23 Miss. Code. R. 212-1.1 - Definitions
The Division of Medicaid defines:
A. Rural Health Clinic as a provider that has
been designated a Rural Health Clinic by the Centers for Medicare and Medicaid
Services (CMS) and for purposes of this policy includes both provider-based
rural health clinics and freestanding rural health clinics.
1. Free Standing Rural Health Clinic as an
independent clinic owned by a provider or a provider entity that does not
qualify for, or have not sought, provider-based status, as designated by
CMS.
2. Provider-Based Rural Health
Clinic as a rural health clinic that is owned and operated as an essential part
of a hospital, nursing home, or home health agency, as designated by
CMS.
B. Rural Health
Clinic (RHC) encounter as a face-to-face visit for the provision of services
provided by physicians, physician assistants, nurse practitioners, nurse
midwives, dentists, optometrists, clinical psychologists, Licensed Clinical
Social Workers (LCSWs), Licensed Professional Counselors (LPCs), Licensed
Marriage and Family Therapists (LMFTs), and Board Certified Behavioral Analysts
(BCBAs).
C. An encounter rate as a
prospective payment system (PPS) rate per encounter.
D. Clinician Administered Drugs and
Implantable Drug System Devices (CADD) as certain physician-administered drugs,
with limited distribution or limited access for beneficiaries and administered
in an appropriate clinical setting, which were not included in the calculation
of the RHC's PPS rate, as determined by the Division of Medicaid.
E. Change in the scope of service as a change
in the type, intensity, duration and/or amount of services.
1. A change in the scope of services occurs
if:
a) The RHC has added or has dropped any
services that meet the definition of an RHC service as provided in federal
regulations.
b) The service is
included as a covered Medicaid service under the Mississippi Medicaid State
Plan.
c) A change in the intensity
is a change in the amount of health care services provided by the RHC during an
average encounter.
2. A
change in the scope of service does not mean:
a) The addition or reduction of staff members
to or from an existing service.
b)
An increase or decrease in the number of encounters.
c) A change in the cost of a service is not
considered in and of itself a change in the scope of service.
F. Allowable costs as
costs that:
1. Result from providing covered
services,
2. Are reasonable in
amount and are necessary for the efficient delivery of those
services,
3. Include the direct
cost center component (i.e., salaries and supplies) of providing the covered
services, and
4. Are an allocated
portion of overhead (i.e., administration and facility).
G. Co-mingling as the simultaneous operation
of an RHC and another physician practice where the two (2) practices share:
1. Hours of operation,
2. Use of the space,
3. Professional staff,
4. Equipment,
5. Supplies, and
6. Other resources.
I. Medical facility as an RHC.
1. The medical facility is limited to an RHC
and must have:
a) A permanent location,
and
b) A published telephone
number.
2. The RHC must
have regularly scheduled hours of operation which are posted in the
facility.
Notes
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.