LATE BREAKING NEWS 2020 WHAT’S NEW?

LATE BREAKING NEWS 2020

WHAT'S NEW?

Opioid Treatment Program (OTP) 10/05/20 4:45pm

To be compliant with the SUPPORT ACT, and contingent upon approval from the Centers for Medicare and Medicaid services, the proposed State Plan Amendment (SPA) 20-0023 Medication Assisted Treatment provided by Opioid Treatment Programs will be effective October 1, 2020.

OTP providers may begin submitting applications to become a MS Medicaid provider. Providers should enroll as a Private Mental Health Center (X01). OTP providers must be certified by the MS Department of Mental Health (DMH) as an Opioid Treatment Provider and include their DMH certification and SAMHSA certification with their application. Any servicing provider must be enrolled independently with the Division of Medicaid.

The Envision website lists application instructions, documentation and forms required to enroll. Providers may start the enrollment process by completing the Mississippi Medicaid Provider Enrollment Application located at . If you have any questions regarding the enrollment application or process, contact a Conduent provider enrollment specialist toll-free at 800-884-3222.

The Opioid Treatment Programs fee schedule can be located at and are for dates of service on or after October 1, 2020. Refer to the fee schedule for the codes and modifiers covered.

If you have any program questions, please contact the Office of Mental Health by emailing Kimberly.SartinHolloway@medicaid. or calling 601-359-9545.

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10/7/2020 11:39 AM

LATE BREAKING NEWS 2020

WHAT'S NEW?

ATTENTION: Speech Therapists ? Prior Authorization

Requirements 09/30/20 9:24am

The Mississippi Division of Medicaid (DOM) requires prior authorization (PA) of outpatient speech therapy services, evaluation, and re-evaluations, for fee-for-service (FFS) beneficiaries. DOM contracts with Alliant Health Solutions as the Utilization Management/Quality Improvement Organization (UM/QIO) vendor. Alliant is responsible for determining medical necessity for fee-for-service (FFS) beneficiaries. Please refer to Alliant Health Solutions' provider portal at , or call Alliant directly at 1-888-2243067. Additionally, providers may submit requests to change information on a PA, as outlined in the Alliant Provider Medical Review Portal User Manual. Please refer to section 2.5 "Submit/View PA Change Request" in the Alliant Provider Medical Review Portal User Manual. In general, change requests are permitted for all pending/not referred and approved PAs and must be submitted within thirty (30) calendar days of the PA request date, or date of service, whichever is greater. Only three (3) change requests per PA may be submitted.

Procedure Code

Speech Therapy Evaluation Codes

Procedure Code Description

PA Required in Outpatient Hospital

PA Required in Clinic or Office

92521

Evaluation of Speech Fluency

Yes

Not currently

92523

Evaluation Speech Sound Production with Language

Yes

Yes

92524

Behavioral and Qualitative Analysis of Voice and Resonance

Yes

Yes

Please refer to the Mississippi Administrative Code Part 213: Therapy Services, Chapter 3: Speech Therapy: Rule 3.5 Prior Authorization/Pre-certification for additional information uploads/2014/01/Admin-Code-Part-213.pdf.

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10/7/2020 11:39 AM

LATE BREAKING NEWS 2020

WHAT'S NEW?

Attention: Cost-Sharing Waived for COVID-19 Related Services

09/29/20 4:11 pm

Medical Fee-For-Service (FFS) Providers:

In the MS Medicaid Provider Bulletin COVID-19, Special Edition, Volume 26, issue 1, DOM notified medical providers that collection of a copayment from beneficiaries was prohibited beginning March 1, 2020. A mass adjustment has been completed to return copayments deducted from provider claims for the DOS March 1, 2020 through June 29, 2020. DOM did not deduct any copayments from claims beginning June 30, 2020 to October 3, 2020. Medical providers must refund any copayments to beneficiaries who paid a copayment during this timeframe. Effective October 4, 2020, DOM will resume deduction of copayments from all claims. However, medical providers are prohibited from collecting copayment from a Medicaid beneficiary for COVID-19 related treatments and services.

Copayment Exception Code "V" Medical providers must place the copayment exception code "V" immediately after the beneficiary ID number in order to waive the copayment deduction from the claim's total payment amount on all COVID-19 related treatments and services until the end of the public health emergency.

Pharmacy Fee for Service Claims (NCPDP D.0) 09/29/20 4:20pm

In the Provider Notice, disseminated by DOM on May 8, 2020, and per the MS Medicaid Provider Bulletin, COVID-19, Special Edition, Volume 26, Issue 1 pharmacy providers were directed to cease collecting copayments until the claims system update allowing COVID-related prescriptions to be identified by entry of the copay exception code "V" as a suffix to the beneficiary's Medicaid ID number.

Claim Timeline and actions required by pharmacy providers:

Claim Date of Service

Action Required

March 1, 2020 through April 8, 2020

April 9, 2020 through October 3, 2020 October 4, 2020 and forward through the end date of the COVID-19 emergency

None- Conduent has already adjusted all pharmacy claims and credited back copays. Pharmacy providers were previously instructed to refund these copayments to beneficiaries

Conduent will adjust all claims and credit back copayments to pharmacy providers

Providers must identify COVID-19 related claims by entering a "V" immediately after the beneficiary ID number in order to waive the $3.00 copay*

*The prescriber has indicated a diagnosis of COVID-19 on the prescription, or *The prescriber notates the beneficiary may have COVID-19 illness on the prescription, or *The beneficiary states that they may have COVID-19 or are being treated for COVID-19.

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10/7/2020 11:39 AM

LATE BREAKING NEWS 2020

WHAT'S NEW?

Attention Dental Providers! 09/02/20 12:15pm

Effective October 1, 2020, dental providers must submit a dental scoring tool for dental services provided in an outpatient hospital setting or Ambulatory Surgical Center (ASC), for fee-for-service (FFS) Medicaid beneficiaries, when requesting a prior authorization (PA) from DOM's Utilization Management and Quality Improvement Organization UM/QIO, Alliant Health Solutions The dental scoring tool can be accessed at the following link: Should you have any questions, please contact Alliant Health Solutions at 888-224-3067.

Attention: All Providers - Copayment Refunds 09/25/20 3:57pm

DOM will mass adjust medical fee-for-service (FFS) claims for dates service March 1 , 2020 through June 29, 2020, reversing the copay deduction from the claim's payment amount. Medical providers are required to refund copayments to beneficiaries who have paid a copayment from March 1 , 2020, through June 29, 2020.

Attention Dental Providers 09/17/20 4:00pm

Effective October 1, 2020, dental providers must submit a dental scoring tool for dental services provided in an outpatient hospital setting or Ambulatory Surgical Center (ASC), for fee-for-service (FFS) Medicaid beneficiaries, when requesting a prior authorization (PA) from DOM's Utilization Management and Quality Improvement Organization UM/QIO, Alliant Health Solutions The dental scoring tool can be accessed at the following link: in OR and ASC.pdf Should you have any questions, please contact Alliant Health Solutions at 888-224-3067.

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10/7/2020 11:39 AM

LATE BREAKING NEWS 2020

WHAT'S NEW?

Important Notice to Community Mental Health Service Providers

09/01/20 1:30 pm On August 28, 2020, the Division of Medicaid (DOM) submitted the proposed State Plan Amendment (SPA) 200022 Mental Health Coverage and Reimbursement. Contingent upon approval from the Centers for Medicare and Medicaid Services, this SPA will be effective September 1, 2020. This SPA includes several enhancements which include, but are not limited to, the following: a) Allowing a more innovative approach to providing Intensive Outpatient Psychiatric services, b) Allowing providers of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) community mental health services to provide services to non-EPSDT beneficiaries, c) Adding coverage and reimbursement of Acute Partial Hospitalization in the outpatient hospital setting or free standing psychiatric unit, a private psychiatric clinic or other provider certified by the Department of Mental Health or other appropriate entity as determined by the Division of Medicaid, d) Adding language to ensure that community mental health services are covered for beneficiaries with a substance use disorder, e) Removing annual service limits for Crisis Response Services and Medication Administration, and f) Increasing the rate for Mental Health Assessments by a non-physician to 90% of the Medicaid physician rate for Psychiatric Diagnostic Evaluations.

Providers are encouraged to review these changes at the following link: .

Attention: Dental Providers 09/01/20 1:30 pm

Effective February 1, 2018, the Mississippi Division of Medicaid (DOM) opened Current Dental Terminology (CDT) code D0120-Periodic Oral Evaluation. This oral evaluation is allowed twice per fiscal year (July 1-June 30) for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) eligible beneficiaries and must be at least five (5) months apart.

Additionally, DOM limits use of CDT code D0150-Comprehensive Oral Evaluation to once every three (3) years per beneficiary, per provider or per provider group. This applies to new patients; established patients who have had a significant change in health conditions or other unusual circumstances, by report, or established patients who have been absent from active treatment for three (3) or more years.

Please contact Provider Services at Conduent at 1-800-884-3222 for additional information.

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10/7/2020 11:39 AM

LATE BREAKING NEWS 2020

WHAT'S NEW?

Attention Providers: Texas, Louisiana Residents displaced by Hurricane Laura 08/27/20 4:51 pm

Please be aware that many Texas and Louisiana residents may have evacuated to Mississippi because of Hurricane Laura and may remain displaced for the near future. If a patient presents a Texas or Louisiana Medicaid card, and you have questions concerning beneficiary eligibility and/or claim submission, please reach out to the specific state's Medicaid program.

Texas Medicaid: 1-800-925-9126 Louisiana Medicaid: 1-888-342-6207

ATTENTION HOSPITAL PROVIDERS: Inpatient Hospital Authorization Process 07/31/20 4:30pm

Effective September 1, 2020, hospital providers will be required to adhere to the outlined timeframes for requesting authorizations from the Division of Medicaid (DOM) Utilization Management and Quality Improvement Organization (UM/QIO), Alliant Health Solutions. Failure to adhere to these timeframes for authorization requests will result in a denial. Nothing in this notification will super sede DOM author ization process for Maternity related services or Newborns. Providers must request the following: Elective or NonEmergency Inpatient Admission-Prior authorization must be obtained at least one (1) to three (3) business days before admission. Emergency Inpatient Admission-The provider must request authorization for an Emergency Inpatient Admission within one (1) business day of admission. Continued Stay Review-Provider must request a continued stay review within 2 business days prior to the expiration of the authorization but no later than 1 business day after the expiration of the authorization. Retrospective Review-Requests for post service reviews will be considered when prior authorization was not obtained due to extenuating circumstances. (i.e., beneficiary was unconscious upon arrival, acts of nature impairing the provider's ability to verify the beneficiary coverage/eligibility status, services authorized by another payer who subsequently determined member was not eligible at the time of service, etc.)

More information regarding DOM policy can be found at .

For assistance with authorization requests, please visit Alliant Health Solutions website at https://

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10/7/2020 11:39 AM

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