Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 208 - Home and Community Based Services (HCBS) Long Term Care
Chapter 4 - Home and Community Based Services (HCBS) Traumatic Brain Injury/Spinal Cord Injury Waiver
Rule 23-208-4.6 - Prior Approval/Certification

A. Prior approval must be obtained from the Division of Medicaid before a beneficiary can receive services through the Home and Community-Based Waiver program. Prior Approval is based on clinical eligibility.

B. Clinical eligibility for waiver services is determined through the utilization of a comprehensive Pre-Admission Screening.

C. The physician must certify the level of care.

D. A physician must verify that the beneficiary has a traumatic brain/spinal cord injury. A brain or spinal cord injury that is due to a degenerative or congenital condition, or that result, intentionally or unintentionally, from medical intervention is excluded.

E. The Plan of Care must be developed by the case manager and, in conjunction with the PreAdmission Screening, should contain objectives, types of services to be furnished, and frequency of services.

F. After the applicant has made an Informed Choice, understands the criteria for the waiver, and meets clinical eligibility, the application along with the Plan of Care (POC) must be submitted to the Division of Medicaid for approval.

G. At the time of the initial certification, the Pre-Admission Screening and the Plan of Care must be completed jointly by the TBI/SCI counselor and registered nurse.

H. At the time of recertification, the Plan of Care must be completed by the IL counselor or the registered nurse.

I. A beneficiary can only be enrolled in one HCBS waiver program at a time.

J. Request to add or change services listed on the approved plan of care requires prior approval.