20 Miss. Code. R. 2-V

Current through December 10, 2024

Section 20-2-V - SKILLED NURSING FACILITY RULES

A.Reimbursement The MAR for medical care provided within the confines of a freestanding skilled nursing facility, a hospital-based skilled nursing facility, or a swing bed facility, shall be four hundred dollars ($400.00) per day. This rate covers and includes all routine and ancillary health care services provided to a claimant during each day of a covered skilled nursing facility stay.

B.Excluded Services The following services are excluded from the daily skilled nursing facility rate, and shall be reimbursed separately and in addition to the above daily rate:

* Cardiac catheterization;

* Angiography;

* Magnetic resonance imaging (MRI) and computerized axial tomography (CT) scans;

* Radiation therapy and chemotherapy;

* Emergency services, which are defined as an admission or services necessitated by a sudden onset of illness or injury which is manifested by acute symptoms of sufficient severity that the failure to provide services could reasonably result in:

- serious impairment of bodily function(s);

- serious or permanent dysfunction of any bodily organ or part or system;

- permanently placing the person's health in jeopardy; or

- other serious medical consequence.

* Outpatient services when provided in a hospital or other free standing outpatient facility separate from the skilled nursing facility;

* Customized prosthetic services;

* Ambulance transportation related to any of the above services; and

* Services provided independent of the facility by physicians, and other qualified health care professionals (e.g., NP, PA, CRNA, psychologist).

C.Exclusions As in other cases, the above provisions shall not apply to any mutual agreement or contract entered into by the payer and provider which sets forth the terms for the provision of skilled nursing facility services and reimbursement therefor.

20 Miss. Code. R. 2-V

Amended 6/14/2017

Amended 6/15/2019.