Update on Mississippi Can and CHIP Coverage

The Mississippi Can program was implemented January 1, 2011 as a coordinated care program for high cost patient populations.  The five populations are as follows:  SSI, Disabled Child Living at Home, Working Disabled, Department of Human Services Foster Care Children and Breast/Cervical Cancer Group.  The Mississippi Division of Medicaid contracted with two coordinated care organizations Coordinated Care Organizations (CCO), Magnolia Health Plan and United Healthcare.  According to the DOM website:

These CCOs are responsible for providing services to the Mississippi Medicaid Beneficiaries who choose to participate or “opt in”.  All Medicaid beneficiaries who are in the categories of eligibility listed above will receive an enrollment packet in the mail that will explain the program in more detail. At that time each beneficiary will have the choice to choose one of the CCOs or choose not to participate or “opt out”. Beneficiaries who choose to enroll will have an open enrollment period, 90 days after their initial enrollment, to either choose another plan or opt out. However, if they choose to stay in the plan they will be locked into the plan for a one year period.

Additional information will be made available to Mississippi Medicaid Providers prior to beneficiary enrollment. If you should have any questions, please call the Mississippi Division of Medicaid, Maternal and Child Health Bureau, toll-free at 1-800-421-2408 or 601-359-6150. http://www.medicaid.ms.gov/mscan/Welcome.aspx   

Comparison of the policies reveal that speech pathology benefits mirror what is stated in the current Medicaid benefit policy manual.  One major difference between the two plans is that United Healthcare requires preauthorization for speech therapy services exceeding 12 visits for services to children.  This is in line with the purpose of Mississippi Can to manage care for improved cost effectiveness. 

The Children’s Health Insurance Program (CHIP) is required to provide what the Mississippi State and School Employee Plan covers.  The Mississippi State and School Employee Plan benefit manual states the following:

Speech Therapy:

Speech therapy services are covered if needed as the result of an illness or injury,if there is a reasonable expectation that the therapy will achieve measurable improvement within a reasonable and predictable period, and services are prescribed by a physician and provided by a licensed speech therapist.

Speech therapy is not covered for maintenance speech, delayed language development, articulation disorders, learning disabilities, attention disorders, psychosocial speech delay, behavioral problems, conceptual handicap, mental retardation, stammering, or stuttering.

Therefore, habilitative coverage for children is excluded in the benefit policy manual for children with CHIP. 

MSHA VP: Healthcare received feedback from providers that they are receiving approvals for services with the Mississippi Can program from both Magnolia and United Healthcare.  Children with CHIP are being denied.  These reports coincide with what is defined in current Mississippi Can and CHIP benefit policy manuals. 

 - Christine Gibson, M.S., CCC-SLP, MSHA Vice-President: Healthcare

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