23 Miss. Code. R. 222-2.3

Current through December 10, 2024

Rule 23-222-2.3 - Documentation Requirements

A. To qualify for reimbursement, a case file with adequate documentation must be maintained for each participant receiving Targeted Case Management (TCM) through the Perinatal High-Risk Management/Infant Services System (PHRM/ISS) program. Each TCM case file must, at a minimum, contain:

1. The name of the individual, as well as other personal information including, but not limited to:

a) Date of birth and Medicaid ID number,

b) Expected date of delivery,

c) Date when prenatal care began,

d) Name of primary provider,

e) Delivery date,

f) Delivery method,

g) Birth control plan chosen by participant,

h) Date(s) of postpartum visit(s) with medical provider,

i) Date of postpartum home visit with Extended Service RN,

j) Birth weight, and

k) Dates of EPSDT well-child visits

l) Release of information consent;

2. The dates and other information regarding case management services including:

a) Medical risk screening form including, but not limited to:

1) Date screening was performed,

2) Name of person/provider completing medical risk screen, and

3) Specific risk factors identified

b) Referral date and referral source,

b) Enrollment date,

c) Assessment dates;

3. The name of the provider agency (if relevant) and the person providing the case management service.

a) Participant transfer to new TCM provider including, but not limited to:

1) Reason for transfer to new TCM provider,

2) Transfer consent form signed and dated by participant, and

3) Transfer notes;

4. The nature, content, units of the case management services received and whether goals specified in the care plan have been achieved.

a) Screening/assessment results,

b) Long and short-term goals with time frame for completion,

c) Planned interventions,

d) Outcome of interventions,

e) Dates and reasons for review and/or revision, and

f) Discharge plans and case closure documentation including, but not limited to:

(1) Reason for closure,

(2) Services provided and outcomes, including any unmet goals and/or ongoing needs,

(3) Referrals to providers and other resources to address unmet goals and ongoing needs, and

(4) Notification to participant and primary care provider(s) regarding case closure and any post case closure referrals that have been made;

5. Whether the individual has declined services in the care plan and the individual's signature declining the service.

6. The need for, and occurrences of, coordination with other case managers, including:

a) Documentation of referrals:

(1) Date of referral,

(2) Name of provider/entity to whom the referral was made,

(3) Reason for referral, and

(4) Outcome of referral(s);

b) Case Conference including, but not limited to:

(1) Date of case conference,

(2) Case conference attendees, and

(3) Case conference notes including interdisciplinary team recommendations/plans and any revisions to the POC;

7. A timeline for obtaining needed services.

8. A timeline for reevaluation of the plan.

23 Miss. Code. R. 222-2.3

Miss. Code Ann. §§ 43-13-121, 43-13-117, 43-13-118, 43-13-129; 42 CFR § 441.18.

Amended 7/1/2024