Font Size
-
+

Approved State Plan Amendments

Approved State Plan Amendments

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

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


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 16-0011 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 16-0009 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.

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.

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.

CHIP #7
This State Plan Amendment is being filed because the benchmark definition requires that any applicable benefit changes made to the State and School Employees Health Insurance Plan be consequently implemented with the CHIP.