23 Miss. Code. R. 211-1.3 - Covered Services

A. The Division of Medicaid limits reimbursement to a Federally Qualified Health Center (FQHC) to no more than four (4) encounters per beneficiary per day, provided that each encounter represents a different type of visit, as the Division of Medicaid only reimburses for one (1) medically necessary encounter per beneficiary per day for each of the following visit:

1. Medical,

2. Mental health,

3. Dental, or

4. Vision.

B. Visits with more than one (1) health professional and multiple visits with the same health professional that take place on the same day at a single location constitute a single encounter, except when the beneficiary:

1. Suffers an illness or injury subsequent to the first visit that requires additional diagnosis or treatment on the same day, or

2. Has multiple visit types on the same day.

C. An FQHC's PPS rate covers the beneficiary's visit to the FQHC, which is inclusive of all services and supplies and drugs and biologicals which are not usually self-administered by the beneficiary, furnished as an incident to a professional service.

1. The FQHC cannot refer the beneficiary to another provider that will bill the Division of Medicaid for the covered service, supply, drug or biological which is included in the FQHC's encounter.

2. Drugs are included in the PPS rate, if purchased at a discounted price through a discount agreement except for Clinician Administered Drugs and Implantable Drug System Devices (CADD).

D. The Division of Medicaid covers CADD drugs separately from an FQHC encounter.

1. CADD drugs are listed on the Division of Medicaid's website.

2. CADD drugs do not count toward monthly prescription drug limits applicable to covered outpatient drugs.

E. The Division of Medicaid covers ambulatory services performed by an FQHC employee or contractual worker for an FQHC beneficiary at the following sites:

1. The FQHC, or

2. Beneficiary's residence.

F. The Division of Medicaid covers an outside laboratory for lab services separate from the encounter rate.

G. The Division of Medicaid covers the delivery of FQHC services in a school-based clinic operated by an FQHC and staffed with a physician, nurse practitioner and/or physician assistant.

H. FQHC mobile units are covered services when the requirements of Miss. Admin. Code Title 23, Part 212, Rule 1.2 are met.

I. Diabetes Self-Management Training (DSMT) is a covered service that is included in the PPS rate for a core service for an FQHC but an encounter is not covered solely for DSMT.

J. Vaccine administration is a covered service that is included in the PPS rate for a core service for an FQHC but is not considered a core service.

Notes

23 Miss. Code. R. 211-1.3

42 C.F.R. Part 491; Miss. Code Ann. §§ 43-13-117, 43-13-121; SPA 2018-0012.

Amended 6/1/2015 Amended 6/1/2019 Amended 11/1/2020 Amended 7/1/2021