Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 223 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
Chapter 6 - Expanded Rehabilitative Services
Rule 23-223-6.4 - Non-Covered Services
Universal Citation: MS Code of Rules 23-223-6.4
Current through September 24, 2024
A. The Division of Medicaid does not cover:
1. Educational interventions of an academic
nature performed by the Department of Education,
2. Same service provided on the same date,
regardless of the setting(s) in which the service was provided unless service
specifically states otherwise.
3.
Community-based mental health services when a beneficiary is an inpatient of a
Medicaid-covered facility except for targeted case management services,
including wraparound services, provided up to thirty (30) days of a covered
stay in a medical institution for EPSDT-eligible beneficiaries with a serious
emotional disturbance (SED) that meet the level of care provided in a
psychiatric residential treatment facility (PRTF),
4. Time spent on documentation, unless
completed during the session and relevant to the treatment goals,
5. Time spent completing a care plan form or
prior authorization request online via web portal,
6. Staff travel time,
7. Field trips and routine recreational
activities,
8. Beneficiary travel
time to and from any service, or
9.
Services provided to more than one (1) beneficiary at a time, unless
specifically allowed in the service definition.
10. Wraparound facilitation for more than one
family member at a time.
11. Case
management components provided or billed as part of a direct care service,
including but not limited to:
a) Assisting a
person in accessing needed services such as medical, social, educational,
transportation, housing, substance use, personal care, employment and other
services that may be identified in the Recovery Support Plan as components of
Health, Home, Purpose and Community,
b) Assisting the person and natural supports
in implementation of therapeutic interventions outlined in the Individual
Service Plan, or
c) Psychoeducation
and training of family, unpaid caregivers, and/or others who have a legitimate
role in addressing the needs of the person.
B. The Division of Medicaid does not cover the following evaluative services:
1. A
neuropsychological evaluation when:
a) Only
administered to rule out attention deficit hyperactivity disorder (ADHD),
or
b) Previous evaluations did not
support the suspicion of cognitive deficits or brain injury.
2. The Division of Medicaid does
not cover a developmental evaluation when:
a)
Referral questions can be adequately answered through behavioral observation
and family interviews, or
b) A
standardized intellectual assessment is appropriate and the beneficiary is
three (3) years or older with no severe disabilities.
C. The Division of Medicaid does not cover case management services that:
1.
Restrict a beneficiary's access to other services under the State
Plan.
2. Require the beneficiary to
receive other Medicaid services as a condition of receipt of case management
services.
3. Duplicates other
services provided by public agencies or private entities.
4. Authorize or deny the provision of other
services under the State Plan.
5.
Constitute the direct delivery of underlying medical, educational, social or
other services to which a beneficiary has been referred.
42 C.F.R. § 441.18; Miss. Code Ann. § 43-13-117.
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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