23 Miss. Code. R. 207-2.16 - Therapy Services
A. All nursing
facilities are required to provide rehabilitation services for residents.
Requirements include physical, occupational and speech-language pathology
therapies. Medicaid, consistent with third party liability rules, is obligated
to cover these services.
B. Prior
authorization/pre-certification of certain physical, occupation, and
speech-language pathology services is required by the Division of Medicaid.
Therapy providers must prior authorize services through the Utilization
Management and Quality Improvement Organization (UM/QIO) for Medicaid. Failure
to obtain prior authorization will result in denial of payment to billing
providers.
C. The UM/QIO will
determine medical necessity, the types of therapy services, and the number of
visits/treatments reasonably necessary to treat the beneficiary's condition. A
complete list of procedure codes that require prior authorization may be
obtained through the UM/QIO. All procedures and criteria set forth by the
UM/QIO are applicable and are approved by Medicaid.
D. Providers must also adhere to all Medicaid
outpatient therapy rules.
E.
Nursing Facility for the Severely Disabled - Miss. Admin. Code Part 207, Rule
2.16 is not applicable to a Nursing Facility for the Severely Disabled (NFSD).
Therapy services for this provider type are inclusive in the per diem rate and
cannot be billed separately.
F.
Medicaid-Only Residents - Therapy services for Medicaid-only residents may be
provided by state-licensed therapists who have a current Medicaid provider
number. Nursing facilities may apply for a group therapy provider number for
billing purposes.
G. Dually
Eligible Residents - Mississippi law requires providers participating in the
Medicaid program to determine if a beneficiary is covered by a third party
source, and to file and collect all third party coverage prior to billing
Medicaid. This includes beneficiaries who are Medicare/Medicaid dual eligibles.
Therapists providing services to dually eligible beneficiaries must bill
Medicare as the primary coverage. All therapy providers must meet state and
federal requirements.
Notes
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.