Mississippi Administrative Code Title 23 - Division of Medicaid
Mississippi Administrative Code – Title 23: Division of Medicaid
This title governs the rules and regulations established by the Mississippi Division of Medicaid (DOM). It provides the regulatory framework for the administration, eligibility, services, and provider standards under the state’s Medicaid program. These regulations ensure that Medicaid services are delivered in accordance with federal guidelines and state-specific policies.
Key Areas Covered in Title 23:
Eligibility and Enrollment
Criteria for Medicaid eligibility (e.g., income, age, disability)
Application and verification processes
Covered populations (e.g., children, pregnant women, elderly, disabled)
Medicaid Services
Benefits and limitations for services like:
Inpatient and outpatient hospital services
Physician and clinic services
Prescription drugs
Home- and community-based services (HCBS)
Dental, vision, and behavioral health services
Provider Participation and Reimbursement
Requirements for Medicaid provider enrollment
Reimbursement methodologies (fee-for-service, managed care)
Documentation and billing standards
Auditing, fraud prevention, and program integrity provisions
Managed Care and Coordinated Services
Operation of Coordinated Care Organizations (CCOs)
Beneficiary rights and choice in managed care plans
Quality control and reporting requirements
Appeals and Hearings
Beneficiary and provider appeal rights
Fair hearing procedures
Dispute resolution mechanisms
Special Programs and Waivers
HCBS waivers (e.g., Elderly and Disabled Waiver, Assisted Living Waiver)
MississippiCAN (Mississippi Coordinated Access Network)
CHIP (Children’s Health Insurance Program)
Administration
Role and authority of the Division of Medicaid
Compliance with federal Medicaid laws (Title XIX of the Social Security Act)
Public notice and rulemaking procedures
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