23 Miss. Code. R. 208-1.6 - Covered Services

A. The Division of Medicaid covers the following services through the Elderly and Disabled (E&D) Waiver:

1. Case Management services include the identification of resources as well as the coordination and monitoring of resources and services by case managers to ensure the health, social needs, preferences and goals of beneficiaries are met throughout the person centered planning process and service provision. The case management agency is responsible for monitoring and implementation of the Plan of Services and Supports (PSS). Monitoring and implementation of the PSS includes, but is not limited to, on-site review activity in the beneficiary's residence, record reviews, annual recertification reviews, telephone interviews by the Medicaid agency, and other strategies as needed.

a) The case management team must consist of a Licensed Registered Nurses (RN) and Licensed Social Worker (LSW), and will conduct the following activities.

1) Conduct face-to-face visits together using the comprehensive long-term services and support (LTSS) assessment instrument at the time of admission and recertification.

(a) Initial assessments must be conducted face-to-face with the waiver applicant in conjunction with a registered nurse.

(b) Recertification assessments must be conducted face-to-face with a beneficiary by the case manager, and a registered nurse must be available for consultation if necessary.

2) Complete face-to-face visits with the beneficiary on a quarterly basis to review the Plan of Services and Supports (PSS).

3) Complete monthly contacts with the beneficiary. Monthly contacts may be completed virtually; however, face-to-face visits for monthly contacts must be completed with beneficiaries if any of the following concerns are identified:

(a) Beneficiary/representative is unable to communicate by phone due to an auditory, speech or cognitive impairment;

(b) Beneficiary has unmet needs that cannot be resolved by phone;

(c) The case management team has identified risks for abuse, neglect or exploitation including the use of restraints or seclusion that require in-person monitoring; or

(d) Beneficiary/representative is unable to be reached by phone.

b) Each case management team must maintain active case load of no more than one hundred and twenty (120) E&D Waiver beneficiaries.

1) If a case management team maintains an average, active case load greater than one hundred and twenty (120), prior approval must be obtained by the Division of Medicaid.

2) Approval will be considered based upon causation and duration of the increase.

2. Adult Day Care (ADC) Services - ADC services include community-based comprehensive programs which provide a variety of health, social and related supportive services in a protective setting during daytime and early evening hours.

a) ADC services must be provided in accordance with a beneficiary's approved PSS.

b) ADC services must meet the needs of aged and disabled persons through an individualized service plan (ISP) developed by the ADC through a person-centered process and must include the following:

1) Personal care and supervision,

2) A minimum of one (1) meal and two (2) snacks per day of an adult's daily nutritional requirement as established by state and federal regulations,

3) Provision of limited health care including medications while the beneficiary is at the facility,

4) Round trip transportation from the beneficiary's home to the facility and to center-sponsored activities, and escort service as needed to ensure a beneficiary's safety,

5) Social, health, and recreational activities which optimize, but not regiment, individual initiative, autonomy, and independence, including, but not limited to, daily activities, physical environment and personal preferences, and

6) Information on, and referral to, vocational services.

c) To be eligible for reimbursement, the ADC must:

1) Submits claims billed in fifteen (15) minute increments for the duration of time the services were provided and the provider will be reimbursed by the Division of Medicaid the lessor of the maximum daily cap or the total amount of the fifteen (15) minute increment units billed for that day.

(a) The duration of the service time must begin when the beneficiary enters the facility and ends upon their departure and does not include the time spent transporting the beneficiary to and from the facility.

(b) Claims must include separate line items for each day of service provision and cannot be span billed.

2) Be open and providing services for at least nine (9) continuous hours per day, Monday through Friday, 8am - 5pm with the exception of any state/federal holidays.

d) ADC settings including outdoor spaces must be safe, clean and physically accessible to the beneficiaries and must:

1) Ensure that beneficiaries receiving Medicaid HCBS have access to the greater community, including opportunities to engage in community life as individuals not receiving Medicaid HCBS.

2) Be selected by the beneficiaries from among setting options including nondisability specific settings. The setting options are identified and documented in the person-centered service plan and are based on the beneficiary's needs and preferences.

3) Ensure a beneficiary's rights of privacy, dignity and respect, and freedom from coercion and restraint.

4) Optimize, but not regiment, a beneficiary's initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and social interaction.

5) Facilitate individual choice regarding services and supports, and who provides them.

6) ADC settings should not restrict a beneficiary within a setting, unless such restriction is documented in the person-centered plan, all less restrictive interventions have been exhausted, and such restriction is reassessed over time.

7) The person-centered service plan should identify and document setting options based on the beneficiary's needs and preferences, including non-disability specific settings, from which the beneficiary can select.

e) ADC settings do not include the following:

1) A nursing facility,

2) An institution for mental diseases,

3) An intermediate care facility for individuals with intellectual disabilities (ICF/IID),

4) A hospital, or

5) Any other locations that have qualities of an institutional setting, as determined by the Division of Medicaid, including but not limited to, any setting:

(a) Located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment,

(b) Located in a building on the grounds of or immediately adjacent to a public institution, or

(c) Any other setting that has the effect of isolating beneficiaries receiving Medicaid.

f) Beneficiaries must not be in transportation vehicles for longer than sixty (60) minutes per trip.

3. Personal Care Services - Personal Care Services (PCS) are non-medical support services provided in the home or community of eligible beneficiaries by trained personal care attendants (PCA) to assist the beneficiary in meeting daily living needs and ensure optimal functioning at home and/or in the community.

a) PCS:

1) Includes assistance to functionally impaired persons allowing them to remain in their home by providing assistance with activities of daily living, instrumental activities of daily living, and assistance in participating in community activities,

2) Must be provided in accordance with a beneficiary's PSS,

3) Are approved by the Division of Medicaid based upon assessed needs of the beneficiary as set forth in the PSS and require sufficient documentation to substantiate the requested number of hours.

(a) The frequency cannot duplicate hours rendered or billed for respite care and/or home health aide services.

(b) Any increase or decrease in the number of hours indicated on the PSS must be prior approved by the Division of Medicaid.

4) A personal care attendant may accompany persons during community activities as a passenger in the vehicle.

(a) The PCA cannot drive the vehicle.

(b) If transportation is provided by a Medicaid Non-Emergency Transportation (NET) provider, there must be documentation that it is medically necessary for a PCA to accompany beneficiaries.

b) PCA responsibilities include:

1) Assisting with personal care including, but not limited to:

(a) Mouth and denture care,

(b) Shaving,

(c) Finger and toenail care excluding the cutting of the nails,

(d) Grooming hair to include shampooing, combing, and oiling,

(e) Bathing in the tub or shower or a complete or partial bed bath,

(f) Dressing,

(g) Toileting including emptying and cleaning a bed pan, commode chair, or urinal,

(h) Reminding beneficiary to take prescribed medication,

(i) Eating,

(j) Transferring or changing the beneficiary's body position, and

(k) Ambulation.

2) Performing housekeeping tasks including, but not limited to:

(a) Assuring rooms are clean and orderly, including sweeping, mopping and dusting,

(b) Preparing shopping lists,

(c) Purchasing and storing groceries,

(d) Preparing and serving meals,

(e) Laundering and ironing clothes,

(f) Running errands,

(g) Cleaning and operating equipment in the home such as the vacuum cleaner, stove, refrigerator, washer, dryer, and small appliances,

(h) Changing linens and making the bed, and

(i) Cleaning the kitchen, including washing dishes, pots, and pans.

3) Reporting to the PCS supervisor, PCS director, or the individual designated to supervise the PCS program.

c) PCA supervisor responsibilities include, but are not limited to:

1) Supervising PCAs in an area within sixty (60) miles driving distance of their designated worksite,

2) Ensuring PCA timesheets and any other documents containing protected health or identifying information are securely stored in a manner that prevents unauthorized disclosure while in the PCA or PCA supervisor's possession and returned to the main office location within ten (10) business days,

3) Supervising no more than twenty (20) full-time PCAs,

4) Making home visits with PCAs to observe and evaluate job performance, including evaluating the work, skills and job performance of the PCA,

5) Reviewing and approving PCA duties on the approved service plans, revising as needed,

6) Receiving and processing requests for services,

7) Being accessible to PCAs for emergencies, case reviews, conferences and problem solving,

8) Interpreting PCS agency policies and procedures relating to the PCS program,

9) Preparing, submitting or maintaining appropriate records and reports, including supervisory reports and submit monthly activity sheets,

10) Planning, coordinating and recording ongoing in-service PCA training,

11) Performing supervised direct monitoring visits in the beneficiary's home while the PCA staff is on-site and unsupervised indirect monitoring visits, which may be performed in the beneficiary's home or by phone while the PCA staff is not on-site, alternating on a bi-weekly basis to assure services and care are provided according to the PSS, and

12) Reporting directly to the PCS agency's Director and in the absence of the Director, being responsible for the regular, routine activities of the PCS program.

d) Director/Compliance Officer responsibilities include, but are not limited to, the following:

1) Ensuring continuing compliance with the Medicaid Administrative Code, Medicaid provider agreement, all applicable state and federal laws, and the CMS approved waiver.

2) Ensuring all mandatory training and certifications are completed timely.

3) Ensuring all background checks are completed timely and maintained appropriately.

4) Ensuring all Office of Inspector General (OIG) and Nursing and Exclusion checks are completed timely and maintained appropriately.

5) Ensuring all Corrective Action Plans are implemented appropriately.

6) Ensuring immediate access to all beneficiary and employee records as required for audit purposes.

e) Persons enrolled in the E&D Waiver who elect to receive PCS must allow providers to utilize the Mississippi Medicaid Electronic Visit Verification (EVV) system and must adhere to and support all policies, rules and regulations in the operations of the EVV system.

4. In-Home or Institutional Respite Services - In-Home Respite (IHR) or Institutional Respite Services, either in an institutional or home setting, is covered for beneficiaries unable to care for themselves in the absence, or need for relief, of the beneficiary's primary full-time, live-in caregiver(s) on a short-term basis during a crisis situation and/or scheduled relief to the primary caregiver(s) to prevent, delay or avoid premature institutionalization of the beneficiary.

a) In-Home Respite services are non-medical, unskilled services.

1) IHR services are covered when a beneficiary:

(a) Is unable to leave home unassisted due to physical or mental impairments, and

(b) Requires twenty-four (24) hour assistance by a caregiver and cannot be safely left alone and unattended for any period of time.

2) No more than sixty (60) hours of IHR services per month are allowed. IHR services in excess of sixteen (16) continuous hours must be prior approved by the case management team.

3) When the person enrolled in the E&D Waiver who elects to receive In-Home Respite allows the provider to utilize the Mississippi Medicaid EVV system must adhere to and support all policies, rules and regulations in the operations of the EVV system.

b) IHR staff responsibilities for respite service include, but are not limited to, the following:

1) The IHR staff providing direct respite care must provide one or more of the following primary activities:

(a) Companionship,

(b) Support or general supervision, or

(c) Feeding and personal care needs.

2) The provision of these services does not entail hands-on nursing care. Any assistance with activities of daily living is incidental to the care of the individual and are not provided as discrete services.

c) IHR supervisor responsibilities include, but are not limited to:

1) Supervising the IHR staff providing services within sixty (60) miles driving distance of the supervisor's designated worksite,

2) Ensuring IHR staff timesheets and any other documents containing protected health or identifying information are securely stored while in the possession of the IHR staff or supervisor in a manner that prevents unauthorized disclosure and are returned to the main office location within ten (10) business days,

3) Supervising no more than twenty (20) full-time IHR staff,

4) Making home visits with IHR staff to observe and evaluate job performance, maintain supervisory reports, and submit monthly activity sheets,

5) Reviewing and approving IHR duties on the approved service plans,

6) Receiving and processing requests for services,

7) Being accessible to IHR staff and beneficiaries/their representatives for emergencies, case reviews, conferences, and problem solving,

8) Evaluating the work, skills, and job performance of the IHR staff, including the completion of hands-on skills assessments,

9) Interpreting IHR agency policies and procedures relating to the IHR program,

10) Preparing, submitting, or maintaining appropriate records and reports,

11) Planning, coordinating, and recording ongoing in-service training for the PCA,

12) Performing supervised direct monitoring visits in the beneficiary's home while the IHR staff is on-site and unsupervised indirect monitoring visits, which may be performed in the beneficiary's home or by phone, while the IHR staff is not on-site, alternating on a biweekly basis to ensure services and care are provided according to the PSS, and

13) Reporting directly to the IHR agency's Director and, in the absence of the Director, is responsible for the regular, routine activities of the IHR program.

d) Director/Compliance Officer responsibilities include, but are not limited to, the following:

1) Ensuring continuing compliance with the Medicaid Administrative Code, Medicaid provider agreement, all other state and federal laws, and the CMS approved waiver, which is available on the Division of Medicaid's website, www.medicaid.ms.gov.

2) Ensuring all mandatory training and certifications are completed timely.

3) Ensuring all background checks are completed timely and maintained appropriately.

4) Ensuring all OIG and Nursing Exclusion checks are completed timely and maintained appropriately.

5) Ensuring all Corrective Action Plans are implemented appropriately if necessary.

6) Ensuring immediate access to all beneficiary and employee records as required for audit purposes.

e) Institutional Respite Care Services are covered only when provided in a Mississippi Medicaid enrolled Title XIX hospital, nursing facility, or licensed swing bed facility.

1) Providers must meet all certification and licensure requirements applicable to the type of respite service provided, and must obtain a separate provider number, specifically for this service, and,

2) Are covered no more than thirty (30) calendar days per state fiscal year.

5. Home Delivered Meals are covered when the following requirements are met:

a) The beneficiary is unable to leave without assistance and is:

(1) unable to prepare their own meals, and/or

(2) has no responsible caregiver in the home.

b) Beneficiaries must receive a minimum of one (1) meal per day, five (5) days per week. If there is no responsible caregiver to prepare meals, the beneficiary will qualify to receive a maximum of one (1) meal per day, seven (7) days per week.

c) Providers offering home delivered meals must adhere to the following requirements:

1) Attest that food handling methods (preparation, storage, and transporting) comply with the Mississippi State Department of Health (MSDH) regulations governing food service sanitation.

2) Provide, at a minimum, the following service supplies with each individual meal:

(a) Straw which is six (6) inches individually wrapped (jumbo size),

(b) Napkin which is thirteen (13) inches by seventeen (17) inches,

(c) Flatware with each individually wrapped package to contain non-brittle medium weight plastic fork or spoon and serrated knife with handles at least three and one half (3^1/2) inches long,

(d) Carry-out tray which is Federal Drug Administration (FDA) approved compartment tray for hot foods.

(e) Condiments to include individual packets of iodized salt and pepper and when necessary to complete the menu other individually packed condiments, such as ketchup, mustard, mayonnaise, salad dressings, and tartar sauce.

(f) Cups which are four (4) ounce styrofoam, with covers for cold foods to accompany carry-out trays.

3) Use transporting equipment designed to protect the meal from potential contamination and designed to hold the food at a temperature below forty-five (45) degrees Fahrenheit, or above one hundred forty (140) degrees Fahrenheit, as appropriate.

4) Have contingency plans to ensure that in the event of an emergency enrolled beneficiaries will have access to a nutritionally balanced meal.

5) Bring to the attention of the appropriate officials for follow-up any conditions or circumstances which place the beneficiary or the household in imminent danger.

6) Comply with all state and local health laws and ordinances concerning preparation, handling and service of food.

7) Must have available for use, upon request, appropriate food containers and utensils for blind members and members with limited dexterity or mobility.

8) Ensure all food preparation employees are supervised by a person who is familiar with the application of hygienic techniques and practices in food handling, preparation and services. This supervisory employee must ensure all hygiene techniques and practices are applied and consult with the service provider dietitian for advice, as necessary.

9) May use various methods of delivery. However, all food preparation standards set forth in this section must be met.

10) Must ensure only one (1) hot meal is delivered per day, per beneficiary, and no more than fourteen (14) frozen meals per delivery, per beneficiary.

11) Maintain documentation of delivered meals including the signature of the beneficiary accepting delivery.

(a) If the beneficiary, or designated caregiver, is not home at time of delivery, the meals must not be delivered.

(b) Meals delivered to anyone other than the beneficiary or their caregiver is not billable.

12) Establish procedures to be implemented by employees during an emergency (fire, disaster) and train employees in their assigned responsibilities. In emergency situations, such as under severe weather conditions, the provider may leave nonperishable meals or food items for a beneficiary, provided that proper storage and heating facilities are available in the home, and the beneficiary is able to prepare the meal with available assistance.

13) Forward billing information including the delivery documentation to the case manager on a monthly basis.

6. Extended Home Health Services, including skilled nursing and home health aide services, are covered when:

a) Extended services have been prior approved by the Division of Medicaid, and are deemed medically necessary by the beneficiary's prescribing primary care provider, after the initial thirty-six (36) State Plan home health visits have been exhausted.

b) Home Health Agencies must follow all rules and regulations set forth in Miss. Admin. Code Part 215.

c) The home health aide cannot be in the beneficiary's home at the same time as a PCA and cannot perform the same duties as are performed by a PCA. Exceptions to this rule must be based on medical justification and thoroughly documented.

7. Physical therapy services are covered when:

a) Services must be provided by an enrolled Mississippi Medicaid home health provider utilizing a physical therapist who:

1) Has a non-restrictive current Mississippi license issued by the appropriate licensing agency to practice in the State of Mississippi, and

2) Meets the state and federal licensing and/or certification requirements to perform physical therapy services in the State of Mississippi.

b) Provided in accordance with Miss. Admin. Code Title 23, Part 213.

8. Speech therapy services are covered when:

a) Services must be provided by an enrolled Mississippi Medicaid home health provider utilizing a speech therapist who:

1) Has a non-restrictive current Mississippi license issued by the appropriate licensing agency to practice in the State of Mississippi, and

2) Meets the state and federal licensing and/or certification requirements to perform physical therapy services in the State of Mississippi.

b) Provided in accordance with Miss. Admin. Code Title 23, Part 213.

9. Community Transition (CT) Services provide assistance with initial expenses required for a beneficiary to set up a household. The expenses must be included in the approved PSS, and expenses are limited to those specifically designated by the Division of Medicaid.

a) To qualify for CT services, a beneficiary must meet all of the following criteria:

1) Reside in a long- term care (LTC) facility for greater than ninety (90) days in a long-term care service track with a minimum of one (1) day paid by Medicaid.

2) Have no other source to fund or attain the necessary items or support to establish a household,

3) Be transitioning from a nursing facility where these covered items and services were provided, and transitioning to a residence where these covered items and services are not normally furnished.

4) Must meet the level of care criteria for a nursing facility and, if not for the provision of HCB long-term care services, the beneficiary would continue to require the level of care provided in the nursing facility.

5) Be transitioning to a qualified residence which must pass a U.S. Department of Housing and Urban Development (HUD) Housing Quality Standards inspection and be prior approved by the Division of Medicaid and meet one (1) of the following criteria:

(a) A home owned or leased by the transitioning beneficiary or the beneficiary's family member,

(b) An apartment with lockable access leased to the transitioning beneficiary which includes living, sleeping, bathing, and cooking areas over which the beneficiary or the beneficiary's family has domain and control, or

(c) A residence in a community-based residential setting in which no more than four (4) unrelated persons reside.

b) Community Transition Services include the following:

1) Security and Utility Deposits which:

(a) Have a limit of $1,000.00 per individual transitioning from the nursing facility back into the community.

(b) Must be required to occupy and use a community domicile.

(c) Only include deposits for telephone, electricity, heating, and water.

(d) May include payment of past due bills which inhibit the beneficiary's ability to transition from the nursing facility into the community when no other payment source is available.

(e) Must be listed on the PSS prior to transitioning from the facility.

2) Essential Household Furnishings which must be documented on the Division of Medicaid's required form and listed in the PSS prior to the beneficiary transitioning from the nursing facility and are limited to:

(a) Items required to occupy and use a community domicile,

(b) Purchased items may only include furniture, window coverings, food preparation items, bed/bath items and cleaning supplies.

3) Moving expenses and a one (1) time cleaning and pest eradication, as necessary for the beneficiary's health and safety, which has a combined limit of two hundred and fifty dollars ($250.00) to ensure that all belongings of the beneficiary located in the institution are able to be taken to the community residence.

4) Necessary Home Accessibility Adaptations (HAA) are covered for physical adaptations to the private residence of the beneficiary or the beneficiary's family, if they are required by the beneficiary's PSS, are necessary to ensure the beneficiary's health, welfare, and their safety and enable the beneficiary to function with greater independence in the residence.

(a) Covered HAA include:

(1) The installation of ramps and grab bars,

(2) Widening of doorways,

(3) Modification of bathroom facilities, and

(4) Installation of specialized electric and plumbing systems to accommodate medical equipment and supplies.

(b) Non-covered HAA include, but are not limited to:

(1) Those that are of general utility and are not of a direct medical or remedial benefit to the beneficiary, or

(2) Those that add to the total square footage of the home except when necessary to complete an adaptation to include improving entrance/egress to a home or configuring a bathroom to accommodate a wheelchair.

(c) HAA will be authorized up to ninety (90) consecutive days prior to the date on which an institutionalized beneficiary transitions to the community setting.

(d) HAAs begun while the beneficiary was institutionalized is not considered complete until the date the beneficiary transitions from the nursing facility into the community setting and is admitted to the E&D Waiver. HAA cannot be billed to the Division of Medicaid until complete.

(e) A home inspection by the Community Transition Specialist and/or a contracted entity whose sole function is to conduct a home inspection must be conducted to determine the needs for the beneficiary utilizing the Person-Centered Planning (PCP) process.

(f) All providers/subcontracted entities rendering HAA services must:

(1) Meet all state or local requirements for licensure/certification including, but not limited to, building contractors, plumbers, electricians or engineers.

(2) Provide services in accordance with applicable state housing and local building codes.

(3) Ensure the quality of work provided meets standards identified below:

(i) All work must be done in a manner that exhibits good craftsmanship.

(ii) All materials, equipment, and supplies must be installed clean, and in accordance with manufacturer's instructions.

(iii) The contractor must obtain all permits required by local governmental bodies.

(iv) All non-salvaged supplies and/or materials must be new and of best quality without defects.

(v) The contractor must remove all excess materials and trash, and leave the site clear of debris at completion of the project.

(vi) All work must be accomplished in compliance with applicable codes, ordinances, regulations and laws.

(vii) The specifications and drawings cannot be modified without a written change order from the case manager.

(viii) The modification and/or construction process cannot create any new accessibility barriers.

5) Durable Medical Equipment (DME) is covered when:

(a) Required by the beneficiary's PSS,

(b) Required to ensure the health, welfare, and safety of the beneficiary, and

(c) It enables the beneficiary to function with greater independence in the home when no other payment source is available.

6) Community Navigation:

(a) Is defined as activities required to:

(1) Access, arrange for, and procure needed resources,

(2) Develop the beneficiary's profile to assist in the PSS development, including conducting person-centered planning meetings, discovery, identification of housing, and assistance with completion of applications for community resources and housing.

(b) Has a maximum unit allowance of two hundred sixty (260) units, which must occur no earlier than ninety (90) days prior to transition to the community.

(c) Is reimbursed per a 15-minute unit rate up to forty (40) units for a maximum of thirty (30) days post transition into the community.

c) Community Transition Services are furnished only to the extent that:

1) They are reasonable and necessary as determined through the service plan development process, and

(a) They are clearly identified in the service plan, and

(b) The beneficiary is unable to pay for the expense or when the services cannot be obtained from other sources.

d) Community Transition Services do not include:

1) Monthly rental or mortgage expenses,

2) Regular utility charges,

3) Food, and/or

4) Household appliances or items that are intended for purely diversional/recreational purposes.

e) Community Transition Services must be essential to:

1) Ensuring that the beneficiary is able to transition from the current nursing facility, and

2) Identifying and eliminating any identified obstacles or barriers that could prevent a successful transition to a more independent setting.

10. Environmental Safety Services are provided for the purpose of maintaining a healthy and safe living environment through the performance of tasks in and around the beneficiary's home environment that are beyond the beneficiary's capability to personally perform.

a) Environmental Safety Services must be provided in accordance with a beneficiary's PSS and may include the following services:

1) minor home maintenance and repair.

2) non-routine disposal of garbage posing a threat to the beneficiary's health and welfare.

3) pest control and services to prevent, suppress, eradicate, or remove pests posing a threat to the beneficiary's health and welfare.

b) Environmental Safety services exclude tasks that:

1) are the legal or contractual responsibility of someone other than the beneficiary.

2) can be accomplished through existing informal and formal supports.

3) do not provide a direct or remedial benefit to the beneficiary.

4) are performed or interventions available through the personal care or in-home respite services.

c) Environmental safety services shall not exceed $500.00 per beneficiary per state fiscal year. These services are limited to additional services not otherwise covered under the State Plan, including EPSDT.

d) Environmental Safety Services are coordinated and billed based on actual invoiced cost to the Division of Medicaid by approved Elderly and Disabled Waiver Case Management providers.

e) Direct services may be contracted out to local vendors. Vendors providing environmental safety services must:

1) Provide services in accordance with applicable state housing and local building codes.

2) Ensure the quality of work meets standards that secure the beneficiary's health and welfare.

3) Coordinate with the Case Managers and the beneficiary to ensure that services are rendered in a person-centered manner.

11. Medication Management services are provided to beneficiaries with one or more chronic health conditions who are prescribed a daily regimen of at least five (5) prescription medications. These services include consultations and follow-up visits with a licensed pharmacist and must be provided in accordance with a beneficiary's approved PSS. Medication management is limited to one initial or annual consultation and fifteen (15) follow-up visits per state fiscal year (SFY). These services are limited to additional services not otherwise covered under the State Plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

a) Medication Management includes the following services:

1) Review of all prescription and over-the-counter medications taken by the beneficiary on at least a monthly basis in order to support the beneficiary's adherence with the therapeutic regimen and minimize potentially preventable decline in condition or hospitalizations/institutionalization resulting from medication errors.

2) Reviews may occur more frequently, on an as needed basis, upon significant change in the beneficiary's condition or immediately following discharge from an acute hospital stay.

3) A comprehensive initial or annual consultation and subsequent follow-up consultations in which the provider will be responsible for collecting a complete medical history and list of current prescribed and over-the-counter medications in order to assess whether:

a) The beneficiary's medication is accurate, valid, non-duplicative and correct for their diagnoses.

b) Therapeutic doses and administration are at an optimal level.

c) Appropriate laboratory monitoring and follow-up are taking place.

d) Drug interactions, drug allergies and contraindications are assessed and prevented.

4) Necessary interventions implemented by the provider including, but not limited to, medication counseling and disease education, referral to a primary care physician, consultation with a physician regarding recommended laboratory tests, and medication delivery or reminder services

Notes

23 Miss. Code. R. 208-1.6

42 C.F.R. §§ 431.53, 440.170, 440.180, 441.301; Miss. Code Ann. §§ 43-13-117, 43-13-121.

Revised - 01/01/2013 Amended 1/1/2017 Amended 12/1/2018 Amended 8/1/2019 Amended 9/1/2023 Amended 6/1/2025