23 Miss. Code. R. 223-4.4 - Prior Authorization and Concurrent Reviews
A.
Private duty nursing (PDN) providers must submit a prior authorization request
to the Division of Medicaid or designee prior to the initiation of PDN services
which must include, at a minimum, the following:
1. A signed physician or specialist's order
for PDN and a signed initial Plan of Care (POC),
2. Beneficiary diagnosis(es),
3. Skilled teaching/instructions to be
provided to a family member or caregiver(s),
4. Treatment plan/physician orders specifying
each skill to be performed including whether the service(s) require a
registered nurse (RN) or a licensed practical nurse (LPN),
5. Expected duration of service,
6. Identification of any other home care
services, including the hours, days, and times of these services being
provided, including, but limited to:
a) Case
management,
b) Physical
therapy,
c) Speech
therapy,
d) Occupational
therapy,
e) Respiratory
therapy,
f) Respite,
g) Hospice, and/or
h) Personal care attendant.
7. When PDN medical necessity
criteria are no longer met, a plan:
a) For
reducing and discontinuing PDN hours, and
b) To transition the beneficiary to the most
appropriate setting.
B. The PDN provider must submit a
recertification of PDN services, every six (6) months indicating the number of
hours per day or week and the duration of the request to the Division of
Medicaid, or designee and include the following:
1. An updated POC,
2. Progress notes,
3. Monthly summaries, and
4. Nursing visit notes.
C. The PDN provider cannot bill the
beneficiary for hours when the provider failed to seek
certification/recertification in a timely manner.
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.