23 Miss. Code. R. 202-4.4 - Reimbursement
A. All
fee-for-service (FFS) transplants performed in the state of Mississippi are
paid under the Mississippi All Patient Refined-Diagnosis Related Group
(APR-DRG) payment methodology, including a policy adjustor.
B. All FFS transplants available in
Mississippi but performed outside the state of Mississippi are paid under the
Mississippi APR-DRG payment methodology, including a policy adjustor.
C. Payment for transplant services not
available in Mississippi is made under the Mississippi APR-DRG payment
methodology including a policy adjustor. If the Mississippi APR-DRG payment
limits access to care, a case rate may be set.
1. A case rate is set at forty percent (40%)
of the sum of billed charges for transplant services as published in the State
Plan according to Milliman's U.S. Organ and Tissue Transplant Cost
Estimates and Discussion.
2. The Milliman categories
comprising the sum of billed charges include outpatient services received
thirty (30) days pre-transplant, procurement, hospital transplant inpatient
admission, physician services during transplant and one-hundred eighty (180)
days post (transplant) hospital discharge. Outpatient immunosuppressants and
other prescriptions are not included in the case rate.
3. If the transplant hospital stay exceeds
the hospital length of stay published by Milliman, an outlier
per-diem payment will be made for each day that exceeds the hospital length of
stay.
4. Reimbursement for
transplant services cannot exceed one-hundred percent (100%) of the sum of
Milliman's billed charges for the categories listed in Miss.
Admin. Code Part 202, Rule
4.4.C.2.
5. Provisions listed in Miss. Admin. Code
Part 202, Rule
4.4 apply to transplant services on
or after October 1, 2012.
6.
Transplant services not available in Mississippi and not listed in the
Milliman's U.S. Organ and Tissue Transplant Cost Estimates and
Discussion will be reimbursed using the Mississippi APR-DRG payment
methodology. If the Mississippi APR-DRG payment limits access to care, the
Division of Medicaid will reimburse what the domicile state pays for the
service.
D. All
conditions of third party liability procedures must be satisfied.
E. All claims must be submitted according to
the requirements of the Mississippi Medicaid program.
F. All charges, both facility and physician,
relating to procurement/storage must be billed by the transplant facility on
the current uniform billing (UB) claim form with the appropriate revenue
code(s).
G. The Division of
Medicaid reimburses all facility and physician charges relating to the
procurement of an organ, whether from a cadaver or a living donor, to the
transplant facility using the appropriate revenue codes.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.