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Amendments for the Medicaid State Plan for the State of Mississippi


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 Notice of Proposed Rule Adoption SPA 2011-004: Federal Regulations at 42 CFR Part 447, Subpart A, 42 CFR Part 434, 42 CFR Part 438, and sections 1902(a)(4), 1902(a)(6), and 1903 of the Social Security Act, and Section 2702 of the Patient Protection and Affordable Care Act of 2010 prohibits Federal payments to States under section 1903 of the Social Security Act for any amounts expended for providing medical assistance for certain hospital inpatient provider-preventable conditions (PPC) and health care-acquired conditions (HCAC) for dates of service effective July 1, 2011, for individuals for which Medicaid is primary and those dually eligible for both the Medicare and Medicaid programs.
  SPA 2011-006Federal Regulations at 42 CFR Part 447, Subpart A, 42 CFR Part 434, 42 CFR Part 438, and sections 1902(a)(4), 1902(a)(6), and 1903 of the Social Security Act and Section 2702 of the Patient Protection and Affordable Care Act of 2010 prohibits Federal payments to States under section 1903 of the Social Security Act for any amounts expended for providing medical assistance for certain hospital outpatient provider-preventable conditions (PPC) and health care-acquired conditions (HCAC) for dates of service effective July 1, 2011, for individuals for which Medicaid is primary and those dually eligible for both the Medicare and Medicaid programs.
 Notice of Termination / Withdrawal of Proposed Rule SPA2005-013SPA 2005-013 This State Plan Amendment is to change the outpatient hospital reimbursement, whereby rates are trended forward annually. In addition, pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment also reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described.
  SPA2005-013 (2)After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2005-013.1After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-008After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-009After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-011After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-012After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-013After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-014After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-015After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-016After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-017After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-018After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-019After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-020After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-021After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-022After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-023After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-024After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-025After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-026After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-027After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-028After additional deliberations, the agency has determined that the proposed rule should be withdrawn in consideration of other options.
  SPA2008-029Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect hospital inpatient reimbursement.
  SPA2008-033SPA 2008-033 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect laboratory and radiology providers.
  SPA2008-034SPA 2008-034 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect home health providers.
  SPA2008-035SPA 2008-035 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect ambulance providers.
  SPA2008-036SPA 2008-036 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect dental providers.
  SPA2008-037SPA 2008-037 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect durable medical equipment and supply providers.
  SPA2008-038SPA 2008-038 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect private mental health providers.
  SPA2008-039SPA 2008-039 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect hearing aid providers.
  SPA2008-040SPA 2008-040 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect therapy providers.
  SPA2008-041SPA 2008-041 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect providers of early and periodic, screening, diagnosis, and treatment services.
  SPA2008-042SPA 2008-042 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect vision providers.
  SPA2008-043SPA 2008-043 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect private duty nursing providers.
  SPA2008-044SPA 2008-044 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect nurse practitioner and physician assistant providers.
  SPA2008-056SPA 2008-056 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect physician providers
  SPA2008-057SPA 2008-057 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect chiropractic providers
  SPA2008-058SPA 2008-058 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect podiatry providers.
  SPA2008-059SPA 2008-059 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect ambulatory surgical center providers and free standing dialysis providers.
  SPA2008-060SPA 2008-060 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan Amendment will affect Christian Science providers.
  SPA2008-061SPA 2008-061 Pursuant to Miss. Code Ann. §43-13-117 (1972, amended), if current or projected expenditures of the Division are reasonably anticipated to exceed the amount of funds appropriated to the Division for any fiscal year, the Governor shall discontinue any or all of the payment of the types of care and services provided under this section that are deemed to be optional services and when necessary, shall institute any other cost containment measures on any program or programs authorized under the article to the extent allowed under the federal laws governing that program. Therefore, this State Plan Amendment reflects necessary cost containment measures to assure Medicaid operates within expected revenues as described. This State Plan amendment will affect pharmacy providers.
  SPA2010-007This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-008This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-009This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-010This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-011This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-012This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-013This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-014This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-015This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-016This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-017This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-018This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-020This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-021This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-022This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-024This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA2010-024This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
 Notice of Rule Adoption - Final Rule CHIP #7This State Plan Amendment is being filed because the benchmark definition requires that any applicable benefit changes made to the State and School Employees Health Insurance Plan be consequently implemented with the CHIP.
  SPA 2005-002This State Plan Amendment is being filed to allow the Division of Medicaid to update the language pertaining to the preferred Drug List.
  SPA 2005-003This State Plan Amendment is being filed to allow the Division of Medicaid to update the language to permit Annual Physical Examinations.
  SPA 2005-004SPA 2005-004 This State Plan Amendment is being filed to allow the Division of Medicaid to comply with House Bill 1104, which deletes the requirement to set physician fees no lower than the 1994 fees, and to adjust the annual updates from January to July
  SPA 2005-005This State Plan Amendment is being filed to allow the Division of Medicaid to make a technical correction to reinstate the PLAD category of eligible individuals.
  SPA 2005-006This State Plan Amendment is being filed to allow the Division of Medicaid to eliminate the optional category of eligibility for hospice individuals under 300% of the SSI limit as required by House Bill 1104.
  SPA 2005-007This State Plan Amendment is being filed to allow the Division of Medicaid to update the language for clarification purposes only. There is no change in reimbursement or service limits, which allows six (6) emergency room visits per adult beneficiary per fiscal year and unlimited outpatient hospital services that are not billed as emergency room services. (Effective July 1, 2005)
  SPA 2005-008This State Plan Amendment is filed to allow the Division of Medicaid to establish a reimbursement rate for non-emergency transportation consistent with the existing contract language and add language which outlines the payment methodology for mass transit providers
  SPA 2005-010This State Plan Amendment is being filed to allow the Division of Medicaid to revise the prescription limits for beneficiaries age 21 and older to five per month with no more than two brand name drugs per month for each non-institutionalized beneficiary, modifies reimbursement methodology for drugs, changes the prescription co-payment amount, and makes a technical correction to Attachment 4.19-B pages 12a.1 and 12a.2.
  SPA 2005-011This State Plan Amendment is being filed to allow the Division of Medicaid to: (1) reduce the number of Home Health service visits from sixty (60) to twenty-five (25) per year; (2) remove the skill requirement for aides; (3) retain consistency between SPA and agency policies related to medical supplies through home health services; and (4) delete physical therapy and speech pathology as covered services through the home health program.
  SPA 2005-012This State Plan Amendment is being filed to change the inpatient hospital reimbursement methodology to a more efficient method whereby rates are trended forward annually; affected State Plan pages also have some inconsequential corrections.
  SPA 2005-014This State Plan Amendment is being filed to remove the optional PLAD coverage group as required in House Bill 1104 and removes the PLAD group from the 1902(r)(2) liberalizations, which was the authority used to increase the PLAD need standard from 100% to 135%. This Amendment also makes applying for Medicare a condition of eligibility for Medicaid benefits. Effective 1/1/06 Comment period ends close of business 12/31/05.
  SPA 2006-002This State Plan Amendment is being filed to allow the Division of Medicaid to pursue supplemental rebates as a cost containment measure. The Division estimates a savings for FFY 2006 and 2007 as $2.25 million and $3 million in state dollars respectively.
  SPA 2006-006This State Plan Amendment is being filed to allow Mississippi Division of Medicaid to place a ceiling on the administrative and operating costs of the Private Nursing Facility for the severely disabled, and to make a technical correction to remove the care related cost exception from the 80% occupancy rule.
  SPA 2006-007The purpose of this State Plan Amendment is to make a technical correction by adding the eligibility category @42 CFR 435.217 (HCBS Waiver Group) to the Mississippi State Plan.
  SPA 2007-002This State Plan amendment is being filed to allow the Division of Medicaid to establish the Division’s oversight of policies and procedures to implement the education of employees regarding the false claims act.
  SPA 2007-003The purpose of this State Plan Amendment is to limit approval of requests by new owners of long-term care facilities to receive maximum reimbursement rate for the interim period until the initial cost report is reviewed. New owners who do not represent a good risk will receive the base rate of the old owner, excluding the property hold harmless and return on equity portion of the rate.
  SPA 2007-004The purpose of this State Plan Amendment is to establish a new methodology for setting dental fees at a percentile of provider charges based on the Ingenix Customized Fee analyzer Report and mandates that fees be adjusted annually. It also establishes a $2,500 benefit limit for dental services per beneficiary per year, with additional benefits available upon prior approval.
  SPA 2007-006The purpose of this State Plan Amendment is to make a technical correction by adding the eligibility category @ 42 CFR 435.217 (HCBS Waiver Group) to the Mississippi State Plan.
  SPA 2007-007The purpose of this State Plan Amendment is to make a technical correction regarding optional drug coverage categories (i.e. OTC formulary, prescription vitamins, cold and cough products, and smoking cessation drugs) and lists drugs by therapeutic classes rather than by individual drugs; and to increase drug options (in response to State Law HB 1695 and SMDL #07-004) and adds more drugs in the optional category of smoking cessation agents for the MS Medicaid beneficiary population.
  SPA 2007-05The purpose of this State Plan Amendment is to establish dental fees at a percentile of private provider charges and enable the fees to be adjusted annually. This amendment sets a $2,500 annual dental benefit limit, allows additional dental benefits with prior authorization, and increases orthodontia lifetime benefits to $4200.
  SPA 2008-002This State Plan Amendment is being filed to correct a technical error relating to the payment of non-covered Medicaid services for Qualified Medicare Beneficiaries (QMB’s). The current SPA 98-08 includes asterisks in the column labeled “Medicaid agency will not reimburse for services that are not covered under the Medicaid State Plan”. The asterisk is being removed on this amendment based on the federal requirement to pay for services not covered under the State’s Medicaid plan. This will become effective April 1, 2008.
  SPA 2008-003This State Plan amendment is being filed to make technical corrections that remove the QI-2 group and presumptive eligibility from the MS State Plan; to add the CHIP group and exisitng income disregards to the State Plan; to insert new provisions of the Deficit Reduction Act of 2005 for transfer of assets and home equity into the State Plan; and to add a braoder description of DOMs outstationing activity.
  SPA 2008-010This amendment adds a co-payment amount of $3.00 per day for services provided in an Ambulatory Surgical Center. Section 43-13-117 (49) of the Mississippi Code Ann. (1972 as amended) authorizes the Division to establish co-payments for all Medicaid services for which co-payments area llowable under federal law or regulations; and, set the amount of the co-payment for each of those services at the maximum amount allowable under federal law or regulation.
  SPA 2008-054This State Plan Amendment is being filed to update language relating to case management or targeted case management per the requirements of the federal regulations (42 CFR Parts 431, 440, and 441 Interim Final Rule). The State Plan pages regarding Targeted Case Management for children in foster care receiving child protective services are being removed because this program was never implemented. This became effective April 1, 2008.
  SPA 2008-055This State Plan Amendment is being filed to update language relating to case management or targeted case management per the requirements of the federal regulations (42 CFR Parts 431, 440, and 441 Interim Final Rule). The State Plan pages regarding Targeted Case Management for children in foster care receiving child protective services are being removed because this program was never implemented. This became effective April 1, 2008.
  SPA 2008-062This State Plan amendment is being filed to comply with federal law by establishing and implementing the Medicaid Integrity Program in Section 1936 of the Deficit Reduction Act of 2005. This provision will also establish Section 1902(a) (69) of the act entitled "State Requirement to Cooperate with Integrity Program Efforts".
  SPA 2008-063This State Plan amendment is being filed to revise accreditation standards for the psychiatric residential treatment facilities. This regulation allows accreditation by the Council on Accreditation of Services for Families and Children (COA) in addition to JCAHO. This State Plan amendment also removes the forty-five day tmie frame for inpatient psychiatric services. Beneficiaries can receive services longer if prior approved as medically necessary, in psychiatric hospitals or in a psychiatric unit of a general hospital. They are also allowed unlimited days of service if medically necessary in a PRTF. Because of the provision for additional days if medically necessary, the 45-day rule is unncessary and has not been used because of the exception.
  SPA 2009-001This State Plan Amendment is to remove language which addresses the pre-certification requirements for swing bed services. To manage utilization and medical necessity, the Division of Medicaid has always required pre-certification for inpatient days during an admission to swing bed. Utilization will be monitored on a post-payment basis. The final approval from DMS allows MD DOM to remove Attachment 3.1-A, Exhibit 1a from the MS State Plan.
  SPA 2009-002This State Plan amendment is being filed to comply with House Bill 71, which directs DOM to submit a State Plan amendment to CMS related to changes in the distribution of hospital DSH and UPL payments beginning in SFY-10. This amendment also clarifies language for rates for new owners and new hospitals and language for providers requesting a rate change due to a 5% increase in costs. There is also a change in the age restriction from under six to under twenty-one for services provided by out-of-state hospitals that cannot otherwise be provided in Mississippi.
  SPA 2009-004This State Plan amendment is being filed to make needed technical updates and corrections to the MS State Plan, Attachment 4.19-D. Technical corrections in this SPA will remove reference to outdated language, such as reference to Review Board that no longer exists, to revise the trend factor example to reflect updates caused by federal changes to the Consumer price indices, to remove working on incontinence supplies as mandated by CMS representatives, and to remove reference to cost report software that was abandoned. There is no expected fiscal impact as a result of this SPA, except for a nominal amount to be paid for feeding assistants training of possibly $100,000 in total funds per year. The approved effective date from CMS is February 8, 2010.
  SPA 2010-001SPA2010-001 This State Plan Amendment is being filed in order for the Division of Medicaid to comply with Miss. Code Ann. §43-13-117 (39). This requires "From on and after July 1, 2009, the Division shall reimburse crossover claims for inpatient hospital services and crossover claims covered under Medicare Part B in the same manner that was in effect on January 1, 2008, unless specifically authorized by the Legislature to change this method." In addition, the SPA is updated to define how the agency is reimbursing all other crossover claims. This filing is compliant with the filing time-line requirement in accordance to Miss Code 25.43.3113.
  SPA 2010-001This State Plan Amendment is being filed in order for the Division of Medicaid to comply with Miss. Code Ann. §43-13-117 (39). This requires "From on and after July 1, 2009, the Division shall reimburse crossover claims for inpatient hospital services and crossover claims covered under Medicare Part B in the same manner that was in effect on January 1, 2008, unless specifically authorized by the Legislature to change this method." In addition, the SPA is updated to define how the agency is reimbursing all other crossover claims. This filing is compliant with the filing time-line requirement in accordance to Miss Code 25.43.3113.
  SPA 2010-003Reason for State Plan Amendment: To allow the administrative and operating per diem for PNF-SD based on allowable costs and patient days.
  SPA 2010-004This State Plan Amendment is being filed in order for MS Division of Medicaid to implement a coordinated care program, entitled MississippiCAN. This program is for a certain targeted, high-cost population (SSI, Foster Care, Working Disabled, Disabled Children Living at Home, Breast and Cervical Cancer waiver participants). The purpose of the program is to improve the health of this population thereby accomplishing a cost savings to the agency. This was filed with CMS on February 26, 2010.
  SPA 2010-004 ORAL PROC.This State Plan Amendment is being filed in order for MS Division of Medicaid to implement a coordinated care program, entitled MississippiCAN. This program is for a certain targeted, high-cost population (SSI, Foster Care, Working Disabled, Disabled Children Living at Home, Breast and Cervical Cancer waiver participants). The purpose of the program is to improve the health of this population thereby accomplishing a cost savings to the agency. This was filed with CMS on February 26, 2010. This filing is to give notice of an oral proceeding scheduled for May 25, 2010.
  SPA 2010-005Asset Verification System (AVS) Implementation - Title VII, section 7001 (d) of P.L. 110-252, Supplemental Appropriations Act of 2008, created a new section 1940 mandating asset verification through access to information held by financial institutions for aged, blind and disabled applicants and recipients subject to an asset test. Mississippi is a FFY-2010 phase in state and CMS requires that Medicaid have an electronic AVS in place by 09/30/2010. An RFP must be issued to select a contractor to perform this function for DOM, specifically a contractor that has an established relationship with financial institutions to conduct this type of match and one that can conduct these required matches electronically.
  SPA 2010-006Reason for State Plan Amendment: To follow the law for payments to the state-owned PRTF, as prescribed by House Bill 71.
  SPA 2010-019this SPA reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the MS Code and/or as allowed pursuant to the provisions of state and federal law.
  SPA 2010-019This State Plan Amendment reflects the Division’s authority to adjust provider reimbursement rates in the event that it becomes necessary to enact cost containment measures as described in Section 43-13-117 of the Mississippi Code and/or as otherwise allowed pursuant to the provisions of state and federal law.
  SPA 2010-026The attached State Plan Amendment is being filed as a requirement by CMS. Section 112 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) amended section 1905(p)(1)(C) of the Act to make the resource limit for the Medicare Cost-Sharing groups of QMB, SLMB and QI-1 (also called Medicare Savings Programs) conform to the resource limit for individuals who qualify for the full subsidy Medicare Part D LIS. Effective January 1, 2010, the resource limit for these groups is $6,600 for an individual and $9,910 for a couple. CMS is requiring that all State Plans reflect this change; however, this change has no significance for MS since DOM eliminated the resource test for the Medicare Cost-Sharing groups effective 07/01/1999. The SPA is cost neutral. Increasing the resource limit will have no impact on the DOM Medicare Cost-Sharing groups because these groups are not subject to a resource limit. This action will not add or remove anyone from the groups at issue.
  SPA 2010-027LTC State Plan Amendment 2010-027– Federal change through CMS to use of MDS 3.0 resident assessment instrument used for nursing facility case mix payment. Secondly, CMS requested that language be included to state the Medicaid assessment is an allowable cost on the cost report. Reason for State Plan Amendment: To conform case mix payment to use of the MDS 3.0. Secondly, to add a provision to clarify that the Medicaid assessment is an allowable cost on the providers’ cost reports.
  SPA 2010-028 ORALAmendment to the Medicaid State Plan regarding a change to the hospital inpatient rate setting methodology whereby Core-Based Statistical Areas (CBSAs) will be used for wage index purposes instead of Metropolitan Statistical Areas (MSAs) for rate years beginning October 1, 2011.
  SPA 2010-029LTC State Plan Amendment 2010-029– State law change to freeze long-term care facility rates at January 1, 2010 level through state fiscal year 2011. Reason for State Plan Amendment: To comply with Medicaid’s FY 2011 Appropriations bill.
  SPA 2010-030Per Section 702 of the Benefits Improvement Act of 2000, the RHC state plan guidelines for the reimbursement of rural health clinic were amended in 2001. However, some sections of the current state plan are vague and ambiguous, thereby making the plan vulnerable to multiple interpretations by providers. Reason for State Plan Amendment: To clarify the language in the current state plan and reduce provider inquiries regarding our RHC reimbursement methodology.
  SPA 2010-031The purpose of this State Plan Amendment is to ensure the hospice coverage page and hospice reimbursement page in the Mississippi State Plan are alike regarding the benefit periods. The hospice benefit period allows for an initial 90-day period, a subsequent 90-day period, and then an unlimited number of 60-day periods provided a physician certifies that the individual is terminally ill or that the condition of the individual has not changed since the previous certification of terminal illness.
  SPA 2010-033This amendment will allow the Division of Medicaid to establish programs to contract with one or more Medicaid RACs for the purpose of identifying underpayments and overpayments and recouping overpayments under the State Plan and under any waiver of the State Plan with respect to all services.
  SPA 2010-035Section 1902 (a) (73) of the Social Security Act requires a State in which one or more Indian Health Programs or Urban Indian Organizations furnish health care services to establish a process for the State Medicaid agency to seek advice on a regular, ongoing basis from designees of Indian health programs, whether operated by the Indian Health Service, Tribes or Tribal organizations under the Indian Self-Determination and Education Assistance Act, or Urban Indian Organizations under the Indian Health Care Improvement Act. Consultation is required concerning Medicaid matters having a direct impact on these Indian health programs.
  SPA 2011-001Section 115 of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) amended section 1917(b)(1) of the act to exempt Medicare cost-sharing benefits (i.e., Part A and Part B premiums, deductibles, coinsurance, and co-payments) paid under the MSPs from estate recovery. The exemption applies to the following groups of dual eligibles: QMB, SLMB, QI, QDWI, QMB Plus, and SLMB Plus. Effective January 1, 2011 Medicare cost-sharing benefits paid under MSPs are exempted from estate recovery. CMS is requiring all State Plans to reflect this change.
  SPA 2011-002Legal Background: Section 6505 of the Affordable Care Act amends section 1902(a) of the Social Security Act (the Act), and requires that a state shall not provide any payments for items or services provided under the State Plan or under a waiver to any financial institution or entity located outside of the U.S. Reason for State Plan Amendment: To conform to Section 1902(a)(80) of the Social Security Act, P.L. 111-148 (Section 6505).
  SPA 2011-003The attached State Plan Amendment is being filed to ensure the financial/reimbursement page for therapy services provided in non-hospital settings is comprehensive and meets all requirements of Section 1902(a)(30)(A) of the Social Security Act. After review of the SPA for expansion of services for adults, it was noted that the corresponding financial/reimbursement page did not meet all necessary federal requirements. This revised SPA is to ensure the Mississippi Medicaid State Plan is in compliance with all federal statutes and regulations and that the State Plan comprehensively and accurately describes payment of these services.
  SPA 2011-005Legal Background: HB 1499 of 2011, Section 17, “The Division shall freeze reimbursement rates for long-term care at the level that rates were in effect on January 1, 2010, except that long-term care rates will be adjusted by an add-on after trended costs used to set the rates in effect on January 1, 2010, as determined by the division, for the change in the provider bed tax rate as required under state law. The Division shall increase funding for the Assisted Living and Elderly and Disabled Home-and-Community Based Waiver programs by Three Million Dollars ($3,000,000). History: DOM normally re-bases LTC rates annually at January 1, and also when a change of ownership or classification occurs. This practice must be stayed until July 1, 2012, under the new state law. Reason for State Plan Amendment: To comply with Medicaid’s FY 2012 Appropriations bill.
  SPA 2011-008This State Plan Amendment is being filed to allow the Division of Medicaid to revise the reimbursement methodology for ASCs payments. Now that Medicare rates have been established for each covered procedure code, the Mississippi Division of Medicaid proposes to set the rates at 80% of the current Medicare Ambulatory Surgical Center Payment System. This methodology allows the Division of Medicaid to update ASC codes and rates annually based on the Medicare changes.

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