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Proposed State Plan Amendments

Proposed State Plan Amendments

The State Plan Amendments below have been submitted to Centers for Medicare and Medicaid Services (CMS) for approval.

2021

MS SPA 21-0041 Preventive Services Vaccines submitted to CMS
State Plan Amendment (SPA) 21-0041 is being 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 21-0045 Dentures submitted to CMS
State Plan Amendment (SPA) 21-0045 is being 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 20-0042 Targeted Case Management (TCM) for Infants Under the Age of One submitted to CMS
State Plan Amendment (SPA) 21-0042 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0044 Eyeglasses submitted to CMS
State Plan Amendment (SPA) 21-0044 is being 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 21-0040 Targeted Case Management (TCM) for the Chronically Mentally Ill (CMI) submitted to CMS
State Plan Amendment (SPA) 21-0040 is being 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. The Division of Medicaid is submitting this SPA to be in compliance with 42 C.F.R. § 440.169 and § 441.18.

MS SPA 21-0039 Targeted Case Management (TCM) for Psychiatric Residential Treatment Facility (PRTF) Level of Care (LOC) submitted to CMS
State Plan Amendment (SPA) 21-0039 is being 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.

MS SPA 21-0033 Therapy Services submitted to CMS
State Plan Amendment (SPA) 21-0033 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0032 Dental and Orthodontic Services submitted to CMS
State Plan Amendment (SPA) 21-0032 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0038 Targeted Case Management (TCM)for Individuals with Intellectual Disabilities (IDD) submitted to CMS
State Plan Amendment (SPA) 21-0038 is being submitted to allow the Division of Medicaid (DOM) to remove the five percent (5%) reimbursement reduction effective July 1, 2021. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0037 Christian Science submitted to CMS
State Plan Amendment (SPA) 21-0037 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0036 Respiratory Care for EPSDT Beneficiaries submitted to CMS
State Plan Amendment (SPA) 21-0036 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0035 Telehealth Services submitted to CMS
State Plan Amendment (SPA) 21-0035 is being 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. Changes 1) through 3) are being made to be in compliance with Miss. Code § 43-13-117, as amended by Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0034 Midwife Services submitted to CMS
State Plan Amendment (SPA) 21-0034 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0031 Home Health, DME and Medical Supply submitted to CMS
State Plan Amendment (SPA) 21-0031 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0030 Hearing Aids submitted to CMS
State Plan Amendment (SPA) 21-0030 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0029 Family Planning Services submitted to CMS
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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0028 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Extended Services submitted to CMS
State Plan Amendment (SPA) 21-0028 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0027 Dialysis Services submitted to CMS
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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0026 Clinic Services submitted to CMS
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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0025 Chiropractor Services submitted to CMS
State Plan Amendment (SPA) 21-0025 is being submitted to allow the Division of Medicaid (DOM) to 1) set the fees for chiropractor 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0024 Rehabilitative Services submitted to CMS
State Plan Amendment (SPA) 21-0024 Rehabilitative Services is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0022 Transportation Services submitted to CMS
State Plan Amendment (SPA) 21-0022 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0021 Extended Services for Pregnant Women submitted to CMS
State Plan Amendment (SPA) 21-0021 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0020 Targeted Case Management (TCM) Early Intervention submitted to CMS
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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0018 Covered Outpatient Drugs submitted to CMS
State Plan Amendment (SPA) 21-0018 is being submitted to allow the Division of Medicaid (DOM) to 1) set the fees for covered outpatient drugs the same as those in effect on July 1, 2020, and 2) remove the five percent (5%) reimbursement reduction for physician administered drugs effective July 1, 2021. Additionally, this SPA allows for setting a ceiling for the blood factor professional dispensing fee of $260.00. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0017 Rural Health Clinic (RHC) submitted to CMS
State Plan Amendment (SPA) 21-0017 is being submitted to allow the Division of Medicaid (DOM) 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 Clinic (FQHC) submitted to CMS
State Plan Amendment (SPA) 21-0016 is being submitted to allow the Division of Medicaid (DOM) 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.There is no estimated economic impact for this SPA.

MS SPA 21-0015 Hospital Outpatient Services submitted to CMS
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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0014 Targeted Case Management for High-Risk Pregnant Women submitted to CMS
State Plan Amendment (SPA) 21-0014 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0013 Ambulatory Surgical Center submitted to CMS
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 in effect for State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0007 All Patient Refined-Diagnosis Related Groups (APR-DRG) Reimbursement submitted to CMS
State Plan Amendment (SPA) 21-0007 All Patient Refined-Diagnosis Related Groups (APR-DRG) Reimbursement is being 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 21-0012 Physician Services submitted to CMS
State Plan Amendment (SPA) 21-0012 is being 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 submitted to CMS
State Plan Amendment (SPA) 21-0011 is being submitted to allow the Division of Medicaid (DOM) to 1) set the fees for orthotics and prosthetics the same as those effective for State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0010 Other Licensed Practitioner Services submitted to CMS
State Plan Amendment (SPA) 21-0010 is being 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. These changes are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0009 Podiatry submitted to CMS
State Plan Amendment (SPA) 21-0009 Podiatry is being submitted to allow the Division of Medicaid (DOM) to remove the five percent (5%) reimbursement reduction effective July 1, 2021. The changes in this SPA are being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0008 Independent Lab and X-ray Services submitted to CMS
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 for State Fiscal Year (SFY) 2021, and 2) remove the five percent (5%) reimbursement reduction effective July 1, 2021. The changes made in this State Plan Amendment are to comply with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

MS SPA 21-0001 COVID-19 Vaccine Administration Reimbursement Emergency Submission submitted to CMS
State Plan Amendment (SPA) 21-0001 is being 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 during the public health emergency (PHE). The Division of Medicaid will reimburse Mississippi Medicaid enrolled Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) outside of the PPS rate for administering the COVID-19 vaccine at 100% of the Medicare rate only if there is no corresponding encounter. If there is an encounter, administration of the COVID-19 vaccine is reimbursed as part of the encounter rate. The administration of the COVID-19 vaccine is being reimbursed at 100% of Medicare to promote wide-spread utilization of the COVID-19 vaccine.

2020

MS SPA 20-0023 Medication Assisted Treatment (MAT) submitted to CMS
State Plan Amendment (SPA) 20-0023 Medication Assisted Treatment (MAT) was submitted to CMS 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 20-0022 Mental Health Services Coverage and Reimbursement submitted to CMS
State Plan Amendment (SPA) 20-0022 is being 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.

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