23 Miss. Code. R. 203-2.1 - Covered Services
A. The Division of
Medicaid covers medically necessary physician-administered drugs and
implantable drug system devices defined as a drug other than vaccines,
diagnostic or therapeutic radio pharmaceutical, contrast imaging agent,
biological or implantable drug system device covered under the Social Security
Act § 1927(k)(2) that:
1. Are administered by
a medical professional in a physician's office or other outpatient clinical
setting,
2. Are incident to
physician services that are separately billed to the Division of Medicaid,
3. Qualifies for rebate in
accordance with
42 USC §
1396r-8,
4. Are Food and Drug Administration (FDA)
approved or follows medically accepted indications and dosing limits supported
by one (1) or more of the official compendia as designated by the Centers for
Medicare and Medicaid Services (CMS), and
5. Are not considered cosmetic,
investigational, experimental or unproven.
B. The Division of Medicaid requires prior
authorization for certain physician-administered drugs and implantable drug
system devices as determined by the Division of Medicaid.
C. The Division of Medicaid reimburses for
discarded drugs or biologicals up to the dosage amount indicated on the
single-use vial or package label minus the administered dose(s) if:
1. The drug or biological is supplied in a
single use vial or single-use package,
2. The drug or biological is actually
administered to the beneficiary to appropriately address his/her condition and
any unused portion is discarded,
3. The amount wasted is recorded in the
beneficiary's medical record,
4.
The provider has written policy and procedures regarding single-use drugs and
biologicals and bills all payers in the same manner, and
5. The amount billed to the Division of
Medicaid as a discarded drug is not administered to another beneficiary or
patient.
D. The
Division of Medicaid does not reimburse for discarded drugs or biologicals
when:
1. A beneficiary misses an appointment,
2. A multi-use vial or package is
used,
3. The actual dose of the
drug or biological administered is less than the billing unit,
4. The drug or biological is administered
during an inpatient stay, or
5.
The extra amount of the drug is provided to account for wastage in a syringe
hub.
E. The Division of
Medicaid defines an implantable drug system device as an instrument, apparatus,
implement, machine, contrivance, implant, in vitro reagent or other similar or
related article, including a component part, or accessory which is:
1. Recognized in the official National
Formulary, the United States Pharmacopoeia or any supplement to one of these,
or
2. Intended for use in the
diagnosing of disease or other conditions, or in the cure, mitigation,
treatment, or prevention of disease.
F. The Division of Medicaid covers the
insertion and removal of a Food and Drug Administration (FDA) approved
implantable drug system device if it:
1. Is
medically necessary,
2. Is in
compliance with its approved uses, specifications and restrictions, and
3. Meets all other applicable
coverage requirements.
G. The Division of Medicaid does not cover:
1. Services related to the use of a
non-covered medical device, or
2.
Implantable drug system devices that are considered experimental or
investigational.
Notes
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No prior version found.