Proposed State Plan Amendments
The State Plan Amendments below have been submitted to Centers for Medicare and Medicaid Services (CMS) for approval.
MS SPA 19-0010 Dental and Orthodontic Reimbursement
State Plan Amendment (SPA) 19-0010 Dental and Orthodontic Reimbursement, with a proposed effective date of July 1, 2019, has been submitted to allow the Division of Medicaid:
1. To 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. To 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.
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, with a proposed effective date of January 1, 2019, has been submitted to allow the Division of Medicaid to:
- Add Autism Spectrum Disorder (ASD) as a covered diagnosis,
- Remove the needs-based criteria,
- Revise the qualifications and training requirements for Targeted Case Managers, and
- Revise 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 19-0003 Non-Emergency Transportation (NET) Broker
State Plan Amendment (SPA) 19-0003 Non-Emergency Transportation (NET) Broker Contract has been submitted to correspond 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 19-0006 Post-Eligibility Treatment of Income
State Plan Amendment (SPA) 19-0006 Post-Eligibility Treatment of Income has been submitted 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 submitted 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 18-0015 Disproportionate Share Hospital (DSH) Payments
State Plan Amendment (SPA) 18-0015 Disproportionate Share Hospital (DSH) Payments has been submitted to update the hospital DSH program effective October 1, 2018:
1. To clarify: a) The treatment of hospital assessments on hospital cost reports according to the entire Section 2122 of the Medicare Provider Reimbursement Manual 15-1,
b) Medicaid costs include Graduate Medical Education (GME) approved program costs in DSH calculations, c) Medicaid costs do not include costs associated with services covered by another third-party payer, including Medicare. When Medicaid eligible patients have access to coverage from another party, payments may be used as a proxy for cost offsets when calculating the Medicaid payment shortage or overage, d) The DSH payment period is from October 1 through September 30. The determination of a hospital DSH status is made annually for hospitals that meet the DSH requirements as of October 1, and 2. Add Section 5-6, Revised Allotments, which describes the treatment of revised DSH allotments.