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Mississippi Medicaid State Plan

 

Mississippi Medicaid State Plan

The Mississippi Medicaid State Plan (State Plan) is a detailed agreement between the State of Mississippi and the Federal Government that describes the nature and scope of Mississippi’s Medicaid Program. The State Plan is based on the federal requirements and regulations found in Title XIX of the Social Security Act. Changes to the State Plan, called State Plan Amendments (SPAs), must be approved by the Centers for Medicare and Medicaid Services (CMS) prior to implementation.

Notification of updates on the State Plan, Administrative Code or Waivers
If a provider or individual would like to be added to the distribution list for notification of updates to the State Plan, Administrative Code, or Waiver please notify the Division of Medicaid at DOMPolicy@medicaid.ms.gov.

Section 1 – Single State Agency Organization

Designation and Authority
Intergovernmental Cooperation Act Waivers
Eligibility Determination and Fair Hearings
Organization and Administration
Single State Agency Assurances
Financial Eligibility Requirements for Non-MAGI Groups
1.5 Pediatric Immunization Program
1.6 State Option to use Managed Care-Population Health Management Program

Attachment 1.1-A Attorney General’s Certification

Attachment 1.2-A Organization and Function of Medicaid State Agency

Section 2 – Coverage and Eligibility

2.1 Application, Determination of Eligibility and Furnishing Medicaid

Attachment 2.1-A Definition of a Health Maintenance Organization

2.2 Coverage and Conditions of Eligibility

Attachment 2.2-A Groups Covered and Agencies Responsible for Eligibility Determinations

2.3 Residence
2.4 Blindness
2.5 Disability
2.6 Financial Eligibility

Attachment 2.6-A Eligibility Conditions and Requirements

2.7 Medicaid Furnished Out of State

Section 3 –  Services: General Provisions

3.1 Amount, Duration and Scope of Services

Attachment 3.1-A Amount, Duration, and scope of Medical and Remedial Care and Services Provided to the Categorically Needy
Attachment 3.1-C Standards and Methods of Assuring High Quality Care
Attachment 3.1-D Methods of Providing Transportation
Attachment 3.1-E Standards for the Coverage of Organ Transplant Procedures
Attachment 3.1-F Condition or Requirement for Coordinated Care Organizations
Attachment 3.1-i Home and Community-Based Services Administration and Operation

3.2 Coordination of Medicaid with Medicare and other insurance

Attachment 3.2-A Coordination of Title XIX with Part A & B of Title XVIII

3.3 Medicaid for Individual Age 65 or Over in Institutions for Mental Disease
3.4 Special Requirement Applicable to Sterilization Procedure
3.5 Families Receiving Extended Medicaid Benefits

Section 4 – General Program Administration

4.1 Methods of Administration
4.2 Hearings for Applicants and Recipients
4.3 Safeguarding Information on Applicants and Recipients
4.4 Medicaid Quality Control
4.46 Provider Screening and Enrollment
4.5 Medicaid Agency Fraud Detection and Investigation Program
4.6 Reports
4.7 Maintenance of Records
4.8 Availability of Agency Program Manuals
4.9 Reporting Provider Payments to the Internal Revenue Service
4.10 Free Choice of Providers
4.11 Relations with Standard-Setting and Survey Agencies

Attachment 4.11-A Standards for Institutions

4.12 Consultation to Medical Facilities
4.13 Required Provider Agreement
4.14 Utilization/Quality Control
4.15 Inspection of Care in Intermediate Care Facilities for the Mentally Retarded, Facilities Providing Inpatient Psychiatric Services for Individuals Under 21, and Mental Hospitals
4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees

Attachment 4.16-A Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies

4.17 Liens and Adjustments or Recoveries

Attachment 4.17-A Liens and Adjustments or Recoveries

4.18 Recipient Cost Sharing and Similar Charges

Attachment 4.18-A Charges Imposed on Categorically Needy

4.19 Payment for Services

Attachment 4.19-A Methods and Standards for Establishing Payment Rates
Attachment 4.19-B Methods and Standards for Establishing Payment Rates – Other Types of Care
Attachment 4.19-C Policy Regarding Payment for Reserving Beds during a Recipient’s absence from a Long Term Care Facility
Attachment 4.19-D Guide Lines for the Reimbursement for Medical Assistance Recipients of Long Term Care Facilities
Attachment 4.19-E Definition of Claim

4.20 Direct Payments to Certain Recipients for Physicians’ or Dentists’ Services
4.21 Prohibition Against Reassignment of Provider Claims
4.22 Third Party Liability

Attachment 4.22-A Requirements for Third Party Liability – Identifying Liable Resources
Attachment 4.22-B Requirements for Third Party Liability – Payment for Claims
Attachment 4.22-C State Medicaid on Cost Effectiveness of Employer Based Group Health Plans

4.23 Use of Contracts
4.24 Standards for Payments for Nursing Facility and Intermediate Care Facility For the Mentally Retarded Services
4.25 Program for Licensing Administrators of Nursing Homes
4.26 Drug Utilization Review Program
4.27 Disclosure of Survey Information and Provider or Contractor Evaluation
4.28 Appeals Process
4.29 Conflict of Interest Provisions
4.30 Exclusion of Providers and Suspension of Practitioners and Other Individuals
4.31 Disclosure of Information by Provider and Fiscal Agents
4.32 Income and Eligibility Verification System

Attachment 4.32-A Income and Eligibility Verification System

4.33 Medicaid Eligibility Cards for Homeless Individuals

Attachment 4.33-A Method of Issuance of Medicaid Eligibility Cards to Homeless Individuals

4.34 Systematic Alien Verification for Entitlements (SAVE)

Attachment 4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance

4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation
4.35 Enforcement of Compliance for Nursing Facilities

Attachment 4.35-A – 4.35-H Enforcement of Compliance for Nursing Facilities

4.36 Required Coordination Between the Medicaid and WIC Programs
4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities

Attachment 4.38 Disclosure of Additional Registry Information
Attachment 4.38-A Collection of Additional Registry Information

4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities

Attachment 4.39 Definition of Specialized Services
Attachment 4.42-A False Claims Act

4.43 Cooperation with Medicaid Integrity Program Efforts
4.44 Medicaid Prohibition on Payments to Institutions or Entities Outside of the United States

Section 5 – Refer to Section 1

Section 6 – Financial Administration
6.1 Fiscal Policies and Accountability
6.2 Cost Allocation
6.3 State Financial Participation

Section 7 – General Provisions
7.1 Plan Amendments
7.2 Nondiscrimination

Attachment 7.2-A Methods of Administration For Recipients of Federal Financial Assistance Title VI-Civil Rights Compliance

7.3 Maintenance of AFDC Efforts (deleted per 3/92 memo from OMP)
7.4 State Governor’s Review