Service Limits

Service Limits A. The Division of Medicaid defines service limits as the maximum quantity of services per beneficiary that are eligible for reimbursement by the Division of Medicaid within a given time frame, either daily or yearly. B. Daily service limits apply to beneficiaries, regardless of the setting, hospital/residential or community-based, in which the services are provided. C. The following yearly service limits apply to non-EPSDT-eligible beneficiaries: 1. The Division of Medicaid covers a combined total of sixteen (16) psychiatric physician office and hospital outpatient department visits per state fiscal year (July 1-June 30). [Refer to Miss. Admin. Code, Part 200, Rule 9.5 for non-psychiatric physician office and hospital outpatient department visits.] 2. Hospital Inpatient Services a) Inpatient hospital psychiatric services are reimbursed under the APR-DRG methodology and are available only if the services are determined to be medically necessary by the Utilization Management/Quality Improvement Organization (UM/QIO). Day outlier payments may be made for mental health long lengths of stay for exceptionally expensive cases. b) Prior authorization is required upon admission and for lengths of stay greater than nineteen (19) days. c) One (1) covered psychiatric service/procedure is eligible for reimbursement per beneficiary per certified day in a general hospital or acute freestanding psychiatric facility.