23 Miss. Code. R. 223-6.4 - Non-Covered Services
A. The Division of
Medicaid does not cover:
1. Educational
interventions of an academic nature performed by the Department of
Education,
2. Same service provided
on the same date, regardless of the setting(s) in which the service was
provided unless service specifically states otherwise.
3. Community-based mental health services
when a beneficiary is an inpatient of a Medicaid-covered facility except for
targeted case management services, including wraparound services, provided up
to thirty (30) days of a covered stay in a medical institution for
EPSDT-eligible beneficiaries with a serious emotional disturbance (SED) that
meet the level of care provided in a psychiatric residential treatment facility
(PRTF),
4. Time spent on
documentation, unless completed during the session and relevant to the
treatment goals,
5. Time spent
completing a care plan form or prior authorization request online via web
portal,
6. Staff travel
time,
7. Field trips and routine
recreational activities,
8.
Beneficiary travel time to and from any service, or
9. Services provided to more than one (1)
beneficiary at a time, unless specifically allowed in the service
definition.
10. Wraparound
facilitation for more than one family member at a time.
11. Case management components provided or
billed as part of a direct care service, including but not limited to:
a) Assisting a person in accessing needed
services such as medical, social, educational, transportation, housing,
substance use, personal care, employment and other services that may be
identified in the Recovery Support Plan as components of Health, Home, Purpose
and Community,
b) Assisting the
person and natural supports in implementation of therapeutic interventions
outlined in the Individual Service Plan, or
c) Psychoeducation and training of family,
unpaid caregivers, and/or others who have a legitimate role in addressing the
needs of the person.
B. The Division of Medicaid does not cover
the following evaluative services:
1. A
neuropsychological evaluation when:
a) Only
administered to rule out attention deficit hyperactivity disorder (ADHD),
or
b) Previous evaluations did not
support the suspicion of cognitive deficits or brain injury.
2. The Division of Medicaid does
not cover a developmental evaluation when:
a)
Referral questions can be adequately answered through behavioral observation
and family interviews, or
b) A
standardized intellectual assessment is appropriate and the beneficiary is
three (3) years or older with no severe disabilities.
C. The Division of Medicaid does
not cover case management services that:
1.
Restrict a beneficiary's access to other services under the State
Plan.
2. Require the beneficiary to
receive other Medicaid services as a condition of receipt of case management
services.
3. Duplicates other
services provided by public agencies or private entities.
4. Authorize or deny the provision of other
services under the State Plan.
5.
Constitute the direct delivery of underlying medical, educational, social or
other services to which a beneficiary has been referred.
Notes
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No prior version found.