Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Chapter 4 - Private Duty Nursing
Rule 23-223-4.4 - Prior Authorization and Concurrent Reviews

Universal Citation: MS Code of Rules 23-223-4.4

Current through September 24, 2024

A. Private duty nursing (PDN) providers must submit a prior authorization request to the Division of Medicaid or designee prior to the initiation of PDN services which must include, at a minimum, the following:

1. A signed physician or specialist's order for PDN and a signed initial Plan of Care (POC),

2. Beneficiary diagnosis(es),

3. Skilled teaching/instructions to be provided to a family member or caregiver(s),

4. Treatment plan/physician orders specifying each skill to be performed including whether the service(s) require a registered nurse (RN) or a licensed practical nurse (LPN),

5. Expected duration of service,

6. Identification of any other home care services, including the hours, days, and times of these services being provided, including, but limited to:
a) Case management,

b) Physical therapy,

c) Speech therapy,

d) Occupational therapy,

e) Respiratory therapy,

f) Respite,

g) Hospice, and/or

h) Personal care attendant.

7. When PDN medical necessity criteria are no longer met, a plan:
a) For reducing and discontinuing PDN hours, and

b) To transition the beneficiary to the most appropriate setting.

B. The PDN provider must submit a recertification of PDN services, every six (6) months indicating the number of hours per day or week and the duration of the request to the Division of Medicaid, or designee and include the following:

1. An updated POC,

2. Progress notes,

3. Monthly summaries, and

4. Nursing visit notes.

C. The PDN provider cannot bill the beneficiary for hours when the provider failed to seek certification/recertification in a timely manner.

42 C.F.R. § 440.80; Miss. Code Ann. §§ 43-13-117, 43-13-12.

Disclaimer: These regulations may not be the most recent version. Mississippi may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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