Medicaid Policy Updates

Periodically Mississippi Division of Medicaid submits to CMS State Plan Amendments (SPA) and updates. You will find updates and plan amendments below. You can also find a complete list of SPAs at the State Plan Amendment page

Pharmacy reimbursement changes will be implemented retrospectively upon approval of State Plan Amendment (SPA) 17-0002 Pharmacy Reimbursement from the Centers for Medicare and Medicaid Services. Also, the deadline for 340B covered entities to complete the Initial 340B Covered Entity Attestation Enrollment Form has been extended to May 1, 2017. 

The Division of Medicaid has submitted to the Centers for Medicare and Medicaid Services (CMS) the Access Monitoring Review Plan (AMRP) as of October 1,  2016 which can be accessed at this link: Access Monitoring Review Plan.

2017

SPA 17-0003 Screening, Brief Intervention, and Referral to Treatment (SBIRT)
State Plan Amendment (SPA) 17-0003 Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Mississippi Division of Medicaid to provide early intervention services for pregnant women with nondependent substance use and to prevent problematic substance use disorders, effective July 1, 2017.

SPA 17-0002 Pharmacy Reimbursement 
Mississippi State Plan Amendment (SPA) 17-0002 Pharmacy Reimbursement has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Mississippi Division of Medicaid to revise the payment methodology for prescription drugs at point-of-sale (POS) pharmacies and describe reimbursement for 340B covered entities effective April 1, 2017.

2016

SPA 16-0020 Autism Spectrum Disorder (ASD) Services
Mississippi State Plan Amendment (SPA) 16-0020 Autism Spectrum Disorder (ASD) Services has been approved by the Centers for Medicare and Medicaid Services (CMS) to allow the Division of Medicaid to cover ASD services for Early and Periodic Screening, Diagnosis and Treatment (EPSDT)-eligible beneficiaries when medically necessary, prior authorized and provided by certain providers operating within their scope of practice, effective January 1, 2017.

SPA 16-0019 Hospital Reimbursement of Long-Acting Reversible Contraceptives (LARCs)
Mississippi State Plan Amendment (SPA) 16-0019 Hospital Reimbursement of Long-Acting Reversible Contraceptives (LARCs)  has been approved to allow the Division of Medicaid to reimburse for LARCs and their insertion at the time of delivery, outside of, and in addition to, the Diagnosis Related Group (DRG) base payment effective August 6, 2016.

SPA 16-0017 Outpatient Prospective Payment System (OPPS) 
Mississippi State Plan Amendment (SPA) 16-0017 Outpatient Prospective Payment System (OPPS) Update has been approved to clarify the Medicare Ambulatory Payment Classification (APC) used to compute the observation code G0378 fee and the Medicare Average Sales Price (ASP) drug pricing file used to compute chemotherapy drug code fees effective July 1, 2016.

SPA 16-0015 Recovery Audit Contractors (RACs)
Mississippi State Plan Amendment (SPA) 16-0015 Recovery Audit Contractors (RACs) has been approved to request a one (1) year exception to 42 CFR § 455.502(b), which requires contracting with a RAC. The State also seeks to expand the duties of the current Medicaid Integrity Contractor to include audits that were previously performed by the RAC effective April 1, 2016.

SPA 16-0014 Rural Health Clinic (RHC) Scope of Service
Mississippi State Plan Amendment (SPA) 16-0014 Rural Health Clinic (RHC) Scope of Service has been approved to clarify the definition of a change in scope of service and the procedure for submitting a request for a rate adjustment due to a change in scope of service with an effective date of May 1, 2016. This approved SPA also includes language for the reimbursement of telehealth services in an RHC as approved in SPA 15-003 Telehealth Services effective January 1, 2015.

SPA 16-0013 Federally Qualified Health Center (FQHC) Scope of Service
Mississippi State Plan Amendment (SPA) 16-0013 Federally Qualified Health Center (FQHC) Scope of Service has been approved to clarify the definition of a change in scope of service and the procedure for submitting a request for a rate adjustment due to a change in scope of service with an effective date of May I, 2016. This approved SPA also includes language for the reimbursement of telehealth services in an FQHC as approved in SPA 15-003 Telehealth Services effective January I, 2015.

SPA 16-0011 Long Term Care Reimbursement
Mississippi State Plan Amendment (SPA) 16-0011 Long-Term Care (LTC) Reimbursement has been approved to add clarification language regarding property reimbursement calculations for the following facilities: Alzheimer’s Units, Nursing Facilities for the Severely Disabled (NFSDs), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs) effective January 1, 2016. SPA 16-0011 does not change the reimbursement methodology but adds language clarification for consistency purposes.

SPA 16-0010 All Patient Refined Diagnosis Related Groups (APR-DRG) Reimbursement 
Mississippi State Plan Amendment (SPA) 16-0010 All Patient Refined Diagnosis Related Groups (APR-DRG) Reimbursement has been approved to update the hospital inpatient payment methodology with an effective date of July 1, 2016.  This proposed SPA is to comply with approved SPA 2012-008.

SPA 16-0009 Current Market Value (CMV)
Mississippi State Plan Amendment (SPA) 16-0009 Current Market Value (CMV) allows Current Market Value (CMV) of real property to be established using the county tax assessed true value as shown on the county tax receipt rather than an initial evaluation using a knowledgeable source statement, per SSI policy. If an applicant or recipient disagrees with the tax assessed value of any countable real property, a knowledgeable source statement will be used to establish CMV.

SPA 16-0008 Primary Care Physician (PCP) Payment for Obstetricians and Gynecologists (OB/GYNs)
Mississippi State Plan Amendment (SPA) 16-0008 Primary Care Physician (PCP) Payment for Obstetricians and Gynecologists (OB/GYNs) has been approved to reimburse certain eligible obstetricians and gynecologists for the provision of certain primary care services at one hundred percent (100%) of the Medicare Physician fee schedule or at the Mississippi regional maximum vaccine administration fee set by the Vaccines for Children program effective July 1, 2016.



For more information contact:
Office of Policy
Office of the Governor, Division of Medicaid
550 High Street, Suite 1000
Jackson, MS 39201 Phone (601) 359-2081

Email: DOMPolicy@medicaid.ms.gov
Website http://www.medicaid.ms.gov