A. In order to receive reimbursement from the
Division of Medicaid for the face-to-face encounter, the encounter must be
conducted by an enrolled Medicaid provider.
B. The Division of Medicaid reimburses for
home health services based on reasonable cost determined in accordance with the
State Plan and Medicare principles of reimbursement, except when Medicare
guidelines are contradictive to directives of the State Plan or the Division of
Medicaid. In such a situation, the State Plan or the Division of Medicaid will
prevail.
1. Medicaid cost reporting schedules
must be included with the Medicare cost report to compute Medicaid
reimbursement.
2. A schedule must
be completed to reflect the lower of reasonable costs or customary charge
provisions as they apply to Medicaid.
3. In addition to the lower of costs or
charge limitations, reimbursement for home health services is limited to and
cannot exceed the prevailing costs of providing nursing facility
services.
C. The Division
of Medicaid reimburses for the initial assessment visit for skilled nursing
services and aide services as listed below:
1. If a beneficiary is assessed for services
without a skilled nursing service performed during the initial assessment visit
and is not admitted to the home health program, the initial assessment visit
cannot be billed and must be claimed as an administrative cost.
2. If a beneficiary is assessed for services
and a skilled nursing service is performed during the initial assessment visit
and is admitted to the home health program for continuation of skilled nursing
and/or aide visits, the initial assessment visit can be billed and is not
considered an administrative cost.
3. If a beneficiary is assessed for services
with a skilled nursing service performed during the initial assessment visit
only and is not admitted to the home health program, the home health agency
must elect either to:
a) Claim the initial
assessment visit as an administrative cost, or
b) Admit and discharge the beneficiary on the
same day from the home health program and bill for the one (1) initial
assessment visit and is not considered an administrative cost.
4. If a beneficiary is assessed
for only home health aide services and a skilled nursing service is not
performed during the initial assessment visit and the beneficiary is not
admitted to the home health program, the initial assessment visit cannot be
billed and is considered as an administrative cost.
5. If a beneficiary is assessed for only home
health aide services and a skilled nursing service is performed during the
initial assessment visit and the beneficiary is admitted to the home health
program, the home health agency must elect either to:
a) Claim the initial assessment visit as an
administrative cost, or
b) Bill the
initial assessment visit as a skilled nursing service.
D. Supervisory visits are
administrative costs and are not directly reimbursable.
E. The Division of Medicaid reimburses a
medical supply add-on calculated as described in the State Plan.
42 C.F.R. §
440.70; Miss. Code Ann. §§
43-13-117,
43-13-121.
