23 Miss. Code. R. 200-4.4 - Effective Date of Provider Agreement and Provider Agreement Termination
A. Each provider or organization furnishing
services under the Mississippi Medicaid State Plan must enter into a provider
agreement with the Mississippi Division of Medicaid.
B. The effective date of the provider
agreement is the earliest day of the following options:
1. The date all required screening has been
completed by the Division of Medicaid if the Division of Medicaid cannot verify
all required screenings have been completed by a:
a) Medicare contractor, or
b) Medicaid agency or Children's Health
Insurance Program (CHIP) of another state,
2. Up to one hundred twenty (120) days prior
to the date of the submission of a Mississippi Medicaid Enrollment application
if the Division of Medicaid can verify that the provider had all required
screenings completed by a:
a) Medicare
contractor, or
b) Medicaid agency
or Children's Health Insurance Program (CHIP) of another state,
3. The date of Medicare
certification, not to exceed three hundred and sixty-five (364) days from the
date of application, if the provider requests enrollment in the Medicaid
program within one hundred twenty (120) days from the date the Medicare Tie-in
Notice was issued to the provider, or
4. The first day of the month in which the
Division of Medicaid receives the provider's enrollment application if the
provider requests enrollment after one hundred twenty (120) days of the
issuance of the Medicare Tie-in Notice.
C. For out-of-state providers, applications
and claims must be submitted within one hundred twenty (120) days of the date
of service. The effective date of the provider agreement will be:
1. The date of the service if the service was
an emergency or if the beneficiary's health would be endangered if they were
required to travel to their state of residence, or
2. The date determined in Miss. Admin. Code
Part 200, Rule 4.4.B.
D. The Division of Medicaid does not make
payments to any provider or organization prior to the date of a valid Medicaid
provider agreement. This rule applies for any services rendered regardless of
any time period provided for under any timely filing provision.
E. Timely filing requirements apply to all
claims submitted by all providers. [Refer to Miss. Admin. Code Part 200, Rule
1.6]
F. Providers of the following state plan
services will continue to receive payment for up to thirty (30) days after the
effective date of termination of a provider agreement for services furnished to
a beneficiary who was admitted before the effective date of the termination to
permit time for an orderly transfer of Medicaid beneficiaries:
1. Inpatient hospital services,
2. Nursing facility (NF) services,
3. Psychiatric residential treatment facility
services (PRTF),
4. Intermediate
care facilities for the intellectually and/or developmentally disabled (ICF/
IDD) facility services, and
5.
Home health services and hospice services furnished under a plan established
before the effective date of termination.
G. The facilities listed in Miss. Admin. Code
Part 200, Rule
4.1.D. must:
1. Notify all Medicaid beneficiaries,
families, and/or sponsors in writing within forty-eight (48) hours of notice of
termination of Medicaid participation,
2. Submit to the Division of Medicaid a
current list of Medicaid beneficiaries who are receiving Medicaid services
along with the name, address and telephone number of the family and/or the
sponsor, when available, and the beneficiary's attending physician.
3. Assist the beneficiaries, families and the
facility in making other facility arrangements for the beneficiaries.
H. Reinstatement may be
granted after a provider has been terminated by the licensing or certification
board, Office of Inspector General, the Centers for Medicare and Medicaid
services (CMS), or the Division of Medicaid when conditions of reinstatement
have been satisfied by the sanctioning entity. Notification of re-instatement
from the appropriate entity must be provided with an application for
re-instatement to participate in the Medicaid program.
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