23 Miss. Code. R. 207-4.11 - Medical Treatment and Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Requirements
A. The Division of
Medicaid covers medically necessary Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT) services for EPSDT-eligible beneficiaries in accordance
with Miss. Admin. Code Part 223, without regard to service limitations and with
prior authorization.
B. A
psychiatric residential treatment facility (PRTF) must ensure that every
individual receives medically necessary EPSDT services regardless of whether
such services are identified in the individual's plan of care.
C. Each PRTF must have written policies and
procedures and a designated area for responding to an individual's physical
and/or medical needs in the PRTF.
D. EPSDT services in a PRTF must be provided
by:
1. The PRTF,
2. Under arrangement between the PRTF and a
qualified Mississippi Medicaid enrolled non-facility provider, and/or
3. By a qualified Mississippi Medicaid
enrolled provider in the community not affiliated with or under arrangement
with the PRTF.
E. The
Division of Medicaid reimburses for medically necessary EPSDT services:
1. On the PRTF's cost report if services are
provided directly by the PRTF or under arrangement with the PRTF, or
2. Directly to the provider directly if EPSDT
services are provided by a qualified Mississippi Medicaid enrolled provider in
the community not affiliated with or under arrangement with the
PRTF.
F. The Division of
Medicaid does not reimburse a provider for any duplicative psychiatric service
that the PRTF is responsible for providing.
G. PRTF providers must document all EPSDT
services provided in the medical record.
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