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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 21-0002 Physician Services submitted to CMS
State Plan Amendment (SPA) 21-0002 is being submitted to allow the Division of Medicaid to remove the list of specific CPT codes, effective January 1, 2021.

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.

MS SPA 20-0007 Rural Health Center (RHC) Services submitted to CMS
State Plan Amendment (SPA) 20-0007 Rural Health Clinic (RHC) Services, effective August 1, 2020, is being submitted to allow the Division of Medicaid:

  1. Clarify the different types of encounters and when reimbursement is made for more than one encounter performed on the same day,
  2. Add requirements for RHC mobile units,
  3. Add coverage for a fee-for-service methodology for early and periodic screening, diagnosis and treatment (EPSDT) screenings provided in a school setting and certain group therapy in the RHC setting.

MS SPA 20-0008 Federally Qualified Health Center (FQHC) Services submitted to CMS
State Plan Amendment (SPA) 20-0008 Federally Qualified Health Center (FQHC) Services, effective August 1, 2020, is being submitted to allow the Division of Medicaid 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 requirements for FQHC mobile units,
  3. Add coverage for a fee-for-service methodology for early and periodic screening, diagnosis and treatment (EPSDT) screenings provided in a school setting and certain group therapy in the FQHC setting.

 

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