Proposed State Plan Amendments
The State Plan Amendments below have been submitted to Centers for Medicare and Medicaid Services (CMS) for approval.
SPA 18-0001 Long Term Care (LTC) Updates
State Plan Amendment (SPA) 18-0001 LTC Updates is being submitted by the Division of Medicaid (DOM) 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.
SPA 18-0003 Medicaid Administration
State Plan Amendment (SPA) 18-0003 Medicaid Administration is being submitted 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 17-0001 Home Health Services
State Plan Amendment (SPA) 17-0001 Home Health Services is being submitted 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.