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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.

2018

SPA 18-0018 Mississippi Coordinated Access Network (MississippiCAN)   
State Plan Amendment (SPA) 18-0018 Mississippi Coordinated Access Network (MississippiCAN) has been submitted to allow the Division of Medicaid to include Psychiatric Residential Treatment Facility (PRTF) services as covered and reimbursed by the Coordinated Care Organizations (CCOs). This SPA also adds 1915(i) Community Support Program (CSP) Services to the list of services that are not covered and reimbursed by the CCOs, effective October 1, 2018.

SPA 18-0014 Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
State Plan Amendment (SPA) 18-0014 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) has been submitted to to revise language to reflect the February 2017 changes in the Fourth (4th) Addition of the Bright Futures/American Academy of Pediatrics (AAP) Periodicity Schedule, effective October 1, 2018. This SPA removes the specific screenings as required by the Fourth (4th) Addition of the Bright Futures/American Academy of Pediatrics (AAP) Periodicity Schedule, but includes the statement that Early and Periodic Screening, Diagnosis and Treatment (EPSDT) providers must screen according to the AAP. The specific requirements are listed in Miss. Admin. Code, Title 23, Part 223.

SPA 18-0008 Rehabilitation Option
State Plan Amendment (SPA) 18-0008 Rehabilitation Option is being submitted to allow the Division of Medicaid to refer to the Mississippi Department of Mental Health’s (DMH’s) Operational Standards for the specific qualifications of practitioners/individuals and allow Autism Spectrum Disorder (ASD) services to be provided and reimbursed through a Community Mental Health Center/Private Mental Health Center (CMHC/PMHC) facility effective July 1, 2018.

SPA 18-0011 Physician Administered Drugs (PAD)
State Plan Amendment (SPA) 18-0011 Physician Administered Drugs (PADs) is being submitted to allow the Division of Medicaid to reimburse for certain PADs under the pharmacy benefit to improve beneficiary access. These certain PADs are currently referred to as Clinician Administered Drug and Implantable Drug System Devices (CADDs) and include, but are not limited to, long-acting reversible contraceptives (LARCs), pregnancy maintaining agents, injectable atypical antipsychotic agents, and chemical dependency treatment agents. CADDs may be billed as either medical or pharmacy point-of-sale (POS) claims, effective July 1, 2018.

SPA 18-0013 Rural Health Clinic (RHC) Physician Administered Drugs (PAD)
State Plan Amendment (SPA) 18-0013 Rural Health Clinic (RHC) Physician Administered Drugs (PADs) is being submitted to allow the Division of Medicaid to allow RHC’s to receive reimbursement outside of the encounter rate for the administration, insertion and removal of physician administered drugs that are reimbursed through the pharmacy benefit, effective July 1, 2018.

SPA 18-0012 Federally Qualified Health Center (FQHC) Physician Administered Drugs (PAD)
State Plan Amendment (SPA) 18-0012 Federally Qualified Health Center (FQHC) Physician Administered Drugs (PADs) is being submitted to allow the Division of Medicaid to reimburse FQHC’s outside of the encounter rate for the administration, insertion and removal of certain PADs that are reimbursed through the pharmacy benefit, effective July 1, 2018.

SPA 18-0007 Outpatient Prospective Payment System (OPPS) Reimbursement
State Plan Amendment (SPA) 18-0007 Outpatient  Prospective  Payment  System  (OPPS) Reimbursement has been submitted to allow the Division of Medicaid (DOM) to remove the five percent (5%) assessment of outpatient hospital services, clarify the Outpatient Prospective Payment System (OPPS) payment methodology, and add the reimbursement methodology for Long Acting Reversible Contraceptives (LARCs) effective July 1, 2018.