23 Miss. Code. R. 205-1.11 - Prior Authorization

A. Prior authorization is required for the initial and all subsequent hospice election periods.

B. All prior authorization requests must be submitted within ten (10) calendar days of the effective date of the election period and must include the following:

1. For the initial ninety (90) day election period:

a) Signed notice of election form,

b) Signed certification/recertification of terminal illness form,

c) Clinical/medical information supporting terminal prognosis,

d) Physician orders,

e) Current medication list, and

f) Hospice provider plan of care.

2. For subsequent ninety (90) day election period and subsequent sixty (60) day election periods:

a) Signed certification/recertification of terminal illness form,

b) Updated clinical/medical information supporting terminal prognosis,

c) Updated physician orders,

d) Updated medication record,

e) Updated plan of care,

f) Beneficiary's current weight, vital sign ranges, lab tests, and

g) Any other documentation supporting continuation of hospice services.

C. All required documentation must be submitted with the prior authorization requests. Documentation that is incomplete or not received within fifteen (15) calendar days of the election period effective date will result in the effective date beginning when completed required documentation is received.

Notes

23 Miss. Code. R. 205-1.11

Miss. Code Ann. § 43-13-121.

Adopted 4/1/2018