Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

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Products and Devices

Transportation Services

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Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Mississippi (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes				Fee for service using a percentage of Medicare allowable payment as ceiling	CN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes	$3/visit		12 Public Health Clinic visits/year included in physician visit limit, Mental Health Clinics not covered	Cost based payment	CN
Federally Qualified Health Center Services
Yes	$3/visit		12 visits/year, visits count toward physician visit limit	Prospective cost based rate/visit	CN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes	$10/day	Non-emergency admissions except maternity	30 days/year, including emergency admissions	Prospective cost based per diem, with limits	CN
Outpatient Hospital Services
Yes	$3/non-emergency visit		6 ER visits/year	Cost based payment using hospital cost to charge ratio	CN
Rehabilitation Services: Mental Health and Substance Abuse
Yes			Limited to therapies and medication related services only	Fee for service	CN
Rural Health Clinic Services
Yes	$3/visit		12 visits/year, visits count toward physician visit limit	Prospective cost based rate/visit	CN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes	$3/visit			Fee for service at 90% of physician fee, 50% of physician fee for medically directed anesthesia	CN
Chiropractor Services
Yes	$3/visit		Payments up to $700/year	Fee for service using a percentage of Medicare allowable payment as ceiling	CN
Dental Services
Yes	$3/visit	Specified services	Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services	Fee for service	CN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes	$3/visit		Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services	Fee for service	CN
Nurse Midwife Services
Yes	$3/visit		12 office, rural health or outpatient hospital visits/year, 36 nursing facility visits/year, 1 inpatient hospital visit/day (2 for ICU)	Fee for service at 90% of physician fee	CN
Nurse Practitioner Services
Yes	$3/visit		12 office, rural health or outpatient visits/year, 36 nursing facility visits/year, visits included in physician visit limitations	Fee for service at 90% of physician fee	CN
Optometrist Services
Yes	$3/visit	Specified services	1 refractive exam/5 years included in physician visit limitations	Fee for service	CN
Physician Services
Yes	$3/visit		12 office, clinic or outpatient hospital visits/year, 36 nursing facility visits/year	Fee for service using a percentage of Medicare allowable payment as ceiling	CN
Podiatrist Services
Yes	$3/visit		12 visits/year included in physician visit limit, routine foot care covered only for specified systemic conditions	Fee for service using a percentage of Medicare allowable payment as ceiling	CN
Psychologist Services
No
Prescription Drugs
Prescription Drugs
Yes	$3/Rx	Specified drugs	5 Rxs/month including 2 brand Rxs, 5 brand Rxs/month for HIV/AIDS, limit not applicable to beneficiaries in nursing facilities	AWP-12% or WAC+9% for brand Rx plus $3.91 dispensing fee; AWP-25% for generic Rx plus $4.91 dispensing fee; non-traditional pharmacies paid $3.91 dispensing fee	CN
Physical Therapy and Other Services
Occupational Therapy Services
No
Physical Therapy Services
No
Services for Speech, Hearing and Language Disorders
No
Products and Devices
Dentures
No
Eyeglasses
Yes	$3/pair		1 pair eyeglasses/5 years	Acquisition cost	CN
Hearing Aids
No
Medical Equipment and Supplies
Yes	$.50-$3/DME service or item, depending on payment	Yes		Fee for service using a percentage of Medicare allowable cost as ceiling	CN
Prosthetic and Orthotic Devices
No
Transportation Services
Ambulance Services
Yes	$3/trip	Urgent fixed wing air ambulance transports		Fee for service, using a percentage of Medicare allowable payment as ceiling	CN
Non-Emergency Medical Transportation Services
Yes		Yes		See service-specific FN	CN
Other Services
Diagnostic, Screening and Preventive Services
Yes			Limited to annual preventive physical exams	Fee for service	CN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes				Fee for service using a percentage of Medicare allowable payment as ceiling	CN
Targeted Case Management
Yes				Fee for service or negotiated rate	CN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes			Services for the following populations: 1, 2, 4 & 8 - See service-specific FN	Dependent upon the services provided	CN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes	$3/visit	Yes	25 skilled nursing and home health aide visits/year	Fee for service with nursing facility rate as upper limit or cost based payment	CN
Hospice Care
Yes			Two 90-day periods with additional 60-day periods as necessary	Prospective rates based on Medicare methodology	CN
Personal Care Services
No
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
No
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
No
Inpatient Psychiatric Services, under age 21
Yes				Prospective cost based per diem	CN
Intermediate Care Facility Services for the Mentally Retarded
Yes			15 hosp leave days/year, 84 therapeutic leave days/year	Prospective cost based per diem with limits	CN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes			Unlimited hosp leave days/year but no more than 15 consecutive hospital leave days, 52 therapeutic leave days/year plus Christmas and Thanksgiving as well as the day prior and after each	Prospective per diem based on cost and facility class, acuity adjusted	CN
Religious Non-Medical Health Care Institution and Practitioner Services
Yes				Prospective cost based per diem up to Medicare limits for facility, practitioner services not covered	CN

Notes: This State has an approved Section 1115 Waiver from CMS under which it extended Medicaid eligibility to a select group of the formerly covered Poverty Level Aged and Disabled (PLAD) population after State Plan benefits had been discontinued. This waiver provides full Medicaid benefits to the most needy of the PLAD population, those who are aged and disabled with income at or below 135 percent of the federal poverty level (FPL) and who do not have Medicare coverage. Mississippi was one of the first states to add the optional Medicaid buy-in group of disabled adults permissible through the Balanced Budget Act of 1997 in its Working Disabled Program. The State subsequently implemented its Demonstration to Maintain Independence and Employment in nine counties of the Mississippi Delta, permissible through the Ticket to Work and Work Incentives Improvement Act (TWWIIA), for working disabled adults with HIV/AIDS. Beneficiaries in both groups are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 250 percent of the FPL. Monthly premiums are required for those with income above 150 percent of the FPL.