23 Miss. Code. R. 223-4.2

Current through December 10, 2024

Rule 23-223-4.2 - Provider Requirements

A. Private duty nursing (PDN) providers must:

1. Have a Division of Medicaid approved PDN proposal package.

1. Establish a provider agreement with the Mississippi Division of Medicaid.

2. Satisfy all requirements in accordance with Part 200, Rule 4.8 and must provide to the Division of Medicaid:

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

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

3. Demonstrate prior successful health care delivery for at least one (1) year,

4. Operate from a business office that is a dedicated professional location and not part of a residence,

5. Disclose ownership information,

6. Maintain auditable medical records on each beneficiary in the provider's business location, and

7. Maintain the highest level of ethical standard in its business practices and adopt written standard of ethical practice, which must include:

a) Neither the owner nor any PDN provider employee shall knowingly mislead a patient, family member or caretaker concerning services, charges, or use of equipment.

b) Neither the owner nor any PDN provider employee shall misuse or misappropriate any property-real or personal-belonging to any patient, family member or caretaker.

c) Neither the owner nor any PDN provider employee shall knowingly and actively recruit a patient under the care of another PDN provider.

d) No employee or patient of a PDN provider shall be coerced into participating in provider fund raising activities.

e) The PDN provider shall accept patient referrals in a professional manner with no remuneration provided to the referring party.

f) Patient clinical records, administrative records, and financial records shall not be falsified by any individual for any reason.

B. PDN providers must, at a minimum:

1. Conduct licensure checks with the Mississippi Board of Nursing, prior to employment and yearly thereafter.

2. Conduct background and abuse registry checks including,

a) National criminal background check with fingerprints, including review of both state and federal databases, on all employees or volunteers prior to employment and every two (2) years thereafter, and maintain the record of the checks in the employee's personnel file.

b) Conduct registry checks, prior to employment and monthly thereafter, to ensure employees 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 of the checks in the employee's personnel file.

3. Not 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.

4. Not 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.

5. Provide each employee a thorough orientation to their position, the provider, policies and objectives, the functions of other personnel and how they relate to each other in caring for the beneficiary, standards of ethical practice, confidentiality and patient's rights. All PDN providers must comply with the Centers for Disease Control and/or the Mississippi Department of Health regarding baseline and routine employee TB testing and education.

6. Provide mandatory annual in-service to RNs and LPNs including, but not limited to:

a) Beneficiary's rights,

b) Requirements to report suspected abuse, neglect, or exploitation immediately and how to report to the appropriate authority,

c) Requirements under Health Insurance Portability and Accountability Act (HIPAA) of 1996 and other relevant laws affecting privacy,

d) Infection control, and

e) Emergency procedures.

7. Ensure Full-time and part-time nurses employed by the PDN provider complete a minimum of twelve (12) hours of pertinent continuing education programs per year.

8. Employ a supervising RN who does not provide direct patient care and must:

a) Conduct a home evaluation visit prior to the initiation of services in the primary residence,

b) Complete the plan of care (POC) and revise as needed,

c) Initiate appropriate preventive and rehabilitative nursing procedures,

d) Inform the primary care physician of any changes in the beneficiary's condition and needs when appropriate,

e) Assign nurses to provide PDN services according to their licensure training, and level of experience,

f) Make a supervisory home visit at least:

(1) Monthly with the servicing LPN present, and

(2) Every other week with the servicing CNA alternately present and absent.

g) Document the following during the supervisory visit:

1) PDN services are provided according to the plan of care,

2) The beneficiary's and/or beneficiary representative's satisfaction level with the PDN services, and

3) That the plan of care has been reviewed and updated with the most current physician's orders.

h) Make a home visit in addition to the monthly visit when:

1) The beneficiary's condition has changed,

2) The beneficiary's health, safety, or welfare is potentially at risk, and

3) Requested by the Division of Medicaid or designee.

i) Make a monthly telephone contact with the beneficiary's guardian or legal representative to ensure satisfaction with services provided.

h) Use a person-centered approach to PDN services and ensure personal goals of the beneficiary are respected,

i) Ensure freedom of choice of providers and/or services is given to the beneficiary, the beneficiary's guardian or legal representative as long as the provider is not an immediate family member or a resident of the beneficiary's home,

j) Educate the beneficiary and family/caregiver(s) in meeting nursing and related goals,

k) Ensure services are provided in a manner that is in the best interest of the beneficiary and does not endanger the beneficiary's health, safety, or welfare;

l) Recommend staff changes when needed,

m) Report to the Division of Medicaid any unethical or incompetent practices that jeopardize public safety or cause a risk of harm to beneficiaries, including household issues that may jeopardize the safety of the PDN, and

n) Ensure that all nurses and caregivers are aware that timesheets must be accurate with arrival and departure time of the nurse.

9. Ensure that an emergency preparedness plan is in place for each beneficiary receiving services,

10. Ensure that no immediate family member or person residing in the home with the beneficiary is providing PDN services submitted for Medicaid reimbursement,

C. An RN or LPN providing PDN services must:

1. Be employed by a Mississippi Medicaid enrolled PDN provider,

2. Maintain a current Mississippi nursing license, and

3. Practice within the scope of their license, and

4. Have at least one (1) year of experience providing the type of care required by the beneficiary's medical needs.

D. PDN providers must provide beneficiaries a written notice at least thirty (30) days prior to the discontinuation of services or closure of the PDN provider except when the requirements of Miss. Admin. Code Title 23, Part 223, Rule 3.5.C. are met.

1. PDN providers must assist with the beneficiary's transition to another provider.

2. PDN providers who fail to provide proper written notice will not be reimbursed for services provided during the thirty (30) day period the beneficiary should have been notified.

E. PDN providers must require all employees to report incidents and/or accidents that result or could have resulted in harm to the beneficiary and/or employee to the direct supervisor immediately and to the Division of Medicaid within twenty-four (24) hours.

F. All PDN providers and their employees must immediately report in writing to the Division of Medicaid Office of Medical Services, the Mississippi Department of Human Services (MDHS), and any other entity required by federal or state law, all alleged or reported instances the following:

1. Abuse,

2. Neglect,

3. Exploitation,

4. Suspicious death, or

5. Unauthorized use of restraints, seclusion or restrictive interventions.

23 Miss. Code. R. 223-4.2

Miss. Code Ann. §§ 43-13-117, 43-13-121.

Adopted 4/1/2020

Amended 6/1/2020

Amended 7/1/2020