23 Miss. Code. R. 208-4.6 - Prior Approval/Certification
A. Prior approval
must be obtained from the Division of Medicaid before a beneficiary can receive
services through the Home and Community-Based Waiver program. Prior Approval is
based on clinical eligibility.
B.
Clinical eligibility for waiver services is determined through the utilization
of a comprehensive Pre-Admission Screening.
C. The physician must certify the level of
care.
D. A physician must verify
that the beneficiary has a traumatic brain/spinal cord injury. A brain or
spinal cord injury that is due to a degenerative or congenital condition, or
that result, intentionally or unintentionally, from medical intervention is
excluded.
E. The Plan of Care must
be developed by the case manager and, in conjunction with the PreAdmission
Screening, should contain objectives, types of services to be furnished, and
frequency of services.
F. After the
applicant has made an Informed Choice, understands the criteria for the waiver,
and meets clinical eligibility, the application along with the Plan of Care
(POC) must be submitted to the Division of Medicaid for approval.
G. At the time of the initial certification,
the Pre-Admission Screening and the Plan of Care must be completed jointly by
the TBI/SCI counselor and registered nurse.
H. At the time of recertification, the Plan
of Care must be completed by the IL counselor or the registered
nurse.
I. A beneficiary can only be
enrolled in one HCBS waiver program at a time.
J. Request to add or change services listed
on the approved plan of care requires prior approval.
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.