23 Miss. Code. R. 208-1.3

Current through August 31, 2024

Rule 23-208-1.3 - Provider Enrollment

A. Providers of Elderly and Disabled (E&D) Waiver services must satisfy all requirements set forth in Title 23 Miss. Admin. Code Part 200, Rule 4.8 in addition to the listed provider-type specific requirements and provide to the Division of Medicaid:

1. A National Provider Identifier (NPI), verification from National Plan and Provider Enumeration System (NPPES),

2. A copy of the provider's current license or permit, if applicable,

3. Verification of a social security number using a social security card, driver's license with a social security number, military ID or a notarized statement signed by the provider noting the social security number. The name noted on verification document must match the name noted on the W-9, and

4. Written confirmation from the Internal Revenue Service (IRS) confirming the provider's tax identification number and legal business name.

B. To participate as a Home and Community-Based Services (HCBS) Elderly & Disabled (E&D) Waiver provider, the provider must:

1. Be approved by Division of Medicaid after attending mandatory orientation and submitting a completed proposal package to the Office of Long-Term Care.

2. Enter into a provider agreement with the Division of Medicaid within six (6) months of receiving an approved proposal package from the Office of Long-Term Care.

3. Have a duly constituted authority and a governing structure which assures responsibility and requires accountability for performance.

4. Maintain responsible fiscal management and an established business line of credit for business operation from a reputable financial institution. The approval amount for the business line of credit must be enough to cover operational costs/expenditures for at least three (3) months at all branch locations.

5. Establish an office in the state of Mississippi with a physical address prior to enrollment and maintain the office's physical address until the provider agreement is terminated.

6. Successfully pass a facility inspection by the Division of Medicaid depending on the provider type.

7. Conduct a national criminal background check with fingerprints on all employees and volunteers prior to employment and every two (2) years thereafter, and maintain the record in the employee's personnel file.

8. Conduct registry checks, prior to employment and monthly thereafter, to ensure employees or volunteers are not listed on the Mississippi Nurse Aide Abuse Registry or listed on the Office of Inspector General's Exclusion Database and maintain the record in the employee's personnel file.

9. Not have been, or employ individuals or volunteers who have been, convicted of or pleaded guilty or nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offense listed in Miss. Code Ann. § 45-33-23(f), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or that any such conviction or plea was reversed on appeal or a pardon was granted for the conviction or plea.

10. Not apply for a Division of Medicaid provider number for the purpose of providing care to friends/family members.

11. Have written criteria for service provision, including procedures for dealing with emergency service requests.

12. Have responsible personnel management including:

a) An appropriate process used in the recruitment, selection, retention, and termination of employees;

b) Written personnel policies and job descriptions, and;

c) Maintenance of a current training plan as a component of the policies/procedures documenting the method for the completion of required training. The training plan must require all employees to meet training requirements as designated by the Division of Medicaid upon hire, and annually thereafter.

d) Maintenance of a personnel file on every employee and volunteer with the following required information including, but not limited to, credentialing documentation, training records, and performance reviews which must be made available to the Division of Medicaid upon request.

13. Maintain a roster of qualified personnel necessary to provide authorized services.

14. Be compliant with all federal and state regulations.

C. E&D providers must ensure all employees and volunteers:

1. Who have direct person contact receive an annual physical examination and have a negative Mantoux tuberculin skin test (TST) and

2. Are trained upon hire, and annually thereafter, as designated by the Division of Medicaid.

D. E&D providers must satisfy the following qualifications, as applicable, to render services.

1. Case Management providers must meet the following requirements:

a) Operate as a statewide network.

b) Be established as an agency and in business providing case management services for a minimum of one (1) year.

c) Provide written documentation to the Division of Medicaid stating how the required standards are to be met.

d) Have a two (2) person case management team which consists of and meets the following:

1) A Registered Nurse (RN) who must:

(a) Maintain an active and current unencumbered license to practice in the state of Mississippi or a privilege to practice in Mississippi with a compact license, and

(b) Have a minimum of:

(1) Two (2) years of nursing experience with aged and/or disabled persons, or

(2) At least ninety (90) days of orientation regarding direction of E&D Waiver services under the supervision of an established E&D Waiver case manager who has two (2) years of E&D Waiver experience.

(c) Be certified to complete the comprehensive long-term services & supports (LTSS) assessment.

2) A Licensed Social Worker (LSW) who must:

(a) Have a current and active social work license.

(b) Have a bachelor's degree in social work or other health related field.

(c) Have a minimum of:

(1) Two (2) years of experience in direct care services for the aged and/or disabled clients, or

(2) At least ninety (90) days of orientation regarding direction of waiver services under the supervision of an established waiver case manager that has two (2) years of waiver experience.

(3) Must be certified to complete the comprehensive long term services & supports (LTSS) assessment.

3) Each team must have an assigned case management supervisor. The case management supervisor cannot carry an active caseload of persons.

2. Adult day care providers must meet the Quality Assurance Standards, as defined by the Division of Medicaid including, but not limited to, the following requirements:

a) Be established and in business as a provider of adult day care services for a minimum of one (1) year.

b) Provide written documentation to the Division of Medicaid stating how the required Quality Assurance Standards are to be met.

c) Serve counties no more than sixty (60) minutes from the facility.

d) Receive approval by the Division of Medicaid of the proposal packet and then meet the requirements of provider enrollment and receipt of a Mississippi Medicaid provider number. Once a provider number is issued any changes to the programming area/facility must be approved by the Division of Medicaid.

e) Be compliant with applicable state and local building restrictions as well as all zoning, fire, health codes and ordinances and meet the requirements of the Americans with Disabilities Act (ADA).

f) Have a sufficient number of employees, who must maintain current and active first aid and cardio pulmonary resuscitation (CPR) certification, with the necessary skills to provide essential administrative and direct care functions to meet the needs of the waiver persons as follows:

1) There must be at least two (2) persons, with one (1) being a paid employee, at the adult day care center at all times when there are persons in attendance, and

2) The employee-to-persons ratio must be a minimum of one to six (1:6) in all programs except in programs serving a high percentage of persons who are severely impaired which must maintain an employee ratio of one to four (1:4).

g) Meet the physical and social needs of each waiver person and maintain compliance with state and federal guidelines regarding services provided

h) Have a facility which must have:

1) At least sixty (60) square feet of program space for multi-purpose use for each day service person,

2) At least one toilet for every ten (10) persons attending the ADC,

3) Sufficient, lighted parking available to accommodate family members, caregivers, visitors, employees and volunteers. A minimum of two (2) parking spaces must be identified as parking for those with a disability being at least thirteen (13) feet wide and located near the entrance door,

4) A rest area for persons,

5) Appropriate signage,

6) A locked, storage area for all toxic substances,

7) At least two (2) well-identified exits with doors opening to the outside (swings outward) or no more than ten (10) feet from an outside exit, and

8) A safe environment free from hazards including, but not limited to, weapons, high steps, steep grades, and exposed electrical cords.

9) Sufficient, safe seating available for all persons.

i) Have a governing body with full legal authority and judiciary responsibility for the overall operation of the program in accordance with applicable state and federal requirements.

j) Have an advisory committee representative of the community and person population.

k) Have a written plan of operation that is reviewed, approved, and revised as needed by the governing board.

l) Have the following employees who must maintain current and active first aid and cardio pulmonary resuscitation (CPR) certification:

1) A qualified administrator, either a chief executive officer or president, responsible for the development, coordination, supervision, fiscal management, and evaluation of services provided through the adult day care services program who must have:

(a) A master's degree and one (1) year supervisory experience, either full-time or an equivalent, in a social or health service setting, or

(b) A bachelor's degree and three (3) years supervisory experience, either full-time or an equivalent, in a social or health service setting; or comparable technical and human service training with demonstrated competence and experience as a manager in a health or human service setting.

2) A program director, either center manager, site manager, or center coordinator, responsible for the organization, implementation, and coordination of the daily operation of the adult day care services program in accordance with the person's needs and any mandatory requirements.

(a) The program director must have:

(1) A bachelor's degree in health, social services, or a related field and one (1) year supervisory experience, either full-time or an equivalent, or

(2) Comparable technical and human services training with demonstrated competence and experience as a manager in a health or human services setting.

(b) The program director must be under the direction of the administrator.

3) A qualified social service employee on staff.

(a) The employee must be:

(1) A licensed social worker (LSW) with a master's degree in social work and at least one (1) year of professional work experience, either full-time or an equivalent, in a human services setting, or

(2) A bachelor's degree in social work and two (2) years of professional work experience, either full-time or an equivalent in a human services setting, or

(3) A bachelor's degree in a health or social services related field and two (2) years' experience, either full-time or an equivalent, in a human services field.

(b) Social workers must comply with all licensure requirements set by the Mississippi State Board of Examiners for Social Workers and Marriage & Family Therapists. In lieu of a licensed social worker, the functions must be carried out by other health service professionals such as certified rehabilitation counselors, licensed gerontologists, licensed professional counselors, or licensed/certified mental health workers.

4) A registered nurse (RN) on staff if the facility provides nursing services. The RN must have a valid state license and a minimum of one (1) year applicable experience, either full-time or the equivalent. The RN must adhere to the scope of practice pursuant to the Nursing Practice Law and the rules and regulations of the Mississippi Board of Nursing.

5) An activities coordinator with a bachelor's degree and at least one (1) year of experience, either full-time or an equivalent, in developing and conducting activities for the type population to be served or an associate's degree in a related field and at least two (2) years of appropriate experience, either full-time or equivalent.

6) A program assistant with a high school diploma or the equivalent and at least one (1) year experience, either full-time or an equivalent, in working with adults in a health care or social service setting. The program assistant must receive training in working with older adults and conducting activities for the population served.

7) A food service director if the facility prepares food on site.

(a) The food service director must be a registered dietician (RD), dietetic technician registered (DTR), RD eligible, DTR eligible, or a four (4) year graduate of a baccalaureate program in nutrition/dietetics/food service. In addition, the food service director must have a minimum of one (1) year experience, either full-time or an equivalent, in working with adults in a health care or social service setting.

(b) If the food is not prepared on site, the facility must contract with a reputable food service provider/caterer.

8) A secretary/bookkeeper who has, at a minimum, a high school diploma or equivalent and the skills and training to carry out the responsibilities of the position.

9) A driver who:

(a) Maintains a valid state driver's license, a safe driving record, and training in first aid and cardiopulmonary resuscitation (CPR),

(b) Maintains compliance with all state requirements for licensure/certification, and

(c) Must be trained in basic transfer techniques and safe ambulation.

m) Must record volunteer hours and activities, if the facility utilizes_volunteers, who:

1) Must be individuals or groups who desire to work with adult day service persons.

2) Must successfully complete an orientation/training program.

3) Have responsibilities that are mutually determined by the volunteers and employees and performed under the supervision of facility staff members.

4) Have duties that either supplement required employees in established activities or provide additional services for which the volunteer has special talent/training.

5) Cannot provide services in place of required employees and only be allowed on a periodic/temporary basis.

3. Personal care service providers must meet the Quality Assurance Standards, as defined by the Division of Medicaid including, but not limited to, the following requirements:

a) Be established and in business providing personal care services for a minimum of one (1) year.

b) Provide written documentation to the Division of Medicaid stating how the required standards are to be met.

c) Serve counties no more than sixty (60) minutes from the physical office or if greater than sixty (60) minutes the provider must maintain a satellite office.

d) Employee qualified personal care attendants and qualified personal care service supervisors.

1) The personal care attendant must meet the following requirements:

(a) Be a high school graduate, have a GED or must demonstrate the ability to read the written personal care services assignment and write adequately to complete required forms and reports of visits,

(b) Successfully complete a curriculum training course covering topics as defined by the Division of Medicaid and pass a scored examination upon hire prior to rendering services, and annually thereafter. All new hire training must include a hands-on skills assessment to ensure the trainee's ability to provide the necessary care safely and appropriately,

(c) Demonstrate the ability to work well with aged and disabled individuals who have limited functioning capacity and exhibit basic qualities of compassion and maturity and be able to respond to waiver persons and situations in a responsible manner,

(d) Be at least eighteen (18) years of age.

(e) Possess a valid state issued identification, and have access to reliable transportation,

(f) Be able to function independently without constant observation and supervision,

(g) Be physically and mentally able to perform the job tasks required including lifting and transferring and provide assurance that communicable diseases of major public health concern are not present, as verified by a physician,

(h) Have interest in, and empathy for, persons who are ill, elderly, or disabled,

(i) Have communication and interpersonal skills with the ability to deal effectively, assertively, and cooperatively with a variety of people,

(j) Maintain current and active first aid and CPR certification,

(k) Be able to carry out and follow verbal and written instructions,

2) The personal care service supervisor must meet the following requirements:

(a) Have at least two (2) years of supervisory experience in programs dealing with elderly and disabled individuals and meet one (1) of the following requirements:

(1) A bachelor's degree in social work, home economics, or a related profession with one (1) year of direct experience working with aged and disabled persons,

(2) A licensed RN or Licensed Practical Nurse (LPN) with one (1) year of direct experience working with aged and disabled persons, or

(3) A high school diploma and four (4) years of direct experience working with aged and disabled persons.

3) Personal Care Service may be furnished by family members if they are not legally responsible for the person and they do not live with the person. Family members must be employed by a Medicaid approved agency that provides Personal Care Services, must meet provider standards, and must be deemed competent to perform the required tasks.

4. In-Home Respite providers must meet the Quality Assurance Standards, as defined by the Division of Medicaid including, but not limited to, the following requirements:

a) Be established and in business providing in-home respite services for a minimum of one (1) year.

b) Provide written documentation to the Division of Medicaid stating how the required standards are to be met.

c) Serve counties no more than sixty (60) minutes from the physical office or if greater than sixty (60) minutes the provider must maintain a satellite office.

d) Employee qualified in-home respite employees and supervisors.

1) In-home respite employees must meet the following requirements:

(a) Be eighteen (18) years of age or older.

(b) Have a High school diploma or GED, and at least for (4) years, either full-time or an equivalent, experience as a direct care provider to the aged or disabled.

(c) Successfully complete a curriculum training course covering topics as defined by the Division of Medicaid and pass a scored examination upon hire prior to rendering services, and annually thereafter. All new hire training must include a hands-on skills assessment to ensure the trainees ability to provide the necessary care safely and appropriately.

(d) Maintain current and active first aid and CPR certification;

(e) Possess a valid state issued identification and have access to reliable transportation;

(f) Have the ability to function independently without constant supervision/observation.

(g) Must be physically and mentally able to perform the job tasks required including lifting and transferring and provide assurance that communicable diseases of major public health concern are not present, as verified by a physician

(h) Have interest in, and empathy for, individuals who are ill, elderly, and/or disabled.

(i) Have emotional maturity and ability to respond to individuals and situations in a responsible manner.

(j) Have effective communication and interpersonal skills with the ability to deal effectively, assertively and cooperatively with a variety of people.

2) In-home respite supervisors must meet the following requirements:

(a) Have a bachelor's degree in social work or a related profession, and

(1) At least one (1) year experience, either full-time or an equivalent, working with aged and disabled persons, and

(2) Two (2) years supervisory experience, either full-time or an equivalent, or

(b) Be a licensed RN or LPN, and have

(1) One (1) year experience, either full-time or an equivalent, working directly with aged and disabled individuals, and

(2) Two (2) years supervisory experience, either full-time or an equivalent, or

(c) Have a high school diploma, and

(1) Four (4) years of experience, either full-time or an equivalent, working directly with aged and disabled individuals, and

(2) Two (2) years supervisory experience, either full-time or an equivalent.

5. Institutional Respite providers must be a Medicaid certified hospital, nursing facility or licensed swing bed facility.

6. Home Delivered Meal providers must meet the following requirements:

a) Be certified through the Mississippi State Department of Health (MSDH).

b) Have a person responsible for the day-to-day operation of the service.

c) Have an adequate number of employees to meet the purpose of the program.

d) Train all employees in the proper technique of preparing for and/or serving meals to aged and disabled persons including, but not limited to, sanitation procedures, proper cleaning of equipment and utensils, first aid and emergency procedures.

e) Provide in-service training for all employees.

f) Be established and in business for a minimum of one (1) year.

g) Submit written policies and procedures, hiring practices, and general business plan detailing the delivery of services prior to entering into Mississippi provider agreement.

h) Provide written documentation to the Division of Medicaid stating how the required standards are to be met.

i) Provide delivery of meals at times coordinated with the person or their designated representative.

7. Extended Home Health providers must meet the following qualifications:

a) Be certified to participate as a home health agency under Title XVIII (Medicare) of the Social Security Act. The Agency must furnish the Division of Medicaid (DOM) with a copy of its current State license certification and/or recertification,

b) Meet all applicable state and federal laws and regulations,

c) Provide the Division of Medicaid with a copy of its approved certificate of need (CON), if applicable, and

d) Execute a provider agreement with the Division of Medicaid, and

e) Ensure direct care providers have a current and active license and/or certification.

8. Physical therapy service providers must meet the following qualifications:

a) Be certified to participate as a Mississippi Medicaid enrolled home health agency under Title XVIII (Medicare) of the Social Security Act. The Agency must furnish the Division of Medicaid with a copy of its current State license certification and/or recertification,

b) Meet all applicable state and federal laws and regulations,

c) Provide the Division of Medicaid with a copy of its certificate of need (CON) approval when applicable,

d) Execute a provider agreement with the Division of Medicaid, and

e) Employ qualified physical therapists who have a non-restrictive current Mississippi license issued by the appropriate licensing agency to practice in the State of Mississippi and Meet the state and federal licensing and/or certification requirements to perform physical therapy services in the State of Mississippi:

9. Speech-Language Pathology providers must meet the following qualifications:

a) Be certified to participate as a Mississippi Medicaid home health agency under Title XVIII (Medicare) of the Social Security Act. The Agency must furnish the Division of Medicaid (DOM) with a copy of its current State license certification and/or recertification,

b) Meet all applicable state and federal laws and regulations,

c) Provide the Division of Medicaid with a copy of its certificate of need (CON) approval when applicable,

d) Execute a participation agreement with the Division of Medicaid, and

e) Employ qualified speech therapists who have a non-restrictive current Mississippi license issued by the appropriate licensing agency to practice in the State of Mississippi and Meet the state and federal licensing and/or certification requirements to perform speech-language therapy services in the State of Mississippi:.

10. Community Transition Service (CTS) providers must meet the following requirements:

a) Be established and in business for a minimum of one (1) year.

b) Provide documentation to the Division of Medicaid of successfully transitioning individuals into the community for a minimum of two (2) years, and/or working with individuals in the community for a minimum of eight (8) years. For those without two (2) years of successfully transitioning individuals into the community, experience will be considered on an individual basis.

c) Have documentation of attending the Division of Medicaid's approved person-centered training or another Division of Medicaid approved training relating to person-centered planning.

d) Attend all quarterly and annual trainings administered by the Division of Medicaid with a minimum of one (1) attendee from the provider.

e) Have written procedures for dealing with an after-hour crisis.

f) Each Community Transition Service provider must have qualified community navigators and qualified supervisors.

1) The community navigator must meet the following requirements:

(a) Be a(n):

(1) Licensed Social Worker (LSW) with valid Mississippi license and a minimum of one (1) year of relevant work experience,

(2) Case manager with at least one (1) year of relevant work experience and certified by the Department of Mental Health (DMH),

(3) RN with a valid Mississippi license and a minimum of one (1) year of relevant work experience,

(4) Individual with relevant experience and training with a minimum of a bachelor's degree and (1) year of work experience in a social or health services setting, or

(5) Individual with comparable technical and human service training and five (5) years' experience will be considered and approved by the Division of Medicaid.

(b) Have documented experience and training in person-centered planning and a minimum of forty (40) hours of training which includes Profile Development training.

(c) Attend an eight (8) hour introductory course to CTS regardless of experience prior to beginning work that is administered by the Division of Medicaid, Office of Community Based Services.

(d) Complete a Person Centered Plan training course designated by the Division of Medicaid within the one (1) year prior to rendering services, unless otherwise excluded.

(e) Demonstrate the ability to work well with aged and disabled individuals who have limited functioning capacity.

(f) Exhibit basic qualities of compassion/maturity and be able to respond to persons and situations in a responsible manner.

(g) Attend all quarterly and annual trainings administered by the Division of Medicaid, unless written exclusion to quarterly or annual training is provided by the Division of Medicaid.

(h) Possess a valid Mississippi driver's license.

(i) Be able to function independently without constant observation and supervision.

(j) Have interest in, and empathy for, people who are ill, elderly, and/or disabled.

(k) Have communication and interpersonal skills with the ability to deal effectively, assertively and cooperatively with a variety of people.

(l) Be able to carry out and follow verbal and written instructions.

(m)Have training in current systems used by the Division of Medicaid including Long-Term Services and Supports (LTSS) and any other systems utilized for documentation purposes.

2) The community navigator supervisor must have a minimum of two (2) years of supervisory experience in programs dealing with elderly and disabled persons and meet one (1) of the following requirements:

(a) Have a bachelor's degree in Social Work, Psychology, or related profession with one (1) year of direct experience working with aged and disabled persons transitioning into the community,

(b) Be an RN with a current Mississippi license and two (2) years of direct experience working with aged and disabled persons transitioning into the community, or

(c) Have a high school diploma or GED with seven (7) years of direct experience working with aged and disabled persons with two (2) of the seven (7) years working directly with persons transitioning into the community.

E. The Division of Medicaid will suspend provider numbers for providers who have been inactive for a period exceeding one (1) year pending a review of provider qualifications.

1. If a provider's Medicaid provider number has been suspended for less than one (1) year, the provider must contact the Office of Long-Term Care and update any information that may have changed in order for their Medicaid provider number to be reinstated.

2. If the provider's Medicaid provider number has been suspended for more than one (1) year, their provider number will be terminated and the provider must re-enroll as a Medicaid provider.

F. The Division of Medicaid may suspend a provider immediately from providing E&D Waiver services if the provider is deemed to no longer meet, or be in violation of, the defined requirements for waiver providers. Providers may be terminated from participation for failure to submit and implement a corrective action plan timely.

23 Miss. Code. R. 208-1.3

28 C.F.R. Part 36; 42 C.F.R. 455, Subpart E; 42 C.F.R. §§ 440.180, 441.301; Miss. Code Ann. §§ 43-13-117, 43-13-121.

Revised - 06/01/2013

Amended 12/1/2018