Font Size
-
+

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

MS 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.

MS 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 18-0005 Long-Term Care (LTC) Updates #2   
State Plan Amendment (SPA) 18-0005 Long-Term Care (LTC) Updates #2 has been submitted to allow the following, effective July 1, 2018: Revise the number of allowed therapeutic leave days for nursing facilities (NFs) and intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs) as required by Senate Bill 2836, remove stock transactions as a change in ownership assets as required by 42 C.F.R. § 489.18, clarify the provider appeals process to include reconsideration prior to an administrative appeals request, remove MDS submissions as appealable, and restrict providers from entering or modifying hospital and therapeutic leave days via the web portal after the corresponding quarter close cutoff.

SPA 18-0010 Transportation
State Plan Amendment (SPA) 18-0010 Transportation is being submitted to update the reimbursement methodology for transportation services and place information regarding coverage and payment of transportation services on the appropriate pages, effective August 1, 2018.

SPA 18-0004 All Patient Refined Diagnosis Related Groups (APR-DRG) Reimbursement
State Plan Amendment (SPA) 18-0004 All Patient Refined Diagnosis Related Groups (APR-DRG) Reimbursement is being submitted to update the reimbursement of hospital inpatient services reimbursement 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.