23 Miss. Code. R. 223-3.5

Current through December 10, 2024

Rule 23-223-3.5 - Reimbursement

A. The Division of Medicaid reimburses 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 every six (6) months.

B. The Division of Medicaid reimburses the lesser of the provider's usual and customary charge or:

1. An hourly rate for each complete hour of PPEC services for the first six (6) complete hours of PPEC services,

2. A daily rate for over six (6) hours of PPEC services, and

3. A daily rate for transportation to and from the PPEC center when provided by the PPEC.

C. The following items and services are not included in the hourly or daily rates for PPEC services and must be billed separately by the rendering provider:

1. Occupational therapy,

2. Physical therapy, and

3. Speech-language pathology.

4. Baby food or formula,

5. Total parenteral and enteral nutrition,

6. Mental health and/or psychiatric services, and

7. Durable medical equipment (DME) and medical supplies.

23 Miss. Code. R. 223-3.5

42 C.F.R Part 441, Subpart B; Miss. Code Ann. §§ 41-125-19, 43-13-117, 43-13-121.

Adopted 2/1/2020