23 Miss. Code. R. 215-1.9

Current through October 10, 2024

Rule 23-215-1.9 - Reimbursement

A. The Division of Medicaid covers home health agency reimbursement for covered services based on reasonable cost which is determined in accordance with the Mississippi Medicaid Home Health Reimbursement Plan and Title XVIII (Medicare) principles of reimbursement, except when Medicare guidelines are contradictive to directives of the State Plan or Division of Medicaid. In such a situation, the State Plan or Division of Medicaid will prevail.

1. Medicaid cost reporting schedules must be included with the Medicare cost report to compute Medicaid reimbursement.

2. A schedule must be completed to reflect the lower of reasonable costs or customary charge provisions as they apply to Medicaid.

3. In addition to the lower of costs or charge limitations, reimbursement for home health services is limited to and cannot exceed the prevailing costs of providing nursing facility services in the Mississippi Medical Assistance (Medicaid) Program.

B. The Division of Medicaid will reimburse for the initial assessment visit for skilled services, either Home Health Skilled (HHSK), Home Health Physical Therapy (HHPT), and/or Home Health Speech Therapy (HHST), and aide services as listed below:

1. If a beneficiary is assessed for skilled services, without a skilled service performed during the initial assessment visit and is not admitted to the home health program, the initial assessment visit is not approved and must be claimed as an administrative cost.

2. If a beneficiary is assessed for skilled services, with a skilled service performed during the initial assessment visit and is admitted to the home health program for continuation of skilled visits, the initial assessment visit is not an administrative cost and can be billed.

3. If a beneficiary is assessed for skilled services with a skilled service performed during the initial assessment visit only, the home health agency must elect either to:

a) Claim this as an administrative cost, or

b) Admit to and discharge the beneficiary from the home health program for this one (1) visit. This is not an administrative cost and can be billed.

4. If a beneficiary is assessed for home health aide services only, without a skilled service performed during the initial assessment visit and is not admitted to the home health program, the initial assessment visit is not approved and must be claimed as an administrative cost.

5. If the beneficiary is assessed for home health aide services only and is admitted to the home health program and a skilled service is performed during the initial assessment visit, the home health agency must elect either to:

a) Claim the assessment as an administrative cost, or

b) Bill the initial assessment visit as a skilled service.

C. Initial assessment visits must be performed by a registered nurse.

D. If the beneficiary is receiving home health aide services only, a supervisory visit must be made every sixty (60) days by a registered nurse while the home health aide is providing patient care. Supervisory visits are administrative costs and are not directly reimbursable.

23 Miss. Code. R. 215-1.9

Miss. Code Ann. § 43-13-121; 42 CFR 484, Subpart E