Rule 23-223-5.4 - Prior Authorization and Concurrent ReviewsA. Private duty nursing (PDN) providers employing Certified Nursing Assistants (CNAs) must submit a prior authorization request to the Division of Medicaid or designee at least two (2) weeks prior to the initiation of personal care services (PCS) that must include, at a minimum, the following: 1. A signed physician or specialist's order for PCS and a signed initial Plan of Care (POC),2. Beneficiary diagnosis(es),3. Skilled teaching/instructions to be provided to a family member or caregiver(s),4. Treatment plan/physician orders specifying each skill to be performed,5. Expected duration of service,6. Identification of any other home care services, including the hours, days, and times of these services being provided, including, but limited to: 7. When PCS medical necessity criteria are no longer met, a plan:a) For reducing and discontinuing PCS hours, andb) To transition the beneficiary to the most appropriate setting.B. A PDN provider employing a CNA must submit a recertification to the Division of Medicaid or designee stating the necessity of PCS for each subject beneficiary every six (6) months indicating the number of hours per day or week and the duration of the request and include the following:3. Monthly summaries, and4. Supervisory nursing visit notes.C. If the required recertification information is not received before the last certified date, the hours from the last certification period up until the date of receipt of the required documentation are subject to denial.D. A PDN provider employing CNAs cannot bill the beneficiary for hours when the provider failed to seek certification/recertification in a timely manner.23 Miss. Code. R. 223-5.4
42 C.F.R. § 440.167; Miss. Code Ann. §§ 43-13-117, 43-13-121.