A. The Division of Medicaid covers home
health agency reimbursement for covered services based on reasonable cost which
is determined in accordance with the Mississippi Medicaid Home Health
Reimbursement Plan and Title XVIII (Medicare) principles of reimbursement,
except when Medicare guidelines are contradictive to directives of the State
Plan or Division of Medicaid. In such a situation, the State Plan or 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 in
the Mississippi Medical Assistance (Medicaid) Program.
B. The Division of Medicaid will reimburse
for the initial assessment visit for skilled services, either Home Health
Skilled (HHSK), Home Health Physical Therapy (HHPT), and/or Home Health Speech
Therapy (HHST), and aide services as listed below:
1. If a beneficiary is assessed for skilled
services, without a skilled service performed during the initial assessment
visit and is not admitted to the home health program, the initial assessment
visit is not approved and must be claimed as an administrative cost.
2. If a beneficiary is assessed for skilled
services, with a skilled service performed during the initial assessment visit
and is admitted to the home health program for continuation of skilled visits,
the initial assessment visit is not an administrative cost and can be
billed.
3. If a beneficiary is
assessed for skilled services with a skilled service performed during the
initial assessment visit only, the home health agency must elect either to:
a) Claim this as an administrative cost,
or
b) Admit to and discharge the
beneficiary from the home health program for this one (1) visit. This is not an
administrative cost and can be billed.
4. If a beneficiary is assessed for home
health aide services only, without a skilled service performed during the
initial assessment visit and is not admitted to the home health program, the
initial assessment visit is not approved and must be claimed as an
administrative cost.
5. If the
beneficiary is assessed for home health aide services only and is admitted to
the home health program and a skilled service is performed during the initial
assessment visit, the home health agency must elect either to:
a) Claim the assessment as an administrative
cost, or
b) Bill the initial
assessment visit as a skilled service.
C. Initial assessment visits must be
performed by a registered nurse.
D.
If the beneficiary is receiving home health aide services only, a supervisory
visit must be made every sixty (60) days by a registered nurse while the home
health aide is providing patient care. Supervisory visits are administrative
costs and are not directly reimbursable.
Miss. Code Ann. §
43-13-121;
42 CFR 484, Subpart E
