23 Miss. Code. R. 212-1.2 - Provider Requirements
A. To participate
as a Rural Health Clinic (RHC) in the Medicaid program, an organization must be
approved by the Department of Health and Human Services, Centers for Medicare
and Medicaid Services (CMS) as an RHC.
B. RHC providers must comply with the
requirements set forth in Miss. Admin. Code Part 200, Rule 4.8 for all
providers in addition to the specific provider type requirements outlined
below:
1. National Provider Identifier (NPI),
verification from the National Plan and Provider Enumeration System
(NPPES),
2. A copy of the interim
rate notice or current rate letter from CMS,
3. Copy of the nurse practitioner's protocol
and license to practice. If the nurse practitioner is not enrolled with the
Division of Medicaid as a provider, the nurse practitioner must complete a
provider application and obtain an individual provider number, and
4. Clinical Laboratory Improvement Amendments
(CLIA) Information form and current CLIA certificate, if applicable.
a) If the RHC performs only the six (6) tests
listed in Miss. Admin. Code Part 212, Rule
1.3.D., a waiver certificate from the
regional Clinical Laboratory Improvement Amendments (CLIA) office must be
obtained.
b) If the RHC provides
other laboratory tests on site, the RHC must comply with all CLIA requirements
for the laboratory services actually provided.
C. An RHC must provide the following six (6)
laboratory services on site which are included in the PPS rate:
1. Chemical examinations of urine by stick or
tablet method or both, including urine ketones,
2. Hemoglobin or hematocrit,
3. Blood glucose,
4. Examination of stool specimens for occult
blood,
5. Pregnancy tests,
and
6. Primary culturing for
transmittal to a certified laboratory.
D. The Division of Medicaid does not allow
co-mingling.
E. Physicians and
non-physician practitioners cannot operate a private Medicare or Medicaid
practice during RHC hours of operation using the RHC's resources.
F. The effective date of the Medicaid
provider enrollment will be:
1. The date of
Medicare certification if the provider requests enrollment in the Medicaid
program within one hundred twenty (120) days from the date the Medicare Tie-in
Notice was issued to the provider, or
2. The first day of the month in which the
Division of Medicaid receives the provider's completed enrollment packet if the
provider requests enrollment after one hundred twenty (120) days of the
issuance of the Medicare Tie-in Notice.
G. The Division of Medicaid does not enroll
out-of-state providers to provide RHC services, except as described in Miss.
Admin. Code Part 200, Rule 4.2 B.
H. RHC mobile units must be surveyed by the
Mississippi Department of Health (MSDH) and receive an approval letter from the
Centers for Medicare and Medicaid Services (CMS) prior to providing services.
1. All federal and state requirements for RHC
mobile units must be met.
2. The
mobile unit must have a fixed set of locations where the unit is scheduled to
be providing services at specified dates and times.
a) Locations for RHC mobile unit services
must meet the rural and shortage area requirements at the time of
survey.
b) Provided only within the
county or within forty (40) miles of the county where the RHC is
located,
c) The schedule of times
and locations must be posted on the mobile unit and publicized by other means
so that beneficiaries will know the mobile unit's schedule in
advance.
3. NPs must
remain within a seventy-five (75) mile distance from the primary
physician.
Notes
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