23 Miss. Code. R. 209-1.3 - Definitions

The Division of Medicaid defines:

A. Durable Medical Equipment (DME) and/or medical appliance as an item meeting all five (5) criteria below:

1. It can withstand repeated use,

2. Is reusable or removable,

3. Is primarily and customarily used to serve a medical purpose,

4. Is generally not useful to a person in the absence of a disability, illness, or injury, and

5. Is appropriate for use in any setting where the beneficiary's normal life activities take place other than a hospital, nursing facility, intermediate care facility for individuals with intellectual disabilities, or any setting in which payment is or could be made by the Division of Medicaid for inpatient services that include room and board.

B. Prior authorization, as used in this chapter, is defined as prior authorization for a service or item based on medical necessity review by the Utilization Management/Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity.

C. An allowed non-physician practitioner is defined as a:

1. A nurse practitioner, clinical nurse specialist or certified nurse midwife working in collaborative/consultative relationship under established protocol or practice guidelines with a Mississippi licensed attending physician enrolled as a Mississippi Medicaid provider,

2. A physician assistant under the supervision of the Mississippi licensed attending physician enrolled as a Mississippi Medicaid provider as required by the Mississippi Board of Medical Licensure.

D. Home is defined as any setting in which normal life activities take place, other than a hospital, nursing facility, intermediate care facility for individuals with intellectual disabilities (ICF/IID), or any setting in which payment is or could be made by the Division of Medicaid for inpatient services that include room and board.

E. The Division of Medicaid defines a trial period as the time required to assess the effectiveness of an item and beneficiary compliance.

Notes

23 Miss. Code. R. 209-1.3

42 U.S.C. § 1395 x(n); 42 C.F.R. § 440.70; Miss. Code Ann. § 43-13-121.

Amended 9/1/2018 Amended 5/1/2021 Amended 7/1/2021