Rule 23-207-4.11 - Medical Treatment and Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) RequirementsA. The Division of Medicaid covers medically necessary Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services for EPSDT-eligible beneficiaries in accordance with Miss. Admin. Code Part 223, without regard to service limitations and with prior authorization.B. A psychiatric residential treatment facility (PRTF) must ensure that every individual receives medically necessary EPSDT services regardless of whether such services are identified in the individual's plan of care.C. Each PRTF must have written policies and procedures and a designated area for responding to an individual's physical and/or medical needs in the PRTF.D. EPSDT services in a PRTF must be provided by: 2. Under arrangement between the PRTF and a qualified Mississippi Medicaid enrolled non-facility provider, and/or3. By a qualified Mississippi Medicaid enrolled provider in the community not affiliated with or under arrangement with the PRTF.E. The Division of Medicaid reimburses for medically necessary EPSDT services: 1. On the PRTF's cost report if services are provided directly by the PRTF or under arrangement with the PRTF, or2. Directly to the provider directly if EPSDT services are provided by a qualified Mississippi Medicaid enrolled provider in the community not affiliated with or under arrangement with the PRTF.F. The Division of Medicaid does not reimburse a provider for any duplicative psychiatric service that the PRTF is responsible for providing.G. PRTF providers must document all EPSDT services provided in the medical record. 23 Miss. Code. R. 207-4.11
U.S.C. § 1396d; 42 C.F.R. §§ 431.107; 455.1; Miss. Code Ann. §§ 43-13-117, 43-13-121.