23 Miss. Code. R. 208-3.5

Current through August 31, 2024

Rule 23-208-3.5 - Prior Approval/Physician Certification

A. Prior approval must be obtained from the Division of Medicaid before an individual can receive services through the Home and Community-Based Waiver Program.

B. Functional eligibility for waiver services is determined through a comprehensive PreAdmission Screening.

1. The physician must certify that the individual meets nursing home level of care.

2. Clinical eligibility must be determined annually using the pre-admission screening for continued AL Waiver services.

C. The Plan of Care must be developed that:

1. Is person-centered,

2. Involves collaboration between the case manager and the participant and/or their designated representative or responsible party,

3. Is all inclusive to meet the needs, desires and goals, including personal goals, for the participant, and

4. Is approved by the Division of Medicaid prior to enrollment into waiver services.

D. A waiver participant shall be locked into only one (1) waiver program at a time.

23 Miss. Code. R. 208-3.5

42 CFR §441.301(b)(1)(i); Miss. Code Ann. § 43-13-121.

Revised Miss. Admin. Code, Part 208, Rule 3.5.C. to correspond with changes in the AL Waiver renewal (eff. 10/01/2013) eff. 05/01/2014.