23 Miss. Code. R. 212-1.3 - Covered Services
A. The Division of
Medicaid limits reimbursement to a Rural Health Clinic (RHC) 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 RHC's PPS
rate covers the beneficiary's visit to the RHC, 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 RHC 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 RHC'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 RHC 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 RHC employee or
contractual worker for an RHC beneficiary at the following sites:
1. The RHC, or
2. Beneficiary's residence.
F. The Division of Medicaid covers
the services of an outside laboratory for laboratory services not listed in
Miss. Admin. Code Part 212, Rule
1.2.C. separate from the encounter
rate.
G. The Division of Medicaid
covers an RHC as an originating and/or distant site telehealth
provider.
H. The Division of
Medicaid covers the delivery of RHC services in a school-based clinic operated
by an RHC and staffed with a physician, nurse practitioner and/or physician
assistant.
I. RHC mobile units are
covered services when the requirements of Miss. Admin. Code Title 23, Part 212,
Rule
1.2 are met.
J. Diabetes Self-Management Training (DSMT)
is a covered service that is included in the PPS rate for a core service for an
RHC but is not considered a core service.
K. Vaccine administration is a covered
service that is included in the PPS rate for a core service for an RHC but is
not considered a core service.
Notes
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No prior version found.