Effective Date of Provider Agreement and Provider Agreement Termination

Effective Date of Provider Agreement and Provider Agreement Termination A. Each provider or organization furnishing services under the Mississippi Medicaid State Plan must enter into a provider agreement with the Mississippi Division of Medicaid. B. The effective date of the provider agreement is the earliest day of the following options: 1. The date all required screening has been completed by the Division of Medicaid if the Division of Medicaid cannot verify all required screenings have been completed by a: a) Medicare contractor, or b) Medicaid agency or Children’s Health Insurance Program (CHIP) of another state, 2. Up to one hundred twenty (120) days prior to the date of the submission of a Mississippi Medicaid Enrollment application if the Division of Medicaid can verify that the provider had all required screenings completed by a: a) Medicare contractor, or b) Medicaid agency or Children’s Health Insurance Program (CHIP) of another state, 3. The date of Medicare certification, not to exceed three hundred and sixty-five (365) days from the date of application, if the provider requests enrollment in the Medicaid program within one hundred twenty (120) days from the date the Medicare Tie-in Notice was issued to the provider, or 4. The first day of the month in which the Division of Medicaid receives the provider’s enrollment application if the provider requests enrollment after one hundred twenty (120) days of the issuance of the Medicare Tie-in Notice. C. For providers subject to survey and certification by the Centers for Medicare and Medicaid Services (CMS) or the State survey agency, the effective date is determined as follows: 1. The agreement is effective on the date the onsite survey is completed, if on that date the provider meets: a) All applicable Federal requirements; and b) Any other requirements imposed by the State for participation in the Medicaid program. 2. If on the date the survey is completed the provider fails to meet any of the requirements of the survey/accreditation, the following rules apply: a) A Nursing Facility provider agreement is effective on the date the nursing facility is found to be in substantial compliance, and b) CMS or the State survey agency receives from the Nursing Facility, if applicable, an approvable waiver request. c) For an agreement with any other provider, the effective date is the earlier of the date on which the provider meets all requirements, or the date on which a provider is found to meet all conditions of participation but has lower level deficiencies, and CMS or the State survey agency receives from the provider an acceptable plan of correction for the lower level deficiencies, or an approvable waiver request, or both. The date of receipt is the effective date of the agreement, regardless of when CMS approves the plan of correction or waiver request, or both. D. If a provider is currently accredited by a national accrediting organization whose program had CMS approval at the time of accreditation survey and accreditation decision, and on the basis of accreditation, CMS has deemed the provider to meet Federal requirements, the effective date depends on whether the provider is subject to requirements in addition to those included in the accrediting organization's approved program. a) For a provider that is subject to additional requirements, Federal or State, or both, the effective date is the date on which the provider meets all requirements, including the additional requirements. b) For a provider that is not subject to additional requirements, the effective date is the date of the provider's initial request for participation if on that date the provider met all Federal requirements. c) If the provider meets the requirements in Miss. Admin. Code Title 23, Part 200, Rule 4.4, (C) (4) (a) or Rule 4.4, (C) (4) (b), the effective date may be retroactive for up to one hundred twenty (120) days. E. For out-of-state providers, applications and claims must be submitted within one hundred twenty (120) days of the date of service. The effective date of the provider agreement will be: 1. The date of the service if the service was an emergency or if the beneficiary's health would be endangered if they were required to travel to their state of residence, or 2. The date determined in Miss. Admin. Code Part 200, Rule 4.4.B. F. The Division of Medicaid does not make payments to any provider or organization prior to the date of a valid Medicaid provider agreement. This rule applies for any services rendered regardless of any time period provided for under any timely filing provision. G. Timely filing requirements apply to all claims submitted by all providers. [Refer to Miss. Admin. Code Part 200, Rule 1.6] H. Providers of the following state plan services will continue to receive payment for up to thirty (30) days after the effective date of termination of a provider agreement for services furnished to a beneficiary who was admitted before the effective date of the termination to permit time for an orderly transfer of Medicaid beneficiaries: 1. Inpatient hospital services, 2. Nursing facility (NF) services, 3. Psychiatric residential treatment facility services (PRTF), 4. Intermediate care facilities for the intellectually and/or developmentally disabled (ICF/ IDD) facility services, and 5. Home health services and hospice services furnished under a plan established before the effective date of termination. I. The facilities listed in Miss. Admin. Code Part 200, Rule 4.1.D. must: 1. Notify all Medicaid beneficiaries, families, and/or sponsors in writing within forty-eight (48) hours of notice of termination of Medicaid participation, 2. Submit to the Division of Medicaid a current list of Medicaid beneficiaries who are receiving Medicaid services along with the name, address and telephone number of the family and/or the sponsor, when available, and the beneficiary’s attending physician. 3. Assist the beneficiaries, families and the facility in making other facility arrangements for the beneficiaries. J. Reinstatement may be granted after a provider has been terminated by the licensing or certification board, Office of Inspector General, the Centers for Medicare and Medicaid services (CMS), or the Division of Medicaid when conditions of reinstatement have been satisfied by the sanctioning entity. Notification of re-instatement from the appropriate entity must be provided with an application for re-instatement to participate in the Medicaid program.