MS SPA 21-0039 Targeted Case Management (TCM) for Psychiatric Residential Treatment Facility (PRTF) Level of Care (LOC) approved by CMS

CMS approved MS SPA 21-0039 on September 20, 2021. State Plan Amendment (SPA) 21-0039 was 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., effective July 1, 2021.

For more information read the approved SPA pages.