Proposed Regulations

This Administrative Code is being filed to set the fees for physician services the same as those effective as of July 1, 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to set the fees for emergency ground transportation services the same as those effective as of July 1, 2021 in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799.

This Administrative Code filing (1) revises the timeframe from 30 to 90 days that providers may request an Administrative Review in Rule 1.8, (2) revises Rule 3.7 to be in compliance with U.S.C § 1396a and 42 C.F.R. § 447.50 et seq.– 447.59, and (3) revises Rule 4.10 to be incompliance with Miss. Code Ann. 43-13-117 as amended by MS Senate Bill 2799.

This Administrative Code filing (1) removes the two (2) or more hospitalizations from the coverage requirements of remote patient monitoring, (2) adds the required information for prior authorization, if it’s required, (3) adds diabetes type II as a covered diagnosis for continuous glucose monitoring (CGM), and (4) revises the coverage requirement for CGM which corresponds with Medicare coverage.

This Administrative Code filing: (1) adds diabetes type II as a covered diagnosis for continuous glucose monitoring (CGM) and (2) adds the rental up to the purchase price of an Federal Drug Administration (FDA) class III medical device for home use for CGM for those beneficiaries with diabetes type II with long-term insulin usage who meet the requirements in Miss. Admin. Code Part 225.

This Administrative Code is being filed to 1) add language allowing DOM to cover a Rural Health Center (RHC) as a distant site provider and 2) to set the fees and or rates for RHC services the same as those effective as of January 1, 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to set the fees for Durable Medical Equipment and Medical Supplies the same as those in effect for State Fiscal Year (SFY) 2021, in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code filing (1) removes the two (2) or more hospitalizations from the coverage requirements of remote patient monitoring, (2) adds the required information for prior authorization, if it’s required, (3) adds diabetes type II as a covered diagnosis for continuous glucose monitoring (CGM), and (4) revises the coverage requirement for CGM which corresponds with Medicare coverage.

This Administrative Code filing: (1) adds diabetes type II as a covered diagnosis for continuous glucose monitoring (CGM) and (2) adds the rental up to the purchase price of an Federal Drug Administration (FDA) class III medical device for home use for CGM for those beneficiaries with diabetes type II with long-term insulin usage who meet the requirements in Miss. Admin. Code Part 225.

This Administrative Code is being filed to: 1) remove coverage of EPSDT screenings by RHCs/FQHCs in a school setting, 2) remove Mississippi Youth Programs Around the Clock (MYPAC) coverage and reimbursement, 3) add language stating the wraparound facilitation is covered as a case management service and 4) set the fees for EPSDT services the same as those effective for State Fiscal Year (SFY) 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to (1) add language allowing FQHCs and RHCs to act as a originating and distant site and (2) and for FQHCs, RHCs, and CMHCs to receive both the distant site and originating site fees when such services are appropriately provided by the same organization, in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to 1) add language allowing DOM to cover a Federally Qualified Health Center (FQHC) as a distant site provider and 2) to set the fees and or rates for FQHC services the same as those effective for January 1, 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to set the fees for immunizations the same as those effective for State Fiscal Year (SFY) 2021 except those for 340B drugs, in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to set the fees for hospice services the same as those effective as of July 1, 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to set the fees for family planning services the same as those effective for State Fiscal Year (SFY) 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to 1) increase the number of physician office visits from twelve (12) to sixteen (16), and 2) set the fees for vision services the same as those effective for State Fiscal Year (SFY) 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to set the fees for dialysis services the same as those effective as of Janaury 1, 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to 1) add language allowing non-physician practitioners to prescribe or order home health services and plans of care, sign home health plans of care, certify and recertify eligibility for home health services and conduct the required initial face-to-face visit with the recipient of the services, and 2) to set the fees and or rates for home health services the same as those effective as of July 1, 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to set the fees for Ambulatory Surgical Centers the same as those effective for State Fiscal Year (FSY) 2021, in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

: This Administrative Code is being filed to set the fees for institutional long term care services the same as those effective as of July 1, 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to 1) include revisions from MS SPA 20-0022 and 2) set the fees for mental health services the same as those effective for State Fiscal Year (SFY) 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to set the fees for physician services the same as those effective as of July 1, 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

: This Administrative Code is being filed to 1) add language requiring electronic submission of reports, 2) increased outpatient observation from twenty-three hours to seventy-two hours, 3) and set the fees for hospital services the same as those effective as of July 1, 2021 in compliance with Miss. Code § 43-13-117, as amended by MS Senate Bill 2799.

This Administrative Code is being filed to set the fees for emergency ground transportation services the same as those effective as of July 1, 2021 in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799.

This Administrative Code filing (1) revises the timeframe from 30 to 90 days that providers may request an Administrative Review in Rule 1.8, (2) revises Rule 3.7 to be in compliance with U.S.C § 1396a and 42 C.F.R. § 447.50 et seq.– 447.59, and (3) revises Rule 4.10 to be incompliance with Miss. Code Ann. 43-13-117 as amended by MS Senate Bill 2799.

This Administrative Code is being filed to correspond with MS SPA 20-0002 that added coverage and reimbursement of PDN and PCS for Early and Periodic Screening, Diagnosis and Treatment (EPSDT)-eligible beneficiaries. The final filing removes the five percent (5%) reduction language and makes technical corrections.

This Administrative Code filing removes the prior authorization requirement for nebulizers and inhaler spacers. The Division of Medicaid (DOM) will cover four (4) spacers a year without prior authorization, and will no longer require prior authorization on nebulizers based on data from September 2019 to present showing 727 prior authorization requests approved and only 2 requests denied for technical errors.

This Administrative Code filing removes the prior authorization requirement for nebulizers and inhaler spacers. The Division of Medicaid (DOM) will cover four (4) spacers a year without prior authorization and will no longer require prior authorization on nebulizers based on data from September 2019 to present showing 727 prior authorization requests approved and only 2 requests denied for technical errors.

This Administrative Code is being filed to correspond with MS SPA 20-0002 that added coverage and reimbursement of PDN and PCS for Early and Periodic Screening, Diagnosis and Treatment (EPSDT)-eligible beneficiaries.

This Administrative Code filing: 1) Allows for the reimbursement of Continuous Positive Airway Pressure (CPAP) supplies during the rental period in alignment with Medicare coverage, 2) Clarifies the rental of DME, 3) Updates the reimbursement methodology to correspond with SPA 20-0001, 4) Includes how to request DME and medical supplies not included on the Division of Medicaid’s fee schedule, and 5) Corrects minor technical errors.

This Administrative Code filing is being submitted to withdraw the proposed rule APA 25433 effective immediately.

This Administrative Code filing: 1) Allows for the reimbursement of Continuous Positive Airway Pressure (CPAP) supplies during the rental period in alignment with Medicare coverage, 2) Clarifies the rental of DME, 3) Updates the reimbursement methodology to correspond with SPA 20-0001, 4) Includes how to request DME and medical supplies not included on the Division of Medicaid’s fee schedule, and 5) Corrects minor technical errors.

This Administrative Code final file adds reimbursement of a facility fee and professional fees for Intensive Outpatient Services and Partial Hospitalization Services in an outpatient hospital setting.

This Administrative Code filing: 1) Allows for the reimbursement of Continuous Positive Airway Pressure (CPAP) supplies during the rental period in alignment with Medicare coverage, 2) Clarifies the rental of DME, 3) Updates the reimbursement methodology to correspond with SPA 20-0001, 4) Includes how to request DME and medical supplies not included on the Division of Medicaid’s fee schedule, and 5) Corrects minor technical errors.

This Administrative Code filing adds verbiage to provide coverage for Intensive Outpatient Treatment and Acute Partial Hospitalization in an outpatient hospital setting resulting in an anticipated decline in hospital readmissions; all while allowing beneficiaries to continue recovering while maintaining daily life in the community.

Administrative Code 21-002 Therapy Services is being filed to 1) remove language requiring prior authorization for evaluations/re-evaluations, and 2) remove the language requiring the number of units/minutes per visit in the Plan of Care.

This administrative code is being filed to update and clarify the Division of Medicaid’s license verification requirements. This filing complies with 42 C.F.R. § 455.412 which requires that state agencies must have methods to ensure that a provider is properly licensed in the state, the provider’s license has not expired and there are no current limitations on the provider’s license.

This Administrative Code is being filed to correspond with MS State Plan Amendment (SPA) 20-0013 that updates vaccine coverage to include administration by pharmacists.

This Administrative Code is being filed to correspond with MS State Plan Amendment (SPA) 20-0013 that updates vaccine coverage to include administration by pharmacists.

This administrative code is being filed to update and clarify the Division of Medicaid’s license verification requirements. This filing complies with 42 C.F.R. § 455.412 which requires that state agencies must have methods to ensure that a provider is properly licensed in the state, the provider’s license has not expired and there are no current limitations on the provider’s license.

Administrative Code 21-002 Therapy Services is being filed to 1) remove language requiring prior authorization for evaluations/re-evaluations, and 2) remove the language requiring the number of units/minutes per visit in the Plan of Care.

This Administrative Code is being submitted to allow the Division of Medicaid (DOM) to allow for cost avoidance of prenatal claims in compliance with the Bipartisan Budget Act of 2018, add the process for providers to request an override of the third party liability edit and update language to reflect current practices, to correspond with SPA 20-0009 effective October 1, 2020.

This Administrative Code is being submitted to allow the Division of Medicaid (DOM) to allow for cost avoidance of prenatal claims in compliance with the Bipartisan Budget Act of 2018, add the process for providers to request an override of the third party liability edit and update language to reflect current practices, to correspond with SPA 20-0009 effective October 1, 2020.

This Administrative Code filing adds verbiage requiring hospice providers to notify the Division of Medicaid within five (5) calendar days of a dual eligible beneficiary’s election and discharge date.

This Administrative Code filing adds verbiage requiring hospice providers to notify the Division of Medicaid within five (5) calendar days of a dual eligible beneficiary’s election and discharge date.

This administrative code filing is being submitted to make corrections to system number 25156. The frequency of treatment plan reviews has been changed from every three (3) months to every six (6) months and additional providers have been added to the medication monitoring documentation requirements to be consistent with who can prescribe medications.

This administrative code filing is being submitted to make corrections to system number 25156. The frequency of treatment plan reviews has been changed from every three (3) months to every six (6) months and additional providers have been added to the medication monitoring documentation requirements to be consistent with who can prescribe medications.

This administrative code filing is being submitted to add coverage of Medication Assisted Treatment for beneficiaries diagnosed with opioid addiction provided by Opioid Treatment Programs certified by the Department of Mental Health in compliance with the SUPPORT Act, to correspond with MS SPA 20-0023 effective October 1, 2020.