 41-4-1, et seq. Notes 24 Miss. Code. R. 1-1.1 Miss Code Ann. § 41-4-1, et seq. Amended 7/10/2015 Amended 4/1/2017 Amended 8/6/2017 Amended 11/1/2018

This regulation shall serve to inform the public about the Department of Mental Health relating to the organization, method of operations, and where the public may contact and receive information from the agency. Notes 24 Miss. Code. R. 1-1.2 Miss Code Ann. § 41-4-1, et seq. Amen…

A. The purpose of the Department of Mental Health is to coordinate, develop, improve, plan for, and provide services for persons with mental illness, persons with emotional disturbance, substance use disorder, and persons with intellectual and developmental disabilities, and Alzh…

The Department of Mental Health operates five programs throughout the state. A. Psychiatric Programs Programs for the care of persons with mental illness are Mississippi State Hospital at Whitfield with Specialized Treatment Program in Gulfport as a satellite program, East Missis…

The Department of Mental Health is responsible for developing and implementing licensure and certification programs for categories of professionals who work for organizations which are operated/administered by the Department of Mental Health and/or who work for organizations whic…

Public requests for information or submissions may be made to the Department of Mental Health at 239 N. Lamar, Suite 1101, Robert E. Lee Building, Jackson, Mississippi 39201. Calls will be received at 601-359-1288. Also see the Department of Mental Health website at www.dmh.state…

Sections 41-4-1 et seq., Section 41-21-102 and other State and Federal Laws, Court Decisions, and Regulations. Notes 24 Miss. Code. R. 1-5.1 Miss Code Ann. § 41-4-1, et seq. and § Section 41-21-102 and other State and Federal Laws, Court Decisions, and Regulations. Amended 7/10/2…

To ensure that all persons living or being treated in programs operated by Department of Mental Health are receiving appropriate care. Notes 24 Miss. Code. R. 1-5.2 Miss Code Ann. § 41-4-1, et seq. and § Section 41-21-102 and other State and Federal Laws, Curt Decisions, and Regu…

All individuals receiving services shall be afforded all rights delineated in Section 41-21-102 of the Mississippi Code as well as any outlined in federal law, regulation, and other appropriate state laws and regulations. A. Executive Director The Executive Director shall work wi…

Each program shall have a Human Rights/Advocacy Committee whose duties are to protect the rights of individuals within the care of the program. A. Composition The committee shall consist of no less than five (5) members, appointed by the Director and confirmed by the Executive Di…

A. Each program will prominently post in each living unit and throughout the program a document setting forth the rights of individuals receiving services and the means by which they may contact a program advocate. B. Each individual receiving services, or legally authorized repr…

Persons may also report concerns or alleged abuse to the 24-hour Constituency Line at 1-877-210-8513. Notes 24 Miss. Code. R. 1-5.6 Miss Code Ann. § 41-4-1, et seq. and § 41-21-102 and other State and Federal Laws, Court Decisions, and Regulations. Amended 7/10/2015 Amended 4/1/2…

Click Here To View Image Notes 24 Miss. Code. R. 11-1.1 Adopted 10/1/2016 Amended 12/19/2019 Amended 11/7/2021

Upon effective date, these rules and regulations supersede and repeal all previous versions of the Operational Standards for Mental Health, Intellectual/Developmental Disabilities, and Substance Use Community Service Providers. Notes 24 Miss. Code. R. 2-1.1 Section 41-4-7 of the …

A. The DMH Deputy Executive Director(s), DMH Executive Director, or designee, reviews and makes decisions regarding actions relating to the denial of a DMH provider certification (if appealed by the applicant) and/or the imposition of appealable administrative actions (if appeale…

A. During the appeals process, an applicant/certified provider may appeal the decision of the DMH Executive Director to the Mississippi State Board of Mental Health. B. The Mississippi State Board of Mental Health, as the authorized entity under applicable state law to promulgate…

A. Mississippi state law grants the Mississippi State Board of Mental Health (through the Mississippi Department of Mental Health) the following authorities which pertain to the certification of Mississippi state mental health system community-based providers of mental health ser…

A. The purposes of the rules and requirements set forth in the Mississippi Department of Mental Health (DMH)Operational Standards for Mental Health, Intellectual/Developmental Disabilities, and Substance Use Community Service Providers (i.e., DMH Operational Standards) are as fol…

A. These rules and requirements are limited to the issuance of provider certification through DMH. B. Actions of the Division of Certification, the Certification Review Committee (CRC), DMH, and the Mississippi State Board of Mental Health should in no way be construed as a recom…

A. The DMH Operational Standards document is made available online on the DMH website. B. The DMH Operational Standards is periodically updated and revised. Interested parties, provider applicants, and certified providers are responsible for ensuring that they have the most curre…

A. DMH promotes nondiscriminatory practices and procedures in all phases of state service administration, as well as in programs funded, certified, and/or operated by DMH according to applicable federal laws. DMH does not discriminate because of race, color, creed, gender, religi…

A. DMH Division of Certification (i.e., the Division) is responsible for developing and managing the application, certification, and compliance processes for providers seeking to obtain and maintain DMH provider certification. B. Major duties of the Division include (but are not …

A. The DMH Certification Review Committee's (CRC's) composition and appointment structure is as follows:1. The CRC is comprised of seven (7) members. 2. Attempts are made to ensure adequate representation among disciplines and programmatic types. 3. Appointments are made by the D…

A. The agency's Office of General Counsel assists in legal matters pertaining to DMH provider certification. B. Except for any stipulations which may be provided in applicable law(s), DMH-certified providers who have engaged attorney representation pertaining to DMH provider cert…

All DMH-certified agency providers, regardless of type, must follow the rules outlined in this chapter. Compliance with the rules in this section will be reviewed by DMH Fiscal Auditors. All source documents related to budgets and financial systems shall be provided to DMH upon r…

A. The agency provider must prepare and maintain annually a formal, written, program-oriented budget of expected revenues and expenditures that must: 1. Categorize revenues for the program by source; 2. Categorize expenses by the types of services or program components provided, …

A. Audited financial statements must be prepared annually by an independent CPA for DMH-certified agencies with more than $1,000,000 in annual revenue or, for state agency-operated service locations, the State Auditor's Office. B. DMH-certified agency providers with $1,000,000 or…

A. Agency providers must develop a cost accounting system that defines and determines the cost of single units of service. B. The agency provider must develop an accounting system to document grant match and funds of people receiving services that:1. Consists of a general ledger,…

A. The certified agency provider must develop and adhere to purchasing policies and procedures that ensure: 1. Proper internal controls over the procurement, storage, and distribution functions are in place and in accordance with federal and state regulations, including proper ov…

A. The fiscal management system of the agency provider must include a fee policy that: 1. Maintains a current written schedule of rate, charge, and discount policies. 2. Is immediately accessible to people served. 3. For community living services, includes the development, and re…

CMHCs must submit a plan to DMH when the Regional Commission and/or related organization has accumulated excess surplus funds in excess of one-half (1/2) its annual operating budget, stating the capital improvements or other projects that require such surplus accumulation. If the…

A. Accounting records must be maintained on generated income from work contracts that detail dollar amounts and fund utilization. B. The agency provider must maintain evidence of prior written authorization from DMH for utilization of generated income for anything other than supp…

A. The agency provider must have written personnel policies and procedures that, at a minimum, provide assurances that personnel management practices are in accordance with all applicable state and federal laws regarding pre-employment inquiries, and the hiring, assignment, and p…

A. CMHCs certified under the DMH/C option and other community service providers certified as DMH/P providers must have multidisciplinary personnel, with at least the following disciplines represented:1. A psychiatrist who is board certified or board eligible and licensed to pract…

A personnel record for each employee, volunteer, and intern must be maintained, and must include, but not be limited to: A. The application for employment or resume, including employment history and experience. B. A copy of the employee's official transcript/proof of high school …

A. DMH's method to verify proof of a degree to meet an education requirement is an official transcript showing that the applicable degree has been awarded/conferred, including the date of degree award/conferral. Applicable degree completion will only be verified by an official tr…

To ensure initial and continuing receipt of certification/funding from DMH or other approved sources, the agency provider must maintain documentation that employees meet the following qualifications unless otherwise specified herein: A. One (1) full-time Executive Director who ha…