Medicaid Amendments Summary

AP2010-30 is related to Speech Therapy

This amendment provides the reason why Division of Medicaid Providers must prior authorize/pre-certify the therapy services through the Utilization Management and Quality Improvement Organization (UM/QIO). It also explains how the UM/QIO works along when it is required. Federal regulations permit DOM to require authorization for any service where it is anticipated or known that the services could either be abused by providers or beneficiaries or could easily result in excessive, uncontrollable Medicaid costs. Certification as referred to in this policy is synonymous with prior authorization. It also reviews the process by providing information on the following areas: 1. Exclusions to Prior Authorization/Pre-certification, 2. Prior Authorization Request 3. Review Outcomes, 4. Urgent Services, 5. Same Day/Non-Urgent Services, 6. Reconsideration Process

There does not appear to be any changes in this amendment that would negatively affect providers in our state.

 

AP2010-29 same as above but for Occupational Therapy

AP2010-31 same as above but for Physical Therapy 

SAP2010-32 is related to therapy services for adults with Mississippi Medicaid.

This amendment gives a description of limitations as to amount, duration, and scope of medical care and services provided for beneficiaries age 21 and over. 

The codes that Speech Language Pathologists use and bill will now be covered by DOM for beneficiaries age 21 and over in all settings we provide services.

SPA2010-031

This amendment reviews Hospice benefits for beneficiaries. Election of the hospice option causes the beneficiary to forfeit all other Medicaid program benefits provided for in the State Plan that may also be available under the hospice benefit related to the treatment of the individual’s terminal illness, except for children under the age of 21.

AP2011-01

The reason for the release of this policy is division of Medicaid’s effort to combine the families and children policy manual and the aged, blind and disabled policy manual into one published manual.  There are no policy changes to address with this amendment.

AP2011-02  Benefits/Exclusions

Reviews what type of services will be denied or excluded.  The only one that relates to speech for children are Services denied by the UM/QIO.  For Adults home health services are not covered if the beneficiaries are in a nursing home.

AP2011-03 Provider policy manual/provider manual/provider enrollment/speech therapist/definitions.  Below is the addendum:

 Additional Provider Type Specific Requirements

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

• Copy of current licensure card or permit

• Copy of current certificate of clinical competence from the American Speech and Hearing Association (ASHA); or

• Documentation from the State Department of Health verifying that they have completed one of the following requirements per CFR 440.110:

                        Has completed the equivalent educational requirements and work experience necessary for the certificate; or

Has completed the academic program and is acquiring supervised work experience to qualify for the certificate.

                        • Verification of social security number using a social security card, driver’s license if it notes the social security number, military ID or a notarized statement signed by the provider noting the social security number

                        Name noted on verification must match the name noted on the W-9

NOTE: Refer to Provider Policy Manual Section 4.01, Definitions, for provider definitions

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