Title 23: Medicaid, Part 208, Chapter 1: Elderly and Disabled Waiver — Documentation/Record Maintenance, Reimbursement, and In-Home Respite (Rules 1.6, 1.8, 1.10)

What this rule requires your agency to do

• 1Claims must be based on services actually rendered as authorized by the PSS, accurately billed by qualified waiver providers, and in accordance with the approved waiver; the Division denies payment when a beneficiary is not Medicaid eligible on the date of service and conducts post-utilization reviews to ensure services were on the approved PSS (Rule 1.10.A, C, D).(Title 23: Medicaid, Part 208, Chapter 1: Elderly and Disabled Waiver — Documentation/Record Maintenance, Reimbursement, and In-Home Respite (Rules 1.6, 1.8, 1.10))
• 2All staff records must include, at minimum: copy of valid state-issued ID; job description; application and date of hire; educational credential or proof of ability to read/write accurately; required licensure/certifications; results of fingerprint-based national criminal background checks; results of monthly Nurse Aide Abuse Registry checks; results of monthly OIG checks; annual attestation of health; signed confidentiality agreement including a social media waiver; and proof of training/evaluations and required certifications including CPR and First Aid (Rule 1.8.B).(Title 23: Medicaid, Part 208, Chapter 1: Elderly and Disabled Waiver — Documentation/Record Maintenance, Reimbursement, and In-Home Respite (Rules 1.6, 1.8, 1.10))
• 3Activity or time sheets must include arrival/service start time and date, departure/service end time and date, activities/tasks performed, and the signature of the beneficiary or legal representative verifying provision of services (Rule 1.8.F).(Title 23: Medicaid, Part 208, Chapter 1: Elderly and Disabled Waiver — Documentation/Record Maintenance, Reimbursement, and In-Home Respite (Rules 1.6, 1.8, 1.10))
• 4All providers of Personal Care Services and In-Home Respite must utilize the Mississippi Medicaid EVV system for the submission of claims unless an exception is approved in writing by the Division of Medicaid (Rule 1.10.H).(Title 23: Medicaid, Part 208, Chapter 1: Elderly and Disabled Waiver — Documentation/Record Maintenance, Reimbursement, and In-Home Respite (Rules 1.6, 1.8, 1.10))
• 5Records for beneficiaries receiving PCS and In-Home Respite must include the referral form/authorization, the approved Plan of Services and Supports (PSS), daily activity/time sheets capturing tasks completed and the beneficiary/representative's signature verifying provision of services (unless task and GPS information is captured electronically in the state-approved EVV system), and a service note explaining any significant variation from the recommended service schedule (Rule 1.8.C).(Title 23: Medicaid, Part 208, Chapter 1: Elderly and Disabled Waiver — Documentation/Record Maintenance, Reimbursement, and In-Home Respite (Rules 1.6, 1.8, 1.10))
• 6No more than sixty (60) hours of In-Home Respite services per month are allowed, and IHR services in excess of sixteen (16) continuous hours must be prior approved by the case management team; institutional respite is covered no more than thirty (30) calendar days per state fiscal year (Rule 1.6.A.4).(Title 23: Medicaid, Part 208, Chapter 1: Elderly and Disabled Waiver — Documentation/Record Maintenance, Reimbursement, and In-Home Respite (Rules 1.6, 1.8, 1.10))
• 7Records documenting the provision of services must be maintained by providers of waiver services for a minimum of five (5) years, and longer if there is ongoing litigation or an open audit at the end of that period (Rule 1.10.E).(Title 23: Medicaid, Part 208, Chapter 1: Elderly and Disabled Waiver — Documentation/Record Maintenance, Reimbursement, and In-Home Respite (Rules 1.6, 1.8, 1.10))