Approved State Plan Amendments

The State Plan Amendments below have been previously approved and are listed by year.

2019 | 2018 | 2017 | 2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005

2024

MS SPA 24-0003 Physician Upper Payment Limit (UPL) approved by CMS
State Plan Amendment (SPA) 24-0003 Physician Upper Payment Limit (UPL) was submitted to allow the Division of Medicaid (DOM) to update the Medicare Equivalent of the average commercial rate (ACR) ratio and remove other professional practitioners, effective April 1, 2024.

MS SPA 24-0015 Prescription Drugs approved by CMS
State Plan Amendment (SPA) 24-0015 was submitted to allow adults to receive above the monthly prescription limit when prior authorized as medically necessary and to allow for coverage of prescription drugs that are not covered outpatient drugs when medically necessary during drug shortages identified by the Food and Drug Administration (FDA), effective October 1, 2024.

MS SPA 24-0012 Value-Based Drug Rebate approved by CMS
State Plan Amendment (SPA) 24-0012 was submitted to allow the Division of Medicaid (DOM) to enter into value-based contracts with manufacturers on a voluntary basis, effective July 1, 2024.

MS SPA 24-0013 Recovery Audit Contractor (RAC) Exemption approved by CMS
State Plan Amendment (SPA) 24-0013 was submitted to allow the Division of Medicaid (DOM) to request an exemption under 42 CFR § 455.516 from the federal requirement to contract with a Recovery Audit Contractor (RAC), effective July 1, 2024.

MS SPA 24-0006 Home Health LPN approved by CMS
State Plan Amendment (SPA) 24-0006 was submitted to allow the Division of Medicaid (DOM) to include coverage of home health services provided by a licensed practical nurse (LPN) under the supervision of a registered nurse (RN), effective July 1, 2024.

MS SPA 24-0005 Anesthesia approved by CMS
State Plan Amendment (SPA) 24-0005 was submitted to allow the Division of Medicaid (DOM) to clarify reimbursement of anesthesia services, effective June 1, 2024.

MS SPA 24-0001 End-Stage Renal Disease (ESRD) Services approved by CMS
State Plan Amendment (SPA) 24-0001 ESRD Services was submitted to comply with 42 C.F.R. § 447.201 which requires the Division of Medicaid to describe the policy and methods used in setting payment rates for each type of service in the Mississippi Medicaid State Plan.

MS SPA 23-0029 Hospital Upper Payment Limit (UPL) approved by CMS
State Plan Amendment (SPA) 23-0029 Hospital Upper Payment Limit (UPL) was submitted to allow the Division of Medicaid (DOM) to establish a hospital upper payment limit (UPL) program effective October 1, 2023.

MS SPA 23-0025 MYPAC Coverage and Reimbursement approved by CMS
State Plan Amendment (SPA) 23-0025 was submitted to allow the Division of Medicaid (DOM) to revise rates to an hourly rate and a fifteen (15) minute add-on rate and remove rate freeze language. These rates are based on actuarial analysis of historical utilization, payment and cost data for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) eligible beneficiaries served in the community that meet the Psychiatric Residential Treatment Facility (PRTF) level of care and the expected utilization of services. This SPA also revises the service components to align with the Department of Mental Health requirements, effective November 1, 2023.

MS SPA 23-0030 Orthodontic Services approved by CMS
State Plan Amendment (SPA) 23-0030 Orthodontic Services was submitted to allow the Division of Medicaid (DOM) to increase reimbursement rates for orthodontic services by ten percent (10%), effective October 1, 2023.

MS SPA 23-0024 Tobacco Cessation approved by CMS
State Plan Amendment (SPA) 23-0024 was submitted to allow the Division of Medicaid (DOM) to add coverage for up to twelve (12) tobacco cessation counseling sessions per year, effective July 1, 2023.

MS SPA 23-0031 Adult Vaccines Attestation approved by CMS
State Plan Amendment (SPA) 23-0031 was submitted to comply with the Inflation Reduction Act (IRA) requirement for the Division of Medicaid to attest to the coverage of all Advisory Committee on Immunization Practices (ACIP) recommended vaccines and their administration, effective October 1, 2023.

MS SPA 23-0026 Non-Emergency Transportation (NET) Emergency Contract approved by CMS
State Plan Amendment (SPA) 23-0026 was submitted to allow the Division of Medicaid to revise NET broker reimbursement in accordance with an emergency contract effective October 1, 2023.

2023

MS SPA 23-0015 Postpartum Coverage approved by CMS
State Plan Amendment (SPA) 23-0015 was submitted to extend postpartum coverage for pregnant women from sixty (60) days to twelve (12) months, effective April 1, 2023.

MS SPA 23-0032 Ambulatory Surgical Centers (ASC) Dental Services approved by CMS
State Plan Amendment (SPA) 23-0032 was submitted to allow the Division of Medicaid (DOM) to update reimbursement of dental services provided in an ambulatory surgical center (ASC). For ASC dental services that do not have a fee on the Medicare ASC Fee Schedule, effective December 1, 2023, the SPA will allow ASC’s to be reimbursed at eighty percent (80%) of the Medicare rate that was in effect January 1, 2023, for the most comparable hospital outpatient service.

MS SPA 23-0028 Hemophilia Coverage approved by CMS
State Plan Amendment (SPA) 23-0028 was submitted to allow the Division of Medicaid (DOM) to include beneficiaries diagnosed with hemophilia in the MississippiCAN program, effective July 1, 2023.

MS SPA 23-0007 Outpatient Prospective Payment System (OPPS) approved by CMS
State Plan Amendment (SPA) 23-0007 Outpatient Prospective Payment System (OPPS) was submitted to allow the Division of Medicaid (DOM) to remove the rate freeze and increase the SFY18 Mississippi conversion factor by 5%, effective July 1, 2023.

MS SPA 23-0016 All Patient Refined Diagnosis Related Groups (APR-DRG) Reimbursement Approved by CMS
MS SPA 23-0016 All Patient Refined Diagnosis Related Groups (APR-DRG) Reimbursement was submitted to update the hospital inpatient methodology with an effective date of July 1, 2023.

MS SPA 23-0021 Community Mental Health Services Rate Update – Approved by CMS
State Plan Amendment (SPA) 23-0021 was submitted to allow the Division of Medicaid (DOM) to increase the reimbursement rates for certain mental health services by 15.8% with half of the increase implemented in State Fiscal Year (SFY) 2024 and the second half of the increase implemented in SFY 2025. Rates are effective for services provided on or after July 1 for each year.

MS SPA 23-0017 Graduate Medical Education (GME) approved by CMS
State Plan Amendment (SPA) 23-0017 Graduate Medical Education was submitted to allow the Division of Medicaid (DOM) to change the payment per resident to a flat rate for all eligible resident programs, effective July 1, 2023.

MS SPA 23-0027 Recovery Audit Contractors (RACs) approved by CMS
State Plan Amendment (SPA) 23-0027 Recovery Audit Contractors (RACs) was submitted to allow the Division of Medicaid (DOM) to request an extension for a period of one (1) year to attempt to procure a new, competitively bid RAC contract that complies with the current state and federal laws and regulations, effective July 1, 2023.

MS SPA 23-0018 1915i Community Support Program (CSP) approved by CMS
MS SPA 23-0018 1915i Community Support Program (CSP) State Plan Amendment (SPA) 23-0018 was submitted to allow the Division of Medicaid to revise the requirements for Targeted Case Manager providers; comply with the Home and Community Based Services (HCBS) final rule through ongoing monitoring and person-centered training; revise service definitions for Day Services, Prevocational Services, Supported Employment Services, and in-Home Respite care; revise policies concerning payment for State Plan HCBS furnished by relatives, legally responsible individuals, and legal guardians; and revise quality measures, effective November 1, 2023.

MS SPA 23-0013 Drugs to Treat Obesity approved by CMS
State Plan Amendment (SPA) 23-0013 Drugs to Treat Obesity was submitted to add coverage for selected drugs that treat obesity, effective July 1, 2023.

MS SPA 23-0011 Copay approved by CMS
State Plan Amendment (SPA) 23-0011 was submitted to allow the Division of Medicaid (DOM) to remove copays from Medicaid services effective May 1, 2023.

MS SPA 23-0010 Private Duty Nursing (PDN) Rate Updates approved by CMS
State Plan Amendment (SPA) 23-0010 was submitted to allow the Division of Medicaid to continue the same PDN rates in effect January 1, 2023 for dates of service beginning May 1, 2023.

MS SPA 23-0019 Prescribed Pediatric Extended Care (PPEC) approved by CMS
State Plan Amendment (SPA) 23-0019 was submitted to allow the Division of Medicaid (DOM) to continue the fifteen percent (15%) increase for Prescribed Pediatric Extended Care (PPEC) facilities that were made effective October 1, 2022, beyond the end of the federal Public Health Emergency.

MS SPA 23-0009 Early Intervention Case Manager approved by CMS
State Plan Amendment (SPA) 23-0009 was submitted to allow the Division of Medicaid (DOM) to revise the education and experience requirements for Early Intervention case managers, effective April 1, 2023.

MS SPA 23-0012 Emergency Transportation approved by CMS
State Plan Amendment (SPA) 23-2012 Emergency Transportation was submitted to allow the Division of Medicaid (DOM) to clarify the categories of emergency ground ambulance services, effective January 1, 2023.

MS SPA 23-0006 One-Time Hospital Payment approved by CMS
State Plan Amendment (SPA) 23-0006 One-Time Hospital Payment was submitted to allow the Division of Medicaid to make a one-time, lump-sum payment to all Mississippi hospitals eligible for supplemental payments under federal and state laws and regulations upon CMS approval and not later than the end of the federal Public Health Emergency, effective March 1, 2023.

MS SPA 23-0004 Ambulance Mileage approved by CMS
State Plan Amendment (SPA) 23-0004 was submitted to add reimbursement for emergency ambulances for the initial twenty-five (25) miles at a rate of $.01 per mile, effective February 1, 2023.

MS SPA 22-0023 Ambulance Supplemental Payment Program Approved by CMS
State Plan Amendment (SPA) 22-0023 was submitted to allow the Division of Medicaid (DOM) to establish a Medicaid Supplemental Payment Program for emergency ambulance transportation providers, effective July 1, 2022.

MS SPA 22-0004 COVID Vaccines and Administration approved by CMS
State Plan Amendment (SPA) 22-0004 was submitted to comply with the American Rescue Plan (ARP) requirements for coverage of COVID vaccines, their administration and vaccine counseling services for children. This SPA was submitted with an 1135 waiver request to allow the effective date to comply with the ARP, effective March 11, 2021.

MS SPA 23-0002 Autism Spectrum Disorder (ASD) Service Rate Update approved by CMS
CMS approved State Plan Amendment (SPA) 23-0002 on April 13, 2023. This 23-0002 Autism Spectrum Disorder (ASD) Services Rate Update was submitted to allow the Division of Medicaid (DOM) to update reimbursement for autism spectrum disorder services to the lesser of the usual and customary charge or a rate calculated by an actuarial firm, effective January 1, 2023.

MS SPA 23-0003 Home Health Services approved by CMS
CMS approved State Plan Amendment (SPA) 23-0003 on April 11, 2023. This SPA 23-0003 Home Health Services was submitted to remove rate freeze language and allow reimbursement to be updated annually based on cost reports, effective February 1, 2023.

MS SPA 22-0025 Disproportionate Share Hospital (DSH) approved by CMS
CMS approved State Plan Amendment (SPA) 22-0025 on February 24, 2023. State Plan Amendment (SPA) 22-0025 was submitted to allow the Division of Medicaid (DOM) to change redistribution methodology for disproportionate share hospital (DSH) audits to allow all providers who were underpaid to receive some benefit, effective October 1, 2022.

MS SPA 22-0028 Private Duty Nursing (PDN) and Prescribed Pediatric Extended Care (PPEC) Services approved by CMS
CMS approved State Plan Amendment (SPA) 22-0028 on February 24, 2023. State Plan Amendment (SPA) 22-0028 was submitted to allow the Division of Medicaid (DOM) to increase the rates for PDN and PPEC services by fifteen percent (15%) for the duration of the Public Health Emergency, effective October 1, 2022.

MS SPA 22-0027 Durable Medical Equipment (DME) and Medical Supplies approved by CMS
CMS approved State Plan Amendment (SPA) 22-0027 Durable Medical Equipment (DME) and Medical Supplies on January 5, 2023. This SPA was submitted to allow the Division of Medicaid (DOM) to update the rates for durable medical equipment (DME) and Medical Supplies October 1, 2022, and July 1 of each year thereafter based on the Medicare Rural Rate in effect January 1 of that year, effective October 1, 2022.

MS SPA 22-0005 COVID Treatment and Complications Coverage approved by CMS
CMS approved State Plan Amendment (SPA) 22-0005 on January 20, 2023. This SPA was submitted to comply with the ARP requirements for coverage of OVID-19 treatment or for a condition that may seriously complicate the treatment of COVID-19 for individuals diagnosed with or presumed to have COVID-19 during the period the individual has COVID-19. This SPA was submitted with an 1135 waiver request to enable the effective date to comply with the ARP.

2022

MS SPA 22-0010 Orthotics and Prosthetics (EPSDT only) approved by CMS
CMS approved State Plan Amendment (SPA) 22-0010 on November 4, 2022. This SPA was submitted to allow reimbursement rates for orthotics and prosthetics to be updated based on eighty (80%) of the Medicare Rate.

MS SPA 22-0007 Tribal Consultation approved by CMS
CMS approved State Plan Amendment (SPA) 22-0007 on December 30, 2022, with an effective date of October 1, 2022. This state plan amendment was submitted to allow the Division of Medicaid (DOM) to update and identify the Mississippi Band of Choctaw Indians (MBCI) designees.

MS SPA 22-0026 Ambulatory Surgical Centers (ASCs) approved by CMS
CMS approved State Plan Amendment (SPA) 22-0026 on December 19, 2022.This state plan amendment was submitted to allow the Division of Medicaid (DOM) to update the rates for ambulatory surgical centers (ASCs) October 1 of each year, based on the Medicare rate in effect July 1 of that year, effective October 1, 2022.

MS SPA 22-0024 Recovery Audit Contractors (RAC) approved by CMS
CMS approved State Plan Amendment (SPA) 22-0024 on December 12, 2022, with an effective date of July 1, 2022 through June 30, 2023. This state plan amendment was submitted to request an exception to the RAC requirements for a period of one (1) year from the approval date of SPA 22-0024 in order to attempt to procure a new, competitively bid RAC contract that complies with current state and federal laws and regulations.

MS SPA 22-0019 Preventative Services approved by CMS
CMS approved State Plan Amendment (SPA) 22-0019 on December 1, 2022. This State Plan Amendment was submitted to allow the Division of Medicaid (DOM) to update rates for preventative services according to the appropriate payment methodology for the service.

MS SPA 22-0001 COVID Testing approved by CMS
CMS approved State Plan Amendment (SPA) 22-0001 on November 14, 2022. State Plan Amendment (SPA) 22-0001 was submitted to allow the Division of Medicaid (DOM) to comply with the American Rescue Plan (ARP) requirements regarding coverage of U.S. Food & Drug Administration (FDA)-authorized COVID diagnostic and screening tests consistent with the Centers for Disease Control and Prevention (CDC) definitions and recommendations when ordered by a practitioner within their scope of practice, effective March 11, 2021.

MS SPA 22-0017 Therapy Services approved by CMS
CMS approved State Plan Amendment (SPA) 22-0017 on November 4, 2022. State Plan Amendment (SPA) 22-0017 was submitted to allow the Division of Medicaid (DOM) to reimburse for therapy services at ninety percent (90%) of the Medicare rate in effect on January 1, 2022, and as may be adjusted each July thereafter.

MS SPA 22-0014 Clinic Services approved by CMS
CMS approved MS SPA 22-0014 on November 4, 2022. State Plan Amendment (SPA) 22-0014 is being submitted to allow the encounter rate for clinic services provided by the Mississippi Department of Health clinics to be updated July of each year.

MS SPA 22-0009 Other Licensed Practitioners approved by CMS
CMS approved State Plan Amendment (SPA) 22-0009 on November 4, 2022. State Plan Amendment (SPA) 22-0009 was submitted to allow reimbursement rates for other licensed practitioners to be updated, when applicable, according to the appropriate State Plan payment methodology.

MS SPA 22-0008 Independent Lab and X-ray Services approved by CMS
CMS approved State Plan Amendment (SPA) 22-0008 on November 4, 2022. State Plan Amendment (SPA) 22-0008 was submitted to allow the Division of Medicaid (DOM) to reimburse independent laboratory and X-Ray services from a statewide uniform fee schedule based on ninety percent (90%) of the Medicare fee schedule in effect January 1 of each year and updated each July, effective for services provided on or after that date.

MS SPA 22-0011 Physician Services approved by CMS
CMS approved MS SPA 22-0011 Physician Services on November 4, 2022. State Plan Amendment (SPA) 22-0011 was submitted to allow the Division of Medicaid (DOM) reimburse for physician services at ninety percent (90%) of the Medicare Physician Fee schedule established on January 1, 2022 and as may be adjusted each July thereafter.

MS SPA 22-0020 Medication Assisted Treatment (MAT) Services approved by CMS
CMS approved State Plan Amendment (SPA) 22-0020 on November 4, 2022. State Plan Amendment (SPA) 22-0020 was submitted to allow the Division of Medicaid (DOM) to update rates for Medication Assisted Treatment (MAT) services according to the applicable fee schedule and reimburse for Opioid Treatment Programs (OTPs) based on ninety percent (90%) of the Medicare fee schedule updated each July, effective for services provided on or after that date.

MS SPA 22-0022 EPSDT Extended Services approved by CMS
CMS approved MS SPA 22-0022 on November 4, 2022. State Plan Amendment (SPA) 22-0022 was submitted to allow the Division of Medicaid (DOM) to update the rates for certain EPSDT services, including physician services and autism spectrum disorder services, effective July 1, 2022

MS SPA 22-0012 Rehabilitative Services approved by CMS
CMS approved State Plan Amendment (SPA) 22-0012 on November 4, 2022. State Plan Amendment (SPA) 22-0012 Rehabilitative Services was submitted to allow rates for psychiatric therapeutic procedures that are billed using Current Procedural Terminology (CPT) codes to be updated based on ninety percent (90%) of the Medicare fee schedule in effect on January 1, 2022 effective July 1, 2022 and as may be adjusted each July thereafter.

MS SPA 22-0015 Family Planning Services approved by CMS
CMS approved MS SPA 22-0015 on November 4, 2022. State Plan Amendment (SPA) 22-0015 was submitted to allow family planning services to be reimbursed ninety percent (90%) of the Medicare fee schedule in effect January 1, 2022 and as may be adjusted each July thereafter.

MS SPA 22-0013 Chiropractor Services approved by CMS
CMS approved MS SPA 22-0013 on November 4, 2022. State Plan Amendment (SPA) 22-0013 was submitted to allow the Division of Medicaid (DOM) to reimburse for chiropractic services at seventy percent (70%) of the Medicare rate in effect as of January 1, 2022 and as may be adjusted each July thereafter.

MS SPA 22-0018 Midwife Services approved by CMS
CMS approved State Plan Amendment (SPA) 22-0018 on November 4, 2022. State Plan State Plan Amendment (SPA) 22-0018 was submitted to allow the Division of Medicaid (DOM) to update the reimbursement rates for midwife services when applicable.

MS SPA 22-0016 Dental and Orthodontic Services approved by CMS
CMS approved MS SPA 22-0016 Dental and Orthodontic Services on November 4, 2022. State Plan Amendment (SPA) 22-0016 was submitted to allow the Division of Medicaid (DOM) to update reimbursement rates, when applicable, and increase reimbursement rates for restorative dental services five percent (5%) above the previous year for state fiscal years (SFY) 2023, 2024, and 2025.

MS SPA 22-0006 Long Term Care was approved by CMS
CMS approved MS SPA 22-0006 on September 13, 2022. SPA 22-0006 Long-Term Care was submitted to allow the Division of Medicaid (DOM) to remove the rate freeze from long-term care facilities and reimburse providers according to the previous payment methodology, effective May 1, 2022.

MS SPA 21-0018A Covered Outpatient Drugs approved by CMS
During CMS review of MS SPA 21-0018, MS SPA 21-0018A was created to ensure the removal of the five percent (5%) reduction for physician administered drugs would take effect July 1, 2021. This SPA removes the five percent (5%) reimbursement reduction for physician administered drugs and includes some minor edits to language for clarification, effective July 1, 2021.

MS SPA 21-0052 Clinical Trial Coverage approved by CMS
CMS approved MS SPA 21-0052 Clinical Trial Coverage on May 4, 2022. State Plan Amendment (SPA) 21-0052 was submitted to comply with Section 210 of the Consolidated Appropriations Act, 2021, which added a mandatory benefit for routine patient costs for items and services furnished in connection with participation by Medicaid beneficiaries in qualifying clinical trials, effective January 1, 2022.

MS SPA 21-0051 Disproportionate Share Hospital (DSH) Payment Update approved by CMS
CMS approved State Plan Amendment (SPA) 21-0051 Disproportionate Share Hospital (DSH) Payment Update on April 26, 2022. On December 27, 2020, the Consolidated Appropriations Act for 2021 was signed into law after it was passed by Congress, which changes the calculation of a hospital’s DSH limit, OBRA, to remove costs and payments of individuals with Medicare or third-party coverage, with the exception of hospitals that meet the 97th percentile for the most recent reporting period. Although this is a requirement for the DSH examinations/audits, the Division of Medicaid intends to be consistent with the calculation of uncompensated care costs and apply it to the DSH payment calculations.

2021

MS SPA 21-0017 Rural Health Center (RHC) Services approved by CMS
CMS approved MS SPA 21-0017 Rural Health Center (RHC) Services on December 6, 2021. State Plan Amendment (SPA) 21-0017 was submitted to: 1) Clarify the different types of encounters and when more than one encounter is performed on the same day, 2) Add the requirements for RHC mobile units, and 3) add language to refer to Attachment 3.1-A Introductory Pages for coverage of telehealth services to be incompliance with Miss. Code Ann. as amended by Senate Bill 2799, effective July 1, 2021.

MS SPA 21-0016 Federally Qualified Health Center (FQHC) Services approved by CMS
CMS approved MS SPA 21-0016 Federally Qualified Health Center (FQHC) Services on December 6, 2021. State Plan Amendment (SPA) 21-0016 was submitted to: 1) Clarify the different types of encounters and when reimbursement is made for more than one encounter performed on the same day, 2) Add the requirements for FQHC mobile units, and 3) add language to refer to Attachment 3.1-A Introductory Pages for coverage of telehealth services to be incompliance with Miss. Code Ann. as amended by Senate Bill 2799, effective July 1, 2021.

MS SPA 21-0048 Medication Assisted Treatment (MAT) Services approved by CMS
CMS approved State Plan Amendment (SPA) 21-0048 on November 29, 2021. State Plan Amendment (SPA) 21-0048 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for medication assisted treatment services the same as those in effect April 1, 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0046 MSCAN Procurement Method approved by CMS
CMS approved MS SPA 21-0046 on November 4, 2021. The Mississippi Division of Medicaid MS SPA 21-0046 was submitted to ensure the state and the agency are able to use the method of procurement most likely to produce quality vendors for Managed Care services in the state. MSDOM intends to implement this SPA during its next Managed Care procurement cycle, beginning in the summer of 2021, and any Managed Care procurement cycles thereafter. The intended effective date is August 1, 2021.

MS SPA 21-0014 Targeted Case Management (TCM) for High Risk Pregnant Women approved by CMS
CMS approved MS SPA 21-0014 on September 17, 2021. State Plan Amendment (SPA) 21-0014 was submitted to allow the Division of Medicaid (DOM) to 1) update coverage and reimbursement of targeted case management to comply with federal regulations 42 C.F.R. §§ 440.169, 441.18, 2) set the fees for targeted case management for high-risk pregnant women the same as those in effect on July 1, 2021, and 3) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0021 Extended Services for Pregnant Women approved by CMS
CMS approved MS SPA 21-0021 on September 23, 2021. State Plan Amendment (SPA) 21-0021 was submitted to allow the Division of Medicaid (DOM) to 1) revise coverage and payment methodology for extended services for pregnant and post-partum women who are at risk of morbidity or mortality, 2) set the fees for extended services for pregnant women the same as those in effect on July 1, 2021, and 3) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0039 Targeted Case Management (TCM) for Psychiatric Residential Treatment Facility (PRTF) Level of Care (LOC) approved by CMS
CMS approved MS SPA 21-0039 on September 20, 2021. State Plan Amendment (SPA) 21-0039 was submitted to allow the Division of Medicaid (DOM) to cover and reimburse for wraparound services under the targeted case management benefit, effective July 1, 2021. The Division of Medicaid submitted MS SPA 20-0022 Mental Health Service Coverage and Reimbursement to CMS on September 30, 2020. SPA 20-0022 proposed to cover a group of all inclusive services called Mississippi Youth Programs Around the Clock (MYPAC). The primary service in this program was wraparound services and providers billed H2022 Wraparound Per Diem for services provided. During the approval process for SPA 20-0022 the Division of Medicaid was notified that wraparound services could not be covered under the rehabilitative services benefit and would need to be covered as a targeted case management program. Under the targeted case management rules, services must be billed separately from case management services. The Division of Medicaid is submitting this SPA to cover wraparound services as a targeted case management benefit that will be reimbursed a monthly rate separate from direct care services included in the beneficiary’s plan of care. The Division of Medicaid is submitting this proposed SPA to be in compliance with 42 C.F.R. § 447.201 which requires all policy and methods used in setting payment rates for services be included in the State Plan. The changes in this SPA are being made to be in compliance with 42 C.F.R. §§ 440.169 and 441.18., effective July 1, 2021.

MS SPA 21-0035 Telehealth approved by CMS
CMS approved MS SPA 21-0035 Telehealth on September 17, 2021. State Plan Amendment (SPA) 21-0035 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for telehealth services the same as those in effect on July 1, 2020, 2) add Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) as distant site providers, 3) add language that FQHCs, RHCs and Community Mental Health Centers (CMHCs) delivering simultaneous distant and originating site can receive the originating or distant site facility fees when such services are appropriately provided by the same organization, 4) add school which employs a school nurse, inpatient hospital and the beneficiary’s home as an originating site, and 5) add telehealth services must be Health Insurance Portability and Accountability Act (HIPAA) compliant, effective July 1, 2021.

MS SPA 21-0040 Targeted Case Management (TCM) for Chronically Mentally Ill approved by CMS
CMS approved MS SPA 21-0040 Targeted Case Management (TCM) for Chronically Mentally Ill on September 20, 2021. State Plan Amendment (SPA) 21-0040 was submitted to allow the Division of Medicaid (DOM) to add coverage language and requirements to targeted case management for the chronically mentally ill to comply with 42 C.F.R. § 440.169 and § 441.18, effective July 1, 2021.

MS SPA 21-0023 Long-Term Care approved by CMS
CMS approved MS SPA 21-0023 Long-Term Care on September 23, 2021. State Plan Amendment (SPA) 21-0023 was submitted to allow the Division of Medicaid (DOM) to freeze all long-term care facility rates in effect July 1, 2021.”

MS SPA 21-0007 APR-DRG approved by CMS
CMS approved MS SPA 21-0007 APR-DRG on September 23, 2021. State Plan Amendment (SPA) 21-0007 All Patient Refined-Diagnosis Related Groups (APR-DRG) Reimbursement was submitted to update the following hospital inpatient services effective July 1, 2021: 1) Update APR-DRG parameters, 2) use cost-to-charge (CCRs) ratios in effect July 1, 2021 to calculate outlier payments for claims with last dates of service on or after July 1, 2021, and 3) remove language that intensive outpatient programs and partial hospitalization programs are not covered in the outpatient hospital setting.

MS SPA 21-0042 Targeted Case Management (TCM) for Infants Under the Age of One approved by CMS
CMS approved MS SPA 21-0042 on September 13, 2021. State Plan Amendment (SPA) 21-0042 was submitted to allow the Division of Medicaid (DOM) to 1) update coverage and reimbursement of targeted case management (TCM) for infants under the age of one (1) to comply with federal regulations 42 C.F.R. §§ 440.169, 441.18, 2) set the fees for TCM for infants under the age of one (1) the same as those in effect on July 1, 2021, 3) Move reimbursement language for TCM for infants under the age of one (1) to a new page, and 4) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0028 EPSDT Extended Services approved by CMS
CMS approved MS SPA 21-0028 on September 13, 2021. State Plan Amendment (SPA) 21-0028 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for EPSDT extended services the same as those in effect on July 1, 2020, 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021, and 3) add coverage and reimbursement of Mississippi Youth Programs Around the Clock (MYPAC) Therapeutic Services effective July 1, 2021.

MS SPA 21-0022 Transportation Services approved by CMS
CMS approved MS SPA 21-0022 on September 13, 2021. State Plan Amendment (SPA) 21-0022 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for transportation services the same as those in effect on July 1, 2020, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0001 COVID Vaccine Administration Reimbursement Emergency approved by CMS
CMS approved MS SPA 21-0001 on September 20, 2021. State Plan Amendment (SPA) 21-0001 was submitted to allow the Division of Medicaid (DOM) to reimburse all Mississippi Medicaid pharmacies, physicians, and non-physician practitioners 100% of the Medicare rate for the administration of an FDA-approved COVID-19 vaccine.

MS SPA 21-0041 Preventive Services approved by CMS
CMS approved State Plan Amendment (SPA) 21-0041 on August 31, 2021. State Plan Amendment (SPA) 21-0041 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for vaccines and vaccine administration the same as those effective for State Fiscal Year (SFY) 2021, 2) to include language regarding the reimbursement for administration of Vaccine For Children (VFC) vaccines, and 3) remove the five percent (5%) reimbursement reduction effective July 1, 2021, to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021.

MS SPA 21-0024 Rehabilitative Services approved by CMS
CMS approved State Plan Amendment (SPA) 21-0024 on August 24, 2021. State Plan Amendment (SPA) 21-0024 Rehabilitative Services was submitted to 1) set the fees for rehabilitative services the same as those in effect on April 1, 2020, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0010 Other Licensed Practitioners approved by CMS
CMS approved State Plan Amendment (SPA) 21-0010 on August 24, 2021. State Plan Amendment (SPA) 21-0010 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for nurse practitioner and physician assistant services the same as those in effect State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 20-0022 Mental Health Service Coverage and Reimbursement approved by CMS
CMS approved MS SPA 20-0022 on August 2, 2021. SPA 20-0022 was submitted to include: a) Replacing Intensive Outpatient Psychiatric (IOP) services with Intensive Community Outreach Teams (ICORT), b) Reimbursing ICORT services at the current IOP rate, c) Including reimbursement language for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) mental health services which the rates are not being revised, d) Allowing providers of EPSDT community mental health services to provide services to non-EPSDT beneficiaries and be reimbursed according to the current payment methodology, e) Adding coverage and reimbursement of Acute Partial Hospitalization in the outpatient hospital setting, f) Adding language to ensure that community mental health services are covered for beneficiaries with a substance use disorder, g) Removing annual service limits for Crisis Response Services and Medication Administration, and h) Increasing the rate for Mental Health Assessments by a non-physician to 90% of the Medicaid physician rate for Psychiatric Diagnostic Evaluation, effective September 1, 2020.

MS SPA 21-0037 Christian Science Services approved by CMS
CMS approved MS SPA 21-0037 Christian Science Services on August 26, 2021. State Plan Amendment (SPA) 21-0037 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for Christian science services the same as those in effect for State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0045 Dentures approved by CMS
CMS approved MS SPA 21-0045 Dentures on August 26, 2021. State Plan Amendment (SPA) 21-0045 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for dentures for EPSDT recipients the same as those effective for State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021, to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799.

MS SPA 21-0044 Eyeglasses approved by CMS
CMS approved MS SPA 21-0044 Eyeglasses on August 26, 2021. State Plan Amendment (SPA) 21-0044 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for eyeglasses the same as those effective for State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021, to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799.

MS SPA 21-0031 Home Health, DME, and Medical Supply approved by CMS
CMS approved MS SPA 21-0031 Home Health, DME, and Medical Supply on August 24, 2021. State Plan Amendment (SPA) 21-0031 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for home health services in effect as of October 1, 2020, 2) set the fees for durable medical equipment and medical supplies in effect as of July 1, 2020, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0032 Dental and Orthodontic Services approved by CMS
CMS approved MS SPA 21-0032 Dental and Orthodontic Services on August 24, 2021. State Plan Amendment (SPA) 21-0032 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for dental and orthodontic services the same as those effective for State Fiscal Year (SFY) 2021, except for a five percent (5%) rate increase for diagnostic and preventative services in SFY 2022, 2023 and 2024, and 2) remove the five percent (5%) reimbursement reduction for all other dental services effective July 1, 2021.

MS SPA 21-0030 Hearing Aids approved by CMS
CMS approved MS SPA 21-0030 Hearing Aids on August 24, 2021. State Plan Amendment (SPA) 21-0030 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for hearing aids the same as those effective for State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction for hearing aids, effective July 1, 2021.

MS SPA 21-0029 Family Planning Services approved by CMS
CMS approved MS SPA 21-0029 on August 24, 2021. State Plan Amendment (SPA) 21-0029 is being submitted to allow the Division of Medicaid (DOM) to set the fees for family planning services the same as those in effect on July 1, 2020.

MS SPA 21-0027 Dialysis Services approved by CMS
CMS approved MS SPA 21-0027 on August 24, 2021. State Plan Amendment (SPA) 21-0027 is being submitted to allow the Division of Medicaid (DOM) to set the fees for dialysis services the same as those in effect January 1, 2021.

MS SPA 21-0025 Chiropractor Services approved by CMS
CMS approved MS SPA 21-0025 on August 24, 2021. State Plan Amendment (SPA) 21-0025 is being submitted to allow the Division of Medicaid (DOM) to 1) set the fees for chiropractic services the same as those in effect for State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0026 Clinic Services approved by CMS
CMS approved MS SPA 21-0026 on August 24, 2021. State Plan Amendment (SPA) 21-0026 is being submitted to allow the Division of Medicaid (DOM) to 1) set the fees for clinic services the same as those in effect for State Fiscal Year (SFY) 2021, and 2) add language addressing cost reports that are not timely filed.

MS SPA 21-0020 Targeted Case Management (TCM) Early Intervention approved by CMS
CMS approved MS SPA 21-0020 on August 24, 2021. State Plan Amendment (SPA) 21-0020 is being submitted to allow the Division of Medicaid (DOM) to set the fees for targeted case management early intervention services the same as those in effect on July 1, 2021.

MS SPA 21-0015 Hospital Outpatient Services approved by CMS
CMS approved MS SPA 21-0015 Hospital Outpatient Services on August 24, 2021. State Plan Amendment (SPA) 21-0015 is being submitted to allow the Division of Medicaid (DOM) to 1) set the fees for hospital outpatient services the same as those in effect on July 1, 2021, and 2) allow Rural Hospitals that have fifty (50) or fewer licensed beds who opt to not be reimbursed using the OPPS payment methodology be reimbursed based on 101% of the rate established under Medicare for a two (2) year period, effective July 1, 2021.

MS SPA 21-0013 Ambulatory Surgical Center Services approved by CMS
CMS approved MS SPA 21-0013 Ambulatory Surgical Center Services on August 24, 2021. State Plan Amendment (SPA) 21-0013 is being submitted to allow the Division of Medicaid (DOM) to 1) set the fees for ambulatory surgical center services the same as those effective October 1, 2020, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0012 Physician Services approved by CMS
CMS approved MS SPA 21-0012 Physician Services on August 24, 2021. State Plan Amendment (SPA) 21-0012 was submitted to allow the Division of Medicaid (DOM) 1) to set the fees for physician services the same as those effective State Fiscal Year (SFY) 2021, effective July 1, 2021, to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, and 2) move vaccine reimbursement language to Attachment 4.19-B 13c Preventative Services.

MS SPA 21-0011 Orthotics and Prosthetics approved by CMS
CMS approved State Plan Amendment (SPA) 21-0011 on August 24, 2021. State Plan Amendment (SPA) 21-0011 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for orthotics and prosthetics the same as those effective State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0009 Podiatry Services approved by CMS
CMS approved State Plan Amendment (SPA) 21-0009 on August 24, 2021. State Plan Amendment (SPA) 21-0009 was submitted to allow the Division of Medicaid (DOM) to allow the Division of Medicaid (DOM) to remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0008 Independent Lab and X-ray Services approved by CMS
CMS approved State Plan Amendment (SPA) 21-0008 on August 24, 2021. State Plan Amendment (SPA) 21-0008 is being submitted to allow the Division of Medicaid (DOM) to 1) set the fees for independent laboratory and x-ray services the same as those effective State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0033 Therapy Services approved by CMS
CMS approved State Plan Amendment (SPA) 21-0033 on August 24, 2021. State Plan Amendment (SPA) 21-0033 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for therapy services the same as those in effect for State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0034 Midwife Services approved by CMS
CMS approved State Plan Amendment (SPA) 21-0034 on August 24, 2021. State Plan Amendment (SPA) 21-0034 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for midwife services the same as those effective for State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction for midwife services effective July 1, 2021.

MS SPA 21-0038 Targeted Case Management (TCM) for Individuals with Intellectual Disabilities (IDD) approved by CMS
CMS approved State Plan Amendment (SPA) 21-0038 on August 24, 2021. State Plan Amendment (SPA) 21-0038 was submitted to allow the Division of Medicaid (DOM) to remove the five percent (5%) reimbursement reduction effective July 1, 2021.

MS SPA 21-0036 Respiratory Services EPSDT Only approved by CMS
CMS approved State Plan Amendment (SPA) 21-0036 on August 24, 2021. State Plan Amendment (SPA) 21-0036 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees the same as those effective for State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction for respiratory care for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Beneficiaries, effective July 1, 2021.

MS SPA 20-0023 Medication Assisted Treatment approved by CMS
CMS approved State Plan Amendment (SPA) 20-0023 on July 13, 2021. SPA 20-0023 was 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, effective October 1, 2020.

MS SPA 21-0005 LTC Facility Add-on Payment Disaster Relief approved by CMS
CMS approved MS State Plan Amendment (SPA) 21-0005 on June 23, 2021. State Plan Amendment (SPA) 21-0005 LTC Add-on Payment Disaster Relief was submitted to allow the Division of Medicaid (DOM) to reimburse all long-term care facilities licensed in Mississippi an add-on payment of $13.00 per day per beneficiary for claims for dates of service from January 1, 2021 through June 30, 2021. Long-term care facilities in Mississippi include nursing facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) and Psychiatric Residential Treatment Facilities (PRTF). The payment increase will assist long-term care facilities with additional costs associated with the public health emergency, such as staffing, personal protective equipment, new costs related to screening of visitors and cleaning and housekeeping supplies. The add-on will be an increase of $13.00 to the calendar year 2021 rates published on our website.

MS SPA 21-0002 Physician Services approved by CMS
CMS approved State Plan Amendment (SPA) 21-0002 on May 24, 2021. SPA 21-0002 was submitted to allow the Division of Medicaid (DOM) to remove the list of specific Current Procedural Terminology (CPT) codes for primary care services reimbursement, effective January 1, 2021.

MS SPA 20-0026 Attorney General Certification Signature approved by CMS
State Plan Amendment (SPA) 20-0026 was approved by CMS on March 4, 2021, to allow the Division of Medicaid (DOM) to replace the Attorney General certification signature with the current Attorney General Certification signature for Lynn Fitch.

MS SPA 20-0024 Physician Upper Payment Limit (UPL) approved by CMS
The Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) 20-0024 Physician Upper Payment Limit (UPL) on March 12, 2021. SPA 20-0024 was submitted to allow the Division of Medicaid to update the initial Medicare equivalent of the average commercial rate (ACR) ratio, effective January 1, 2021.

MS SPA 20-0028 Dental Reimbursement Update approved by CMS
The Centers for Medicare and Medicaid Services approved MS SPA 20-0028 Dental Reimbursement Update on March 11, 2021. This SPA was submitted in order to comply with federal Medicaid regulations. 42 C.F.R. § 447.201 requires the Division of Medicaid to submit a SPA describing the policy and methods used in setting payment rates for each type of service included in the Mississippi State Plan.

2020

MS SPA 20-0013 Vaccines approved by CMS
CMS approved State Plan Amendment (SPA) 20-0013 Vaccines on December 23, 2020, effective September 1, 2020. SPA 20-0013 was submitted to allow the Division of Medicaid to:
1) Change the reimbursement methodology of vaccine administration by a licensed pharmacist, employed by a Mississippi Medicaid pharmacy provider, working within the scope of their pharmacy license to a fee calculated at 100% of the Medicare rate.
2) Allows for the coverage of all vaccines recommended by the Centers of Disease Control and Prevention (CDC) through the pharmacy venue for beneficiaries ages 10 and above.
3) Requires pharmacy providers to be enrolled as a Vaccine for Children (VFC) provider to receive an administration fee for beneficiaries ages 10 and above.

MS SPA 20-0009 Third Party Liability approved by CMS
CMS approved State Plan Amendment (SPA) 20-0009 on November 20, 2020. SPA 20-0009 was submitted to allow the Division of Medicaid (DOM) to add language to include the cost avoidance of prenatal claims in compliance with the Bipartisan Budget Act of 2018, update the language describing data exchanges with other agencies, add the process for providers to request an override of the third party liability edit and update the code reference to ICD-10-CM, effective October 1, 2020.

MS SPA 20-0021 Out-of-State Transplant Rates approved by CMS
CMS approved MS SPA 20-0021 Out-of-State Transplant Rates on November 10, 2020. State Plan Amendment (SPA) 20-0021 was submitted to allow the Division of Medicaid (DOM) to update the out-of-state transplant rates as published in the Milliman U.S. Organ and Tissue Transplant Cost Estimates and Discussion effective July 1, 2020.

MS SPA 20-0006 Autism Spectrum Disorder (ASD) Reimbursement approved by CMS
CMS approved MS SPA 20-0006 Autism Spectrum Disorder (ASD) Reimbursement on October 21, 2020. State Plan Amendment (SPA) 20-0006 Autism Spectrum Disorder (ASD) Reimbursement was submitted to allow the Division of Medicaid (DOM) to remove the annual Autism rate updates and specifies that Autism rates will remain the same as those effective July 1, 2019. This State Plan Amendment (SPA) is effective July 1, 2020.

MS SPA 20-0016 Emergency Ground Ambulance Reimbursement approved by CMS
CMS approved MS SPA 20-0016 Emergency Ground Ambulance Reimbursement on November 9, 2020. SPA 20-0016 was submitted to allow the Division of Medicaid to revise the reimbursement methodology for emergency ground ambulance transportation. Emergency ground ambulance transportation base rate and mileage will be reimbursed based on the lesser of the provider’s usual and customary charge or a fee from a statewide uniform fee schedule set as of July 1, 2020 and effective for services provided on or after July 1, 2020, and is calculated as one hundred percent (100%) of the Medicare ambulance urban fee schedule in effect as of January 1, 2020. If a Medicare fee is not established, then the fee is set at one hundred percent (100%) of the Medicare fee for a comparable service effective July 1, 2020

MS SPA 20-0002 Private Duty Nursing (PDN) and Personal Care Services (PCS) approved by CMS
CMS approved State Plan Amendment (SPA) 20-0002 Private Duty Nursing (PDN) and Personal Care Services (PCS) on October 19, 2020. MS SPA 20-0002 was submitted to add coverage and reimbursement of PDN and PCS for Early and Periodic Screening, Diagnosis and Treatment (EPSDT)-eligible beneficiaries to the State Plan, effective July 1, 2020.

MS SPA 20-0005 Physician Administered Drugs approved by CMS
CMS approved MS State Plan Amendment (SPA) 20-0005 on October 14, 2020. SPA 20-0005 Physician Administered Drugs was submitted to allow the Division of Medicaid (DOM) to revise the fee schedule update from quarterly to annually, clarify if there is no Average Sales Price (ASP) or Medicare Addendum B OPPS fee schedule that a fee will be calculated using the Wholesale Acquisition Cost (WAC) pricing, and remove “plus six percent (6%)” from the ASP due to the ASP already including this 6% and is redundant effective July 1, 2020.

MS SPA 20-0019 Community Mental Health Center (CMHC) Emergency Interim Payments approved by CMS
CMS approved State Plan Amendment (SPA) 20-0019 on September 15, 2020. State Plan Amendment (SPA) 20-0019 is being submitted to allow the Division of Medicaid (DOM) to make interim payments based on fee-for-service (FFS) utilization only to the fourteen (14) Community Mental Health Centers (CMHCs) that have had a decline in utilization due to the COVID-19 pandemic, effective April 1, 2020.”

MS SPA 20-0003 All Patient Refined Diagnosis Related Groups (APR-DRG) Reimbursement approved by CMS
CMS approved State Plan Amendment (SPA) 20-0003 on September 10, 2020. SPA 20-0003 was submitted to update the hospital inpatient payment methodology with an effective date of July 1, 2020.

MS SPA 20-0018 Graduate Medical Education Payments approved by CMS
CMS approved State Plan Amendment (SPA) 20-0018 on September 2, 2020. SPA 20-0018 was submitted to allow the Division of Medicaid (DOM) to address calculations for GME payments for a hospital during a cap building period effective June 1, 2020.

MS SPA 20-0004 LTC Cost Report Filings effective April 1, 2020, approved by CMS
CMS approved State Plan Amendment (SPA) 20-0004 LTC Cost Report Filings on August 31, 2020. SPA 20-0004 was submitted to allow the Division of Medicaid (DOM) to revise the method for submitting cost reports and any supporting data from hard copy to electronic upload, and specifies the handling of capitalized assets valued at less than $5,000 each and related depreciation schedule documentation if the provider chooses to capitalize the item for financial purposes, but expenses the item for cost report purposes effective April 1, 2020. ”

MS SPA 20-0017 Inpatient Hospital Cost Report Submittals effective April 1, 2020, approved by CMS
CMS approved State Plan Amendment (SPA) 20-0017 Inpatient Hospital Cost Report Submittals on August 31, 2020. SPA 20-0017 was submitted to allow the Division of Medicaid (DOM) to revise the method for submitting cost reports and any supporting data from hard copy to electronic upload effective April 1, 2020.

MS SPA 20-0001 Durable Medical Equipment (DME) and Medical Supply Reimbursement effective April 1, 2020, approved by CMS
CMS approved State Plan Amendment (SPA) 20-0001 Durable Medical Equipment (DME) and Medical Supply Reimbursement on August 27, 2020. SPA 20-0001 was submitted to allow the Division of Medicaid to include a reimbursement methodology for certain durable medical equipment (DME) and medical supplies that are not on the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule, effective April 1, 2020.

MS SPA 20-0014 1915(i) Community Support Program (CSP) Emergency effective April 1, 2020 approved by CMS
The Centers for Medicare and Medicaid Services approved SPA 20-0014 on July 15, 2020. SPA 20-0014 addresses CSP service delivery limitations during the COVID-19 emergency.

MS SPA 20-0011 COVID-19 Cost Sharing Waiver effective March 1, 2020 approved by CMS
The Centers for Medicare and Medicaid Services approved SPA 20-0011 on June 30, 2020. SPA 20-0011 waives cost sharing for all beneficiaries, regardless of the ultimate diagnosis, for testing services and treatments for COVID-19, including vaccines, specialized equipment, and therapies effective March 1, 2020.

MS SPA 20-0015 Telehealth Emergency Template effective March 1, 2020 approved by CMS
The Centers for Medicare and Medicaid Services approved SPA 20-0015 on May 7, 2020. SPA 20-015 allows for flexibilities regarding telehealth services during a state of emergency as declared by either the Governor of Mississippi or the President of the United States effective March 1, 2020

MS SPA 19-0022 Drug Utilization Review (DUR) Requirements
State Plan Amendment (SPA) MS SPA 19-0022 Drug Utilization Review (DUR) Requirements has been approved to demonstrate that the Division of Medicaid is in compliance with the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act effective October 1, 2019.

2019

SPA 19-0001 Targeted Case Management (TCM) for Beneficiaries With Intellectual and/or Developmental Disabilities (IDD) in Community-Based Settings
State Plan Amendment (SPA) 19-0001 Targeted Case Management (TCM) for Beneficiaries With Intellectual and/or Developmental Disabilities (IDD) in Community-Based Settings has been approved by the Centers for Medicare and Medicaid Services (CMS), effective January 1, 2019. The SPA includes the following changes: a) Adding Autism Spectrum Disorder (ASD) as a covered diagnosis, b) Removing the needs-based criteria, c) Revising the qualifications and training requirements for Targeted Case Managers, and d) Revising the reimbursement for TCM for beneficiaries with IDD in community-based settings from $14.88 per fifteen (15) minute unit to a rate of $151.01 per month.

SPA 19-0002 Prescribed Pediatric Extended Care (PPEC)
State Plan Amendment (SPA) 19-0002 Prescribed Pediatric Extended Care (PPEC), effective January 1, 2020, has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid to add coverage and reimbursement of PPEC services for Early and Periodic Screening, Diagnosis and Treatment (EPSDT)-eligible beneficiaries to the State Plan

SPA 19-0003 Non-Emergency Transportation (NET) Broker Contract
State Plan Amendment (SPA) 19-0003 Non-Emergency Transportation (NET) Broker Contract has been approved by the Centers for Medicare and Medicaid Services (CMS) which corresponds with the new NET Broker contract operational effective date of February 1, 2019. This SPA includes the following changes: a) Updating the reimbursement methodology to reflect the new NET Broker Contract, b) Adding non-emergency air transportation services to the NET Broker program, c) Describing the reimbursement methodology for NET ambulance hospital-to-hospital transports, d) Removing long-term care residents from the NET Broker program, and e) Adding language regarding coverage of and reimbursement for transportation provided by Prescribed Pediatric Extended Care (PPEC) centers outside of the NET Broker program.

SPA 19-0004 Prescription Drug Limit Increase
State Plan Amendment (SPA) 19-0004 Prescription Drug Limit Increase has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid to increase the prescription drug limit from five (5) to six (6) per month, effective July 1, 2019.

SPA 19-0005 Home Health Visit Increase
State Plan Amendment (SPA) 19-0005 Home Health Visit Increase has been approved to allow the Division of Medicaid to increase the number of home health visits from twenty five (25) visits to thirty-six (36) visits per state fiscal year (SFY) and to clarify the provider appeals process to include reconsideration prior to an administrative hearing request, effective July 1, 2019.

SPA 19-0006 Post-Eligibility Treatment of Income
State Plan Amendment (SPA) 19-0006 Post-Eligibility Treatment of Income has been approved by the Centers for Medicare and Medicaid Services to allow the Division of Medicaid to include in the state plan post-eligibility treatment of income deductions by institutionalized individuals for amounts of incurred expenses for medical or remedial care that are not subject to payment by the Division of Medicaid or other third party insurance, effective January 1, 2019.

SPA 19-0009 Transitional Medical Assistance (TMA)
State Plan Amendment (SPA) 19-0009 Transitional Medical Assistance (TMA) has been approved by the Centers for Medicare and Medicaid services (CMS) to allow the Division of Medicaid to include language for a less restrictive transitional medical assistance (TMA) reporting allowed under Section 1931 of the Social Security Act (SSA). The Division of Medicaid has processed TMA in this manner since 1997 but this provision was superseded by the Affordable Care Act (ACA) with the SPA page being obsolete. This SPA will allow the Division of Medicaid to continue Medicaid eligibility under TMA for an initial period of twelve (12) months effective January 1, 2019.

SPA 19-0010 Dental and Orthodontic Reimbursement
State Plan Amendment (SPA) 19-0010 Dental and Orthodontic Reimbursement has been approved by the Centers for Medicare and Medicaid Services (CMS), effective March 1, 2019, to allow the Division of Medicaid to:

1. Revise the reimbursement methodology for dental and orthodontic services as the lesser of: a) The provider’s usual and customary charge, b) A fee from the Mississippi Medicaid statewide uniform dental fee schedule in effect July 1, 2018, or c) The fiftieth (50th) percentile fee reflected in the 2019 National Dental Advisory Service (NDAS) Fee Report.

2. Remove language excluding dental services for: a) Pregnant women as required by the Affordable Care Act (ACA), and b) Beneficiaries enrolled in the Healthier Mississippi Waiver (HMW) as required by the 2014 waiver renewal.

MS SPA 19-0011 Preadmission Screening and Annual Resident Review (PASRR) in Nursing Facilities (NF)
State Plan Amendment (SPA) 19-0011 Preadmission Screening and Annual Resident Review (PASRR) and Specialized Services has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid to replace the term “mental retardation” with “intellectual and developmental disability (IDD)”, effective July 1, 2019.

MS SPA 19-0013 Outpatient Prospective Payment System (OPPS) Reimbursement
State Plan Amendment (SPA) 19-0013 Outpatient Prospective Payment System (OPPS) Reimbursement has been approved to update hospital outpatient reimbursement as follows, effective July 1, 2019: 1. Remove specific diagnosis codes related to Never Events and refer to the diagnosis code descriptions, 2. Use the Medicare outpatient Addendum B as of January 1 of each year as published by CMS to calculate the Medicaid OPPS fee, 3. Apply the multiple discounting policy to dental procedures billed on the hospital outpatient claim to price the highest allowed dental procedure at one hundred percent (100%) of the allowed amount or published fee and price all subsequent dental procedures at twenty-five percent (25%) of the allowed amount or published fee, and 4. Require prior authorization on all dental procedures performed in the outpatient hospital setting.

MS SPA 19-0014 Utilization Review (UR) in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs)
State Plan Amendment (SPA) 19-0014 Utilization Review (UR) in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid to change control of the utilization of ICF/IIDs from the Mississippi State Department of Health (MSDH) to the contracted Utilization Management/Quality Improvement Organization (UM/QIO), effective September 1, 2019.

MS SPA 19-0018 Treatment of Resources
State Plan Amendment (SPA) 19-0018 Treatment of Resources has been approved to allow the Division of Medicaid to use Supplemental Security Income (SSI) rules in the treatment of vehicles for purposes of resource eligibility. One vehicle is totally excluded for adult applicants or recipients, if used for transportation. The value of other vehicles, not excluded under another provision, is determined using equity value.

MS SPA 19-0019 Graduate Medical Education
State Plan Amendment (SPA) 19-0019 Graduate Medical Education (GME) has been approved by the Centers for Medicare and Medicaid Services (CMS) to revise the calculation of direct graduate medical education (GME) costs for Mississippi hospitals with an accredited and Medicare approved teaching program, as determined by the Division of Medicaid, effective October 1, 2019.

MS SPA 19-0020 All Patient Refined-Diagnosis Related Groups (APR-DRG) Reimbursement
State Plan Amendment (SPA) 19-0020 All Patient Refined-Diagnosis Related Groups (APR-DRG) Reimbursement has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid to make the following changes, effective July 1, 2019: 1) The following APR-DRG parameters will be updated for discharges on and after July 1, 2019: The base price will change from $6,585 in State Fiscal Year (SFY) 2019 to $6,574 in SFY 2020, which represents a 2.5% increase over the SFY 2018 base price, and the DRG cost outlier threshold will change from $45,000 to $47,000. 2) Clarify language regarding the issuance of public notices, and 3) Update transplant case rates and post the transplant case rates on the Division of Medicaid’s Fee Schedule webpage.

2018

SPA 18-0020 Physician Visit Limit Increase
State Plan Amendment (SPA) 18-0020 Physician Visit Limit Increase has been approved to allow the Division of Medicaid to increase the physician office and outpatient hospital visit limit from twelve (12) to sixteen (16) per state fiscal year for both psychiatric and non-psychiatric services. These are two (2) separate service limits and both will be increased, effective January 1, 2019.

SPA 18-0019 State Governor’s Review
Mississippi State Plan Amendment (SPA) 18-0019 State Governor’s Review is a technical amendment approval, effective July 1, 2018. SPA 18-0019 allows the Division of Medicaid to update the appointed Executive Director authorized to submit the State Plan on behalf of the Division of Medicaid, Office of the Governor, the single state agency. The State Governor’s Review, located in Section 7 on Page 89, was originally submitted with SPA 18-0003 Medicaid Administration on May 30, 2018. The Centers for Medicare and Medicaid (CMS) instructed the Division of Medicaid to resubmit this page in a separate SPA as this page is not located in the reviewable unit in the new MACPro system.

SPA 18-0018 Mississippi Coordinated Access Network (MississippiCAN)
Mississippi State Plan Amendment (SPA) 18-0018 Mississippi Coordinated Access Network (MississippiCAN) has been approved to allow the Division of Medicaid to include Psychiatric Residential Treatment Facility (PRTF) services as covered and reimbursed by the Coordinated Care Organizations (CCOs).

SPA 18-0015 Disproportionate Share Hospital (DSH) Payments
State Plan Amendment (SPA) 18-0015 Disproportionate Share Hospital (DSH) Payments has been approved which updates the hospital DSH program effective October 1, 2018, to:

Continue to include GME approved costs,
Modify language to clearly state that Medicare and third party payor cost and payments would be included the DSH UCC,
Clarify that the DSH year is from October I through September 30,
Allow hospital taxes as specified in PRM- 1, Section 2 122,
Propose a remedy for situations where the federal DSH allotment is adjusted after June I of the DSH payment year, and
Clarify that DSH audits would be performed on those hospitals that receive DSH payments.

SPA 18-0014 Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Mississippi State Plan Amendment (SPA) 18-0014 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) has been approved to revise language to reflect the February 2017 changes in the Fourth (4th) Addition of the Bright Futures/American Academy of Pediatrics (AAP) Periodicity Schedule, effective October 1, 2018. This SPA removes the specific screenings as required by the Fourth (4th) Addition of the Bright Futures/American Academy of Pediatrics (AAP) Periodicity Schedule, but includes the statement that Early and Periodic Screening, Diagnosis and Treatment (EPSDT) providers must screen according to the AAP. The specific requirements are listed in Miss. Admin. Code, Title 23, Part 223.

SPA 18-0013 Rural Health Clinic (RHC) Physician Administered Drugs (PAD)
State Plan Amendment (SPA) 18-0013 Rural Health Clinic (RHC) Physician Administered Drugs (PADs) has been approved to allow the Division of Medicaid to reimburse an RHC the encounter rate for the administration of certain categories of physician administered drugs (PADs), referred to as Clinician Administered Drug and Implantable Drug System Devices (CADDs), reimbursed under the pharmacy benefit to the extent the CADDs were not included in the calculation of the RHC encounter rate, effective July 1, 2018.

SPA 18-0012 Federally Qualified Health Center (FQHC) Physician Administered Drugs (PAD)
State Plan Amendment (SPA) 18-0012 Federally Qualified Health Center (FQHC) Physician Administered Drugs (PADs) has been approved to allow the Division of Medicaid to reimburse an FQHC the encounter rate for the administration of certain categories of physician administered drugs (PADs), referred to as Clinician Administered Drug and Implantable Drug System Devices (CADDs), reimbursed under the pharmacy benefit to the extent the CADDs were not included in the calculation of the FQHC encounter rate, effective July 1, 2018.

SPA 18-0011 Physician Administered Drugs (PAD)
State Plan Amendment (SPA) 18-0011 Physician Administered Drugs (PADs) has been approved to allow the Division of Medicaid to reimburse for certain PADs under the pharmacy benefit to improve beneficiary access. These certain PADs are currently referred to as Clinician Administered Drug and Implantable Drug System Devices (CADDs) and include, but are not limited to, long-acting reversible contraceptives (LARCs), pregnancy maintaining agents, injectable atypical antipsychotic agents, and chemical dependency treatment agents. CADDs may be billed as either medical or pharmacy point of sale (POS) claims, effective July 1, 2018.

SPA 18-0010 Transportation
Mississippi State Plan Amendment (SPA) 18-0010 Transportation has been approved to update the reimbursement methodology for transportation services and place information regarding coverage and payment of transportation services on the appropriate pages, effective August 1, 2018.

SPA 18-0009 Indian Health Services (IHS) Encounter Limit
Mississippi State Plan Amendment (SPA) 18-0009 Indian Health Services (IHS) Encounter Limit has been approved by the Centers for Medicare and Medicaid Services to allow the Division of Medicaid to reimburse IHS up to five (5) outpatient visits per beneficiary per calendar day for professional services at the most current applicable rates published in the Federal Register or Federal Register Notices effective June 1, 2018.

SPA 18-0007 Outpatient Prospective Payment System (OPPS) Reimbursement
State Plan Amendment (SPA) 18-0007 Outpatient Prospective Payment System (OPPS) Reimbursement has been approved to allow the Division of Medicaid (DOM) to remove the five percent (5%) assessment of outpatient hospital services and clarify the Outpatient Prospective Payment System (OPPS) payment methodology effective July 1, 2018.

SPA 18-0006 1915(i) Community Support Program (CSP)
Mississippi State Plan Amendment (SPA) 18-0006 1915(i) Community Support Program (CSP) has been approved to renew the 1915(i) state plan services, due to expire October 31, 2018, to the Centers for Medicare and Medicaid (CMS) in compliance with 42 C.F.R. § 441.745, effective November 1, 2018.

SPA 18-0005 Long-Term Care (LTC) Updates #2
State Plan Amendment (SPA) 18-0005 Long-Term Care (LTC) Updates #2 has been approved to allow the following, effective July 1, 2018: Revise the number of allowed therapeutic leave days for nursing facilities (NFs) and intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs) as required by Senate Bill 2836, remove stock transactions as a change in ownership assets as required by 42 C.F.R. § 489.18, clarify the provider appeals process to include reconsideration prior to an administrative appeals request, remove MDS submissions as appealable, and restrict providers from entering or modifying hospital and therapeutic leave days via the web portal after the corresponding quarter close cutoff.

SPA 18-0004 All Patient Refined Diagnosis Related Groups (APR/DRG) Reimbursement
Mississippi State Plan Amendment (SPA) 18-0004 All Patient Refined Diagnosis Related Groups (APR-DRG) Reimbursement has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid (DOM) to to update the reimbursement of hospital inpatient services reimbursement effective July 1, 2018.

SPA 18-0003 Medicaid Administration
Mississippi State Plan Amendment (SPA) 18-0003 Medicaid Administration has been approved by the Centers for Medicare and Medicaid Services to allow the Mississippi Division of Medicaid (DOM), the single state agency, to update the organizational structure and administration of the Medicaid program effective January 1, 2018.
Pursuant to 42 C.F.R. § 431.10, 431.11, 431.50 and 42 CFR § 430.12(b), The Mississippi Division of Medicaid is required to include in the State Plan the designation and certification of the agency. The plan must include any delegation of authority to determine eligibility and to conduct fair hearings other than the single state agency as well as the written agreements for such delegation.

SPA 18-0002 Physician Upper Payment Limit (UPL)
Mississippi State Plan Amendment (SPA) 18-0002 Physician Upper Payment Limit (UPL) has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid (DOM) to update the initial Medicare equivalent of the average commercial rate (ACR) ratio, effective January 1, 2018.

SPA 18-0001 Long Term Care (LTC) Updates
Mississippi State Plan Amendment (SPA) 18-0001 LTC Updates has been approved by the Centers for Medicare and Medicaid Services to:

Modify the reimbursement methodology by adding respiratory therapy expenses as an allowable cost pursuant to 42 C.F.R. § 483.65.
Clarify DOM’s intent to exclude reimbursement of hospital taxes through long-term care facility (LTC) rates.
Clarify the appropriate timing for LTC facilities to claim for reimbursement for (a) the cost of tuition paid for employees to attain a certification/license not related to, or to enhance, their current licensed/certified position of employment and (b) the cost of legal and accounting fees incurred during legal proceedings against agencies administering the Medicaid program.
Clarify the allocations of shared expense between a hospital and the affiliated LTC facility should only include reasonable and necessary expense applicable to the nursing facility.
Revise the error threshold for expanded casemix nurse reviews from “greater than twenty-five percent (25%)” to “twenty-five percent (25%) and greater”.
Revise the verbiage of when a hospital leave ends to be consistent with the definition of patient days. Currently, language is not consistent within the state plan for reporting and billing purposes and this revision will correct this inconsistency.

2017

SPA 17-0015 Durable Medical Equipment (DME) and Medical Supply Reimbursement
Mississippi State Plan Amendment (SPA) 17-0015 Durable Medical Equipment (DME) and Medical Supply Reimbursement has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid (DOM) to revise the payment methodology for DME and medical supplies effective November 9, 2017.

SPA 17-0014 Recovery Audit Contractors (RACs)
Mississippi State Plan Amendment (SPA) 17-0014 Recovery Audit Contractors (RACs) has been approved by the Centers for Medicare and Medicaid Services (CMS) to reflect implementation of the Division of Medicaid’s (DOM) Recovery Audit Contractor (RAC) program in compliance with 42 C.F.R. Part 455, Subpart F. Effective April 1, 2017, a contract was awarded for a RAC to identify and facilitate recovery of improper payments made by DOM and the Managed Care Organizations (MCOs).

SPA 17-0013 Supplemental Drug Rebates
Mississippi State Plan Amendment (SPA) 17-0013 Supplemental Drug Rebates (SDR) has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid (DOM) to revise the current Supplemental Drug Rebate Agreement (SDRA) to be in compliance with the Covered Outpatient Drug Rule, to revise references to various federal laws that have been changed, and to have consistent language with other states in the consortium effective January 1, 2018.

SPA 17-0004 Tribal Notification Requirements
Mississippi State Plan Amendment (SPA) 17-0004 Tribal Notification Requirements has been approved by the Centers for Medicare and Medicaid Services (CMS) to remove specific staff names of Mississippi Division of Medicaid and Mississippi Band of Choctaw Indians personnel and to revise the notification time frame to thirty (30) days for State Plan Amendments effective October 1, 2017.

SPA 17-0003 Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Mississippi State Plan Amendment (SPA) 17-0003 Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Mississippi Division of Medicaid to provide early intervention services for pregnant women with nondependent substance use and to prevent problematic substance use disorders, effective July 1, 2017.

SPA 17-0002 Pharmacy Reimbursement
Mississippi State Plan Amendment (SPA) 17-0002 Pharmacy Reimbursement has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Mississippi Division of Medicaid to revise the payment methodology for prescription drugs at point-of-sale (POS) pharmacies and describe reimbursement for 340B covered entities effective April 1, 2017.

SPA 17-0001 Home Health Services
Mississippi State Plan Amendment (SPA) 17-0001 Home Health Services has been approved by the Centers for Medicare and Medicaid Services (CMS) to require (1) a face-to-face visit with a physician or authorized non-physician practitioner prior to the initiation of home health visits or provision of durable medical equipment (DME) and appliances, (2) to require the provision of home health services in any setting in which normal life activities take place, and (3) to revise the definition of DME to comply with the Medicaid Home Health Final Rule, published February 2, 2016.

2016

SPA 16-0020 Autism Spectrum Disorder (ASD) Services
Mississippi State Plan Amendment (SPA) 16-0020 Autism Spectrum Disorder (ASD) Services has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid to cover ASD services for Early and Periodic Screening, Diagnosis and Treatment (EPSDT)-eligible beneficiaries when medically necessary, prior authorized and provided by certain providers operating within their scope of practice, effective January 1, 2017.

SPA 16-0019 Hospital Reimbursement of Long-Acting Reversible Contraceptives (LARCs)
Mississippi State Plan Amendment (SPA) 16-0019 Hospital Reimbursement of Long-Acting Reversible Contraceptives (LARCs) has been approved to allow the Division of Medicaid to reimburse for LARCs and their insertion at the time of delivery, outside of, and in addition to, the Diagnosis Related Group (DRG) base payment effective August 6, 2016.

SPA 16-0017 Outpatient Prospective Payment System (OPPS)
Mississippi State Plan Amendment (SPA) 16-0017 Outpatient Prospective Payment System (OPPS) Update has been approved to clarify the Medicare Ambulatory Payment Classification (APC) used to compute the observation code G0378 fee and the Medicare Average Sales Price (ASP) drug pricing file used to compute chemotherapy drug code fees effective July 1, 2016.

SPA 16-0015 Recovery Audit Contractors (RACs)
Mississippi State Plan Amendment (SPA) 16-0015 Recovery Audit Contractors (RACs) has been approved to request a one (1) year exception to 42 CFR § 455.502(b), which requires contracting with a RAC. The State also seeks to expand the duties of the current Medicaid Integrity Contractor to include audits that were previously performed by the RAC effective April 1, 2016.

SPA 16-0014 Rural Health Clinic (RHC) Scope of Service
Mississippi State Plan Amendment (SPA) 16-0014 Rural Health Clinic (RHC) Scope of Service has been approved to clarify the definition of a change in scope of service and the procedure for submitting a request for a rate adjustment due to a change in scope of service with an effective date of May 1, 2016. This approved SPA also includes language for the reimbursement of telehealth services in an RHC as approved in SPA 15-003 Telehealth Services effective January 1, 2015.

SPA 16-0013 Federally Qualified Health Center (FQHC) Scope of Service
Mississippi State Plan Amendment (SPA) 16-0013 Federally Qualified Health Center (FQHC) Scope of Service has been approved to clarify the definition of a change in scope of service and the procedure for submitting a request for a rate adjustment due to a change in scope of service with an effective date of May I, 2016. This approved SPA also includes language for the reimbursement of telehealth services in an FQHC as approved in SPA 15-003 Telehealth Services effective January I, 2015.

SPA 16-0011 Long Term Care Reimbursement
Mississippi State Plan Amendment (SPA) 16-0011 Long-Term Care (LTC) Reimbursement has been approved to add clarification language regarding property reimbursement calculations for the following facilities: Alzheimer’s Units, Nursing Facilities for the Severely Disabled (NFSDs), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs) effective January 1, 2016. SPA 16-0011 does not change the reimbursement methodology but adds language clarification for consistency purposes.

SPA 16-0010 All Patient Refined Diagnosis Related Groups (APR-DRG) Reimbursement
Mississippi State Plan Amendment (SPA) 16-0010 All Patient Refined Diagnosis Related Groups (APR-DRG) Reimbursement has been approved to update the hospital inpatient payment methodology with an effective date of July 1, 2016. This proposed SPA is to comply with approved SPA 2012-008.

SPA 16-0009 Current Market Value (CMV)
Mississippi State Plan Amendment (SPA) 16-0009 Current Market Value (CMV) allows Current Market Value (CMV) of real property to be established using the county tax assessed true value as shown on the county tax receipt rather than an initial evaluation using a knowledgeable source statement, per SSI policy. If an applicant or recipient disagrees with the tax assessed value of any countable real property, a knowledgeable source statement will be used to establish CMV.

SPA 16-0008 Primary Care Physician (PCP) Payment for Obstetricians and Gynecologists (OB/GYNs)
Mississippi State Plan Amendment (SPA) 16-0008 Primary Care Physician (PCP) Payment for Obstetricians and Gynecologists (OB/GYNs) has been approved to reimburse certain eligible obstetricians and gynecologists for the provision of certain primary care services at one hundred percent (100%) of the Medicare Physician fee schedule or at the Mississippi regional maximum vaccine administration fee set by the Vaccines for Children program effective July 1, 2016.

2015

SPA 15-019 Mississippi Coordinated Access Network (MSCAN) Psychiatric Residential Treatment Facility (PRTF)
Mississippi State Plan Amendment (SPA) 15-019 Mississippi Coordinated Access Network (MSCAN) Psychiatric Residential Treatment Facility (PRTF) has been approved to remove language that Medicaid beneficiaries in a PRTF are excluded from the MSCAN program effective December 1, 2015. SPA 15-019 MSCAN PRTF allows a Medicaid beneficiary enrolled in a Coordinated Care Organization (CCO) to remain enrolled in a CCO at the time of admission to the PRTF. This will ensure continuity of care for beneficiaries once discharged from the PRTF.

SPA 15-018 Transplants
State Plan Amendment (SPA) 15-018 Transplants has been approved to remove language that the Division of Medicaid is responsible for payment of inpatient transplant services for beneficiaries enrolled in a Coordinated Care Organization (CCO) effective December 1, 2015. The submittal of SPA 15-010 MSCAN removes inpatient hospital services from the excluded list of MSCAN services to comply with Miss. Code Ann. § 43-13-117(A)(18)(b)-(c), effective December 1, 2015. SPA 15-018 Transplants requires the CCOs to be responsible for reimbursement of transplant services received in the inpatient setting for those beneficiaries who are enrolled in a CCO.

SPA 15-017 Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Mississippi State Plan Amendment (SPA) 15-017 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) has been approved submitted to require EPSDT screening providers to adhere to the periodicity schedule of the American Academy of Pediatrics (AAP) Bright Futures for physical, mental, psychosocial and/or behavioral health, vision, hearing, adolescent, and developmental screenings and the American Academy of Pediatric Dentistry (AAPD) for dental screenings.

SPA 15-012 Mississippi Hospital Access Program (MHAP) Transition Payment and Inpatient Hospital Upper Payment Limit (UPL) Program Elimination
Mississippi State Plan Amendment (SPA) 15-012 Mississippi Hospital Access Program (MHAP) Transition Payment and Inpatient Hospital Upper Payment Limit (UPL) Program Elimination has been submitted to allow the Division of Medicaid (DOM) to make transition payments for inpatient hospital services rendered by in-state hospitals and the out-of-state hospital that is authorized by federal law to submit intergovernmental transfers (IGTs) to the State of Mississippi and is classified as a Level I trauma center located in a county contiguous to the State of Mississippi, subject to the approval by the Centers for Medicare and Medicaid Services (CMS). This proposed SPA also removes the inpatient hospital Upper Payment Limit (UPL) program for inpatient hospital services rendered after July 1, 2015. The Division of Medicaid may make transition payments these inpatient hospitals to comply with Miss. Code Ann. § 43-13-117(A)(18)(c)(ii) and shall eliminate the inpatient hospital UPL program subject to CMS approval of the MHAP to comply with Miss. Code Ann. § 43-13-117(A)(18)(c)(i).

SPA 15-011 Outpatient Prospective Payment System (OPPS) Phase II
Mississippi State Plan Amendment (SPA) 15-011 Outpatient Prospective Payment System (OPPS) Phase II has been approved to allow the Division of Medicaid to implement discounts of claims with more than one (1) significant procedure and compute a Mississippi Medicaid fee when a procedure’s Ambulatory Payment Classification (APC) rate, including all of its bundled services, is determined to be insufficient for the Mississippi Medicaid population, effective July 1, 2015. 42 C.F.R. § 447.201 requires the Division of Medicaid to submit a SPA describing the policy and methods used in setting payment rates for each types of service included in the Mississippi State Plan.

SPA 15-010 Mississippi Coordinated Access Network (MSCAN)
Mississippi State Plan Amendment (SPA) 15-010 Mississippi Coordinated Access Network (MSCAN) has been submitted to remove inpatient hospital services from the excluded list of MSCAN services to comply with Miss. Code Ann. § 43-13-117(18)(b)-(c), effective December 1, 2015.

SPA 15-008 All Patient Refined Diagnosis Related Groups (APR-DRG) Updates
Mississippi State Plan Amendment (SPA) 15-008 All Patient Refined Diagnosis Related Groups (APR-DRG) Updates has been approved to amend the inpatient hospital payment methodology, effective July 1, 2015. These updates will (1) transition from V.31 to V.32 of the 3M APR-DRG Grouper; (2) decrease the DRG marginal cost percentage; (3) increase the Cost Outlier Threshold; (4) adjust the adult mental health policy adjustor; (5) adjust the obstetrics & newborn policy adjustor; and (6) adjust the neonate policy adjustor. MS SPA 2012-008 APR-DRG, effective October 1, 2012, requires the Division of Medicaid to submit a SPA for any changes to the APR-DRG inpatient hospital payment methodology.

SPA 15-006 Targeted Case Management (TCM) for Beneficiaries with Intellectual/Developmental Disabilities (IDD) in Community-Based Settings
State Plan Amendment (SPA) 15-006 Targeted Case Management (TCM), effective April 1, 2015, has been approved to revise TCM for beneficiaries with Intellectual/Developmental Disabilities (IDD). State Plan pages will include the definition of the IDD target group, description of services to be furnished, frequency of assessments and monitoring, and qualifications of providers as required in 42 CFR §§ 440.169 and 441.18.

SPA 15-005 Physician Upper Payment Limit (UPL)
MS State Plan Amendment (SPA) 15-005 Physician Upper Payment Limit (UPL) has been approved to provide for supplemental payments for physicians and other professional services practitioners who are employed by a qualifying hospital for services rendered to Medicaid recipients in compliance with the Social Security Act § 1902(a)(30) and 42 CFR §§ 447.10, 447.204 and Miss. Code Ann. § 43-13-117, effective January 1, 2015.

SPA 15-004 Nursing Facility (NF) Reimbursement
MS State Plan Amendment (SPA) 15-004 Nursing Facility (NF) Reimbursement has been approved to revise the payment methodology for nursing facilities (NFs), psychiatric residential treatment facilities (PRTFs), and intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs) to comply with Miss. Code Ann. § 43-13-117, effective January 1, 2015.

SPA 15-003 Telehealth Services
State Plan Amendment (SPA) 15-003 allows the Division of Medicaid (DOM) to specify methods and standards for reimbursement of Telehealth Services effective January 1, 2015.

SPA 15-002 Increased Primary Care Provider Payment
State Plan Amendment (SPA) 15-002 Increased Primary Care Provider Payment allows the Division of Medicaid (DOM) to continue reimbursement from January 1, 2015 through June 30, 2015 at the same rate as in calendar year (CY) 14 to providers who meet the requirements of 42 CFR § 447.400(a). Effective July 1, 2015, reimbursement for eligible providers will be at one hundred percent (100%) of the Medicare Physician Fee Schedule in effect as of January 1 of each year. The Medicaid Primary Care Provider Fee Schedule will be updated July 1 of each year based on one hundred percent (100%) of the Medicare Physician Fee Schedule in effect as of January 1 of each year.

SPA 15-001 Mississippi Application for Health Benefits Revision
State Plan Amendment (SPA) 15-001 Mississippi Application for Health Benefits Revision has been approved to include in the Mississippi Application for Health Benefits the beneficiary’s choice of a preferred Coordinated Care Organization (CCO) or auto-assignment to a CCO, and to include language to satisfy Medicaid regulations governing the single, streamlined Medicaid application.

2014

SPA 14-024 Mississippi Coordinated Access Network (MSCAN)
Mississippi Medicaid State Plan Amendment (SPA) 14-024 changes the Mississippi Coordinated Access Network (MSCAN) to include (1) increasing the percentage of Medicaid enrollees, (2) adding additional categories of eligibility, and (3) requiring mandatory participation in MSCAN for certain Medicaid beneficiaries.

SPA 14-021 Public Assistance Reporting Information System (PARIS)
This SPA 14-021 Public Assistance Reporting Information System (PARIS) Match is to include the Centers for Medicare and Medicaid Services (CMS) required Attachment 4.32-A Income and Eligibility Verification System Procedures in the State Plan.

SPA 14-020 Disproportionate Share Hospital (DSH) and Upper Payment Limits (UPL) Payments
State Plan Amendment (SPA) 14-020 Disproportionate Share Hospital (DSH) and Upper Payment Limits (UPL) Payments, effective October 1, 2014, allows the Division of Medicaid (DOM) to update the existing Medicaid State Plan language to comply with Miss. Code Ann. § 43-13-145(10) regarding inpatient hospital DSH and UPL payments. This amendment includes: (1) changes to the cost reporting periods used to calculate uninsured costs, (2) changes to the inpatient payment data used to calculate UPL distributions to Fiscal Year (FY) 2013 payments, and (3) eliminates the additional UPL payments to Free-standing Psychiatric Hospitals.

SPA 14-018 Durable Medical Equipment (DME) and Medical Supply Reimbursement
State Plan Amendment (SPA) 14-018 Durable Medical Equipment (DME) and Medical Supply Reimbursement revises the payment methodology for DME and medical supplies effective July 1, 2014.

SPA 14-016 All Patient Refined Diagnosis Related Groups (APR-DRG) Updates
SPA 14-016 All Patient Refined Diagnosis Related Groups (APR-DRG) Updates amends the inpatient hospital payment methodology, effective July 1, 2014. This amendment includes (1) transitioning from V.30 to V.31 of the 3M APR-DRG Grouper; (2) updating the DRG relative weights; (3) increasing the statewide DRG base price; (4) increasing the Cost Outlier Threshold; (5) adjusting the pediatric mental health and rehab policy adjustor; and (6) expanding the list of discharge statuses.

SPA 14-013 Outpatient Prospective Payment System (OPPS) Updates
This State Plan Amendment (SPA) 2014-013 Outpatient Prospective Payment System (OPPS) Updates revises the payment computation of the Mississippi Medicaid calculated fee for the observation code G0378 using the Ambulatory Payment Classification (APC) 8009 instead of the average of APC 8002 and APC 8003 effective July 1, 2014.

SPA 14-012 Supplemental Rebate Agreement
This State Plan Amendment (SPA) 2014-012 was submitted to allow rebates to be collected on coordinated care claims and implement a uniform PDL for fee-for-services and coordinated care pharmacy claims with an effective date of July 1, 2014.

SPA 14-011 Non-Excluded Prescription Drugs
State Plan Amendment (SPA) 2014-011 Non-Excluded Prescription Drugs removes barbiturates, benzodiazepines and all drugs used for smoking cessation from the Medicaid excluded drugs list. This SPA does not change the coverage of these drugs as the Division of Medicaid still covers these drugs but removes them from the Centers for Medicare and Medicaid Services (CMS) pre-print for excluded drugs. This change is required to comply with the Affordable Care Act. The effective date of this SPA is January 1, 2014.

SPA 14-010 Outpatient Hospital Prospective Payment System (OPPS) Three Never Events
State Plan Amendment (SPA) 14-010 Outpatient Hospital Prospective Payment System (OPPS): Three Never Events was submitted to allow the Division of Medicaid (DOM) to transition from a manual method of identifying and adjusting claims subject to the three never events to a systematic approach in the Mississippi Medicaid Information System (MMIS), effective July 1, 2014.

SPA 14-009 Health Care Acquired Conditions (HCAC)
SPA 14-009 Inpatient Health Care Acquired Conditions (HCAC) allows the Division of Medicaid to transition from a manual method of identifying and adjusting claims subject to inpatient hospital HCAC to implementing the 3M All Patient Refined-Diagnosis Related Group (APR-DRG) HCAC utility, effective July 1, 2014.

SPA 14-008 Other Provider Preventable Conditions (OPPC) Three Never Events
State Plan Amendment (SPA) 2014-008 Other Provider Preventable Conditions: Three Never Events, effective July 1, 2014, was submitted to the Centers for Medicare and Medicaid (CMS) to transition from a manual method of identifying and adjusting claims subject to the three never events to a systematic approach in the Mississippi Medicaid Information System (MMIS).

SPA 14-003 Dialysis Center Services Reimbursement
SPA 14-003 Dialysis Center Services Reimbursement allows the Division of Medicaid (DOM) to change the payment methodology for freestanding and hospital-based dialysis centers, referred to as “dialysis centers”, from a composite rate system to a prospective payment system (PPS) effective January 1, 2014. As of January 1, 2014, the Centers for Medicare and Medicaid Services (CMS) will no longer publish a composite rate. Therefore, DOM must implement the bundled end-stage renal disease (ESRD) PPS effective January 1, 2014.

SPA 14-002 Physician Administered Drugs and Implantable Drug System Devices
State Plan Amendment (SPA) 14-002 Physician Administered Drugs and Implantable Drug System Devices allows the Division of Medicaid to define coverage and the reimbursement methodology for physician administered drugs, implantable drug system devices, diagnostic or therapeutic radiopharmaceuticals and contrast imaging agents in an office setting effective July 1, 2014. This filing is to comply with Social Security Act § 1927(k)(2) and 42 USC § 1396r-8.

2013

SPA 2013-033 Rural Health Clinic (RHC) Reimbursement
This State Plan Amendment (SPA) 2013-033 Rural Health Clinic (RHC) Reimbursement allows the Division of Medicaid (DOM) to implement an alternative payment methodology for RHCs which includes a prospective payment rate per encounter and an additional fee for other certain services. The previous payment methodology for RHCs did not allow additional reimbursement for physician office visits during “provider established office hours” which are outside of DOM’s definition of “office hours”. SPA 2013-033, effective November 1, 2013, allows RHCs to receive this additional reimbursement.

SPA 2013-032 Federally Qualified Health Centers (FQHC) Reimbursement
This State Plan Amendment (SPA) 2013-032 Federally Qualified Health Centers (FQHC) Reimbursement allows the Division of Medicaid (DOM) to implement an alternative payment methodology for FQHCs which includes a prospective payment rate per encounter and an additional fee for other certain services. The previous payment methodology for FQHCs did not allow additional reimbursement for physician office visits during “provider established office hours” which are outside of DOM’s definition of “office hours”. SPA 2013-032, effective November 1, 2013, allows FQHCs to receive this additional reimbursement.

SPA 2013-024 Hospital Presumptive Eligibility
This State Plan Amendment (SPA) 2013-024 Hospital Presumptive Eligibility CMS requires each state to submit this SPA in the event a qualified hospital opts to make presumptive eligibility decisions.

SPA 2013-023 Citizenship and Immigration Status
This State Plan Amendment (SPA) 2013-023 Citizenship and Immigration Status the ACA did not make any changes to existing policy requiring eligible individuals to be U.S. citizens or immigrants in a satisfactory immigration status. This SPA does represent any change over existing policy.

SPA 2013-022 State Residency
This State Plan Amendment (SPA) 2013-022 specifies that individuals in MS for a temporary period with no intent to reside are not MS residents. Individuals temporarily absent from the state to attend school or obtain medical treatment are considered MS residents.

SPA 2013-021 MAGI Income Methodology
This State Plan Amendment designates the income options the state is electing in 2014 into the Medicaid state plan in accordance with the Affordable Care Act.

SPA 2013-020 Eligibility
This State Plan Amendment (SPA) 2013-020 MS will use the CMS model single streamlined application for MAGI-related eligibility; however, it has been branded with DOM logo. MS will also use electronic means of accepting applications and will use available databases to verify income to the extent possible. Renewal processes will be in accordance with ACA mandates.

SPA 2013-019 MAGI-Based Eligibility Groups
The State Plan Amendment 2013-0019 MAGI-Based Eligibility Groups is an eligibility-related provision effective January 1, 2014 as required by the Affordable Care Act (ACA).

SPA 2013-017 Eligibility for Pregnant Minors and Non-IV-E Adoption Assistance Children
The State Plan Amendment 2013-017 Eligibility for Pregnant Minors and Non-IV-E Adoption Assistance Children, effective December 31, 2013, is to continue: 1) Coverage of pregnant minors (under age 19), regardless of parental income, who qualify under 42 CFR § 435.222 and 2) The practice of disregarding income for all non-IV-E adoption assistance children qualifying under 42 CFR § 435.227 beyond January 1, 2014.

SPA 2013-016 Inpatient Hospital Services
SPA 2013-016 is a technical amendment for CMS approval of Attachment 3.1-A Exhibit 1 Inpatient Hospital Services inadvertently not approved with the 04/11/2013 approval of the previously submitted APA 2012-008 Hospital Reimbursement Plan Attachment 4.19-A page 1-72.

SPA 2013-013 Hospice Care
This State Plan Amendment (SPA) 2013-13 Hospice Care is a mandate by the Centers for Medicare and Medicaid (CMS) to add language to Attachment 3.1-A page 7, #18, which adds the option that hospice care is “Provided in accordance with section 2302 of the Affordable Care Act”. This is a technical change because the Division of Medicaid currently covers both curative treatment and palliative care for beneficiaries under the age of 21 under the hospice benefit.

SPA 2013-012 Outpatient Hospital Service Enhanced Payment
This State Plan Amendment 2013-012 Outpatient Hospital Services Enhanced Payment is to issue Mississippi Medicaid providers an estimated one time enhanced payment for paid claim lines under the Ambulatory Payment Classification (APC) methodology with the dates of service September 1, 2012, through December 31, 2012. The enhanced payment estimate for each hospital is final and cannot be appealed. All claims must be adjudicated by April 11, 2013, to be eligible for the enhanced payment.

SPA 2013-011 Prescribed Drugs
State Plan Amendment (SPA) 2013-011 Prescribed Drugs was approved to comply with Section 175 of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) amended section 1860D-2(e)(2)(A). The Act requires barbiturates “used in the treatment of epilepsy, cancer, or a chronic mental health disorder” and benzodiazepines be included in Part D drug coverage effective January 1, 2013. If a Medicaid agency continues to provide drug coverage for Medicare covered drugs for the dually eligible beneficiary then a state must shoulder one-hundred (100%) of these costs.

SPA 2013-007 Other Laboratory and Radiology Services Approved
State Plan Amendment (SPA) 2013-007 Other Laboratory and Radiology Services requires prior authorization (PA) by the Utilization Management/Quality Improvement Organization (UM/QIO) for certain advanced imaging procedures except when performed during an inpatient hospitalization, during an emergency room visit or during a twenty-three (23) hour observation period with an effective date of July 1, 2013.

SPA 2013-006 APR-DRG
This State Plan Amendment (SPA) 2013-006, effective October 1, 2013, is to amend the existing Medicaid State Plan which transitions 3M Health Information System Hospital Inpatient APR-DRG Grouper version 29 (V.29) to version 30 (V.30).

SPA 2013-004 APC Phase 1
SPA 2013-004 APC Phase I A changes reimbursement under the APC methodology to ensure access to care for all Medicaid beneficiaries: 1. Revises the payment methodology of chemotherapy drugs and concomitant non-chemotherapy drugs administered during the chemotherapy treatment; 2. Clarifies observation is paid using a Mississippi Medicaid calculated fee; 3. Includes a manual pricing procedure in the payment hierarchy; and 4. Changes reimbursement from ninety percent (90%) of Medicare to one-hundred percent (100%) of Medicare.

SPA 2013-003 Increased Primary Care Service
Primary Care Services Payment Increase was submitted to implement a CMS mandate. Section 1202 of the Patient Protection and Affordable Care Act of 2010 mandates a temporary payment increase for certain primary care Evaluation and Management (E&M) and Vaccine Administration procedure codes for calendar years 2013 and 2014 when delivered by a qualified provider enrolled as a Mississippi Medicaid provider. Qualified physicians will receive one hundred percent (100%) of the Medicare rate and qualified non-physician practitioners will receive an increased payment based on the current percentage of the increased physician payment.

SPA 2013-002 Tobacco Cessation Services for Pregnant Women
This State Plan Amendment (SPA) 2013-002 Smoking Cessation Services for Pregnant Women is being submitted to comply with section 4107 of the Affordable Care Act requiring coverage of face–to-face counseling services for cessation of tobacco use by pregnant women. This coverage is defined in the SSA § 1905(bb) (1) as diagnostic, therapy, and counseling services.

SPA 2013-001 1915(i) State Plan Home and Community-Based Services
SPA 2013-001 1915(i) Home and Community-Based Services (HCBS) will provide habilitation services to individuals with intellectual and developmental disabilities (IDD). Habilitation services include Day Support, Prevocational and Supported Employment services. Presently, IDD individuals requiring less than institutional level of care are not eligible for HCBS under the 1915(c) waiver but will be eligible for services under the 1915(i) HCBS state plan.

2012

SPA 2012-013 MSCAN Expansion
This State Plan Amendment implements changes to Medicaid’s coordinated care program, MississippiCAN, as specified in House Bill 421 passed by the 2012 Mississippi legislature. The changes include (1) increasing the percentage of Medicaid enrollees, (2) adding additional categories of eligibility, (3) requiring mandatory participation in MississippiCAN for certain Medicaid eligibles, (4) requiring beneficiaries enrolled in MississippiCAN to receive mental health services from a coordinated care organization network provider, and (5) mandatorily excluding enrollment for beneficiaries with hemophilia.

SPA 2012-010 Long Term Care (LTC) Nursing Facility Rate Freeze
The attached State Plan Amendment 2012-010 Long Term Care (LTC) Nursing Facility Rate Freeze is in response to House Bill 421 to freeze nursing facility rates at January 1, 2010 level through state fiscal year 2013. Division of Medicaid normally re-bases LTC rates annually at January 1, and also when a change of classification occurs. However, this practice must be stayed until July 1, 2013, under the new state law.

SPA 2012-009 Hospital Outpatient Ambulatory Payment Classification (APC) Payment Methodology
This State Plan Amendment implements a Hospital Outpatient Ambulatory Payment Classification (APC) payment methodology, replacing the current cost-to-charge ratio (CCR) method, as authorized by HB 421 passed by the MS State Legislature in the 2012 session. SPA 2012-009 also removed the six (6) emergency room visit limit per fiscal year.

SPA 2012-008 Inpatient Hospital All Patient Refined Diagnosis Related Groups (APR-DRGs)
This State Plan Amendment implements a new method of paying for hospital inpatient services. Under this new method hospitals are paid per inpatient stay based on All Patient Refined Diagnosis Related Groups (APR-DRGs) with every inpatient stay assigned to a single DRG that reflects the difficulty of the case. SPA 2012-008 also removes the thirty (30) day inpatient hospital stay limit for adults.

SPA 2012-007 Supplemental Rebate Agreements and Preferred Drug Lists
This SPA allows DOM to join into a multistate pooling consortium to increase supplemental rebates from pharmaceutical manufacturers. This SPA is also a technical change deleting redundant information on Attachment 3.1-A page 4 and deleting specific exceptions to the Preferred Drug List (PDL) as this information is best identified in the routinely published criteria for exceptions in the PDL. In this way changes in product information and clinical practice can be quickly addressed assuring prescribers and beneficiaries fully understand the conditions of coverage at any given time.

SPA 2012-006 Clinic Services
State Plan Amendment (SPA) 2012-006 Clinic Services is in response to the CMS companion letter dated March 26, 2012, and updates language specifying clinic services are limited to those services as described in CFR 42 § 440.90 provided in the Mississippi State Department of Health (MSDH) clinics, removes “Other” from Clinic Services, removes “home visits” from Clinic Services, removes Rural Health Center (RHC) and Ambulatory Surgical Center (ASC) services from the Clinic Services reimbursement page and requires providers to use a CMS-approved cost report. Additionally, this SPA places ASC services on a new benefits page.

SPA 2012-005 Freestanding Birthing Centers
This State Plan Amendment is a CMS mandate to specify there are no licensed or approved freestanding birthing center facilities in Mississippi in order to comply with Section 2301 of the Affordable Care Act.

SPA 2012-004 Provider Screening and Enrollment
This State Plan Amendment establishes requirements necessary to prevent or combat fraud, waste and abuse under the Medicare, Medicaid programs and Children’s Health Insurance Program (CHIP). This State Plan Amendment (SPA) is required by Centers for Medicare & Medicaid Services (CMS) according to federal regulations set forth from provisions of the Affordable Care Act Section 6401(a) and (b) and 42 CFR Parts 405, 424, 447, 455, 457, 498 and 1007.

SPA 2012-003 Community Mental Health Centers
This State Plan Amendment made revisions to the Rehabilitation Option of the State Plan to provide more evidence based practices in service delivery in the community. The SPA implements service limits and prior authorization on the most intensive services available in the community. The SPA outlines the reimbursement methodology for establishing rates for this provider type. The SPA removes disease management which is no longer being provided.

SPA 2012-002 Optometrist Services
This State Plan Amendment is a technical correction to add Optometrist services as a covered service to allow Optometric service providers to participate in the Medicaid Electronic Health Record (EHR) incentive program for eligible professionals.

SPA 2012-001 Payment Adjustment for Other Provider Preventable Conditions in Other Health Care Settings
This State Plan Amendment makes changes to payment adjustments for other provider preventable conditions (OPPC) including at a minimum, the three never events: wrong surgery, wrong patient, wrong body part in settings other than inpatient and outpatient hospital where surgery can occur. This SPA also defines Medicaid’s new payment adjustment for OPPC in settings other than inpatient and outpatient hospital.

2011

SPA 2011-008
This 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.

SPA 2011-006
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 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.

SPA 2011-005
Legal 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 2011-004
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 October 1, 2011, for individuals for which Medicaid is primary and those dually eligible for both the Medicare and Medicaid programs.

SPA 2011-003
The 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 2011-002
Legal 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 2011-001
Section 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.

2010

SPA 2010-035
Section 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 2010-033
This 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 2010-031
The 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 2010-030
Per 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 2010-029
LTC 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 2010-028
ORAL Amendment 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 2010-027
LTC 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 2010-026
The 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 2010-019
This 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 2010-006
Reason for State Plan Amendment: To follow the law for payments to the state-owned PRTF, as prescribed by House Bill 71.

SPA 2010-005
Asset 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 2010-004 Oral Procedure
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 2010-004
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.

SPA 2010-003
Reason for State Plan Amendment: To allow the administrative and operating per diem for PNF-SD based on allowable costs and patient days.

SPA 2010-001
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.

2009

SPA 2009-004
This 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 2009-002
This 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 2009-001
This 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.

2008

SPA 2008-063
This 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 time 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 unnecessary and has not been used because of the exception.

SPA 2008-062
This 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 2008-055
This 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 2008-054
This 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 2008-010
This 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 are allowable 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 2008-003
This 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 existing 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 broader description of DOMs outstationing activity.

SPA 2008-002
This 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.

2007

SPA 2007-007
The 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 2007-006
The 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 2007-005
The 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 2007-004
The 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 2007-003
The 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 2007-002
This 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.

2006

SPA 2006-007
This State Plan amendment establishes a non-emergency medical transportation broker model in accordance with the provisions of the Deficit Reduction Act of 2005 (Pub.L.109-171)(Section 6083) as signed by President Bush on February 8, 2006.

SPA 2006-006
This 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 2006-002
This 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.

2005

SPA 2005-014
This 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 2005-012
This 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 2005-011
This 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 2005-010
This 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 2005-008
This 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 2005-007
This 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 2005-006
This 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 2005-005
This 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 2005-004
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 2005-003
This State Plan Amendment is being filed to allow the Division of Medicaid to update the language to permit Annual Physical Examinations.

SPA 2005-002
This State Plan Amendment is being filed to allow the Division of Medicaid to update the language pertaining to the preferred Drug List.

Approved State Plan Amendments