23 Miss. Code. R. 223-3.3

Current through December 10, 2024

Rule 23-223-3.3 - Covered Services

A. The Division of Medicaid covers up to twelve (12) hours per day of medically necessary prescribed pediatric extended care (PPEC) services for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) eligible beneficiaries when:

1. Ordered by the beneficiary's attending physician,

2. Provided by a Mississippi licensed and Medicaid enrolled PPEC center, and

3. Prior authorized by the Division of Medicaid or designee:

a) Prior authorizations must be submitted every six (6) months, and

b) The ordering physician must perform an in-person evaluation of the beneficiary a minimum of every six (6) months to review and update the plan of care (POC) as necessary.

B. PPEC services include, but are not limited to:

1. Nursing services,

2. Respiratory therapy,

3. Developmental services,

4. Nutrition services,

5. Social services,

6. Physical therapy, occupational therapy and/or speech-language pathology,

7. Durable medical equipment and medical supplies as required by the Mississippi Department of Health (MSDH), and

8. Transportation to and from the PPEC facility unless the beneficiary's parent and/or legal guardian chooses for the beneficiary to be transported by a family member or friend.

C. All PPEC services must meet the MSDH's minimum standards in order to be covered.

23 Miss. Code. R. 223-3.3

42 U.S.C § 1396 d; Miss. Code Ann. §§ 41-125-19, 43-13-117, 43-13-121.

Adopted 2/1/2020