23 Miss. Code. R. 223-3.5 - Reimbursement
A. The Division of Medicaid reimburses up to
twelve (12) hours per day of medically necessary prescribed pediatric extended
care (PPEC) services for Early and Periodic Screening, Diagnosis and Treatment
(EPSDT) eligible beneficiaries when:
1.
Ordered by the beneficiary's attending physician,
2. Provided by a Mississippi licensed and
Medicaid enrolled PPEC center, and
3. Prior authorized by the Division of
Medicaid or designee every six (6) months.
B. The Division of Medicaid reimburses the
lesser of the provider's usual and customary charge or:
1. An hourly rate for each complete hour of
PPEC services for the first six (6) complete hours of PPEC services,
2. A daily rate for over six (6) hours of
PPEC services, and
3. A daily rate
for transportation to and from the PPEC center when provided by the
PPEC.
C. The following
items and services are not included in the hourly or daily rates for PPEC
services and must be billed separately by the rendering provider:
1. Occupational therapy,
2. Physical therapy, and
3. Speech-language pathology.
4. Baby food or formula,
5. Total parenteral and enteral nutrition,
6. Mental health and/or
psychiatric services, and
7.
Durable medical equipment (DME) and medical supplies.
Notes
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