23 Miss. Code. R. 208-2.1 - General
A. The Division of Medicaid covers certain
Home and Community-Based Services (HCBS) as an alternative to
institutionalization in a nursing facility through the Independent Living (IL)
Waiver.
B. Waiver participants
must reside in a private residence which is fully integrated with opportunities
for full access to the greater community, and meet the requirements of a Home
and Community-Based (HCB) setting.
C. The Division of Medicaid does not cover IL
Waiver services to persons in congregate living facilities, institutional
settings, on the grounds of or adjacent to institutions, or any other setting
that has the effect of isolating persons receiving Medicaid Home and
Community-Based Services (HCBS).
D. The IL Waiver is administered by the
Division of Medicaid and jointly operated by the Division of Medicaid and
Mississippi Department of Rehabilitation Services (MDRS).
E. The Division of Medicaid maintains
responsibility for the administration of the waiver and formulates policies,
rules, and regulations. Under the direction of the Division of Medicaid, the
fiscal agent is responsible for processing claims, issuing payments to
providers, and notifications regarding billing. MDRS is responsible for
operational functions and maintaining a current Medicaid provider number as
outlined in an interagency agreement.
F. The average cost for a waiver
applicant/person must not be above the average estimated cost for nursing
facility level of care approved by the Centers for Medicare and Medicaid
Services (CMS) for the current waiver year. The State may refuse entrance to
the waiver to any otherwise eligible individual when the State reasonably
expects that the cost of the facility and community-based services furnished to
that individual would exceed the cost of a level of care specified for the
waiver up to an amount specified by the State.
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