Provider Enrollment

Provider Enrollment A. The Mississippi Department of Rehabilitation Services (MDRS), as the provider of Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver services, must satisfy all requirements set forth in Title 23 Miss. Admin. Code Part 200, Rule 4.8 in addition to the listed provider-type specific requirements and provide to the Division of Medicaid. 1. A National Provider Identifier (NPI), verification from National Plan and Provider Enumeration System (NPPES), 2. A copy of the provider’s current license or permit, if applicable. 3. Verification of a social security number using a social security card, driver’s license with a social security number, military ID or a notarized statement signed by the provider noting the social security number. The name noted on verification document must match the name noted on the W-9, and 4. Written confirmation from the Internal Revenue Service (IRS) confirming the provider’s tax identification number and legal business name. B. To participate as a Home and Community-Based Services (HCBS) TBI/SCI Waiver provider, MDRS must: 1. Conduct a national criminal background check with fingerprints on case managers, nurses, and direct care workers (DCW) personal care or transition services prior to employment and every two (2) years thereafter, and maintain the record in the employee’s personnel file; 2. Conduct registry checks, prior to employment and monthly thereafter, to ensure individuals providing case management, personal care services, or transition services are not listed on the Mississippi Nurse Aide Abuse Registry or listed on the Office of Inspector General’s (OIG) Exclusion Database and maintain the record in the employee’s personal file. The provider must not employ individuals whose name appears on registry or database; 3. Not have been, or employed or currently employ individuals or volunteers who have been, convicted of, pleaded guilty to, or pleased nolo contendere to a felony of possession or sale of drugs, murder, manslaughter, armed robbery, rape, sexual battery, any sex offense defined in Miss. Code Ann. § 45-33-239(f), child abuse, arson, grand larceny, burglary, gratification of lust, aggravated assault, or felonious abuse and/or battery of a vulnerable adult, or any other crime of violence. Any such conviction or plea which was reversed on appeal or for which a pardon was granted shall not be considered; 4. Have written criteria for service provision, including procedures for dealing with emergency service requests; 5. Be compliant with all federal and state regulations; and 6. Have responsible personnel management including: a) Appropriate processes used in the recruitment, selection, retention, and termination of employees, b) Maintain written personnel policies and job descriptions, c) Maintain a current training plan as a component of the policies/procedures documenting the method for the completion of required training. The training plan must require all employees to meet training requirements as designated by the Division of Medicaid upon hire, and annually thereafter, and d) Maintain a current personnel file on every employee and volunteer with the following required information including, but not limited to, credentialing documentation, training records and performance reviews which must be made available to the Division of Medicaid upon request. C. MDRS must ensure that all employees and contracted entities meet the service specific requirements below prior to the provision of services: 1. Case Management must be provided by Registered Nurses (RN) and Case Managers who must meet the following qualifications: a) The Registered Nurse must: 1) Have a current and active unencumbered RN license to practice in the state of Mississippi or be working in Mississippi on a privilege with a valid compact RN license, and 2) Have at least one (1) year of experience with the aged and/or individuals with disabilities. b) The Case Manager must: 1) Possess at a minimum a bachelor’s degree in Rehabilitation Counseling or other related field, and 2) Have one (1) year of experience working with aged and/or individuals with disabilities. c) Mississippi Department of Rehabilitation Services (MDRS) is responsible for validating qualifications of the Registered Nurse and Rehabilitation Case Manager. d) MDRS must subscribe with the Mississippi Board of Nursing to receive immediate electronic notification of adverse or disciplinary action taken against any nurse providing services under the TBI/SCI waiver. e) MDRS must verify provider qualifications upon hire and at least annually and maintain documentation of that verification in the employee file. 2. Personal Care Services (PCS) must be provided by a Direct Care Worker (DCW) who must meet the following qualifications: a) Be chosen by the beneficiary/representative as someone with whom they are comfortable providing their personal care or chosen from a list of available, eligible/qualified DCW. b) Must meet basic competencies that include both educational and functional requirements. c) Be certified by MDRS Case Managers which includes documentation that the DCW meets the requirements. d) Must have completed training/instruction that covers the purpose, functions, and tasks associated with the Personal Care Services program. 1) The educational program must be personalized with participation of the beneficiary to ensure his/her specific needs are met. 2) The cost of training/instruction time for personal care attendants cannot be reimbursed by the Division under the waiver. 3) The individual must demonstrate competency to perform each activity of daily living task to the beneficiary/representative and Case Manager prior to rendering any Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) waiver service. 4) In addition to the technical skills required, the DCW must demonstrate the ability to comprehend and comply with basic written and verbal instructions at a level determined by the beneficiary /representative and Case Manager to be adequate in fulfilling the responsibilities of personal care. (a) DCW training must be conducted by the Case Manager, or an agency permitted by law to train nurse aides, must be tailored to the personal care required for the beneficiary, and must include: (1) The purpose and philosophy of self-directed services by the disabled, (2) Disability awareness, (3) Employee-employer relationships, (4) The need for respect for the beneficiary’s privacy and property, (5) Basic elements of body functions, (6) Infection control procedures, (7) Maintaining a clean and safe environment, (8) Appropriate and safe techniques in personal hygiene and grooming to include bed, sponge, tub, or shower bath, hair care, nail and skin care, oral hygiene, dressing, bladder and bowel routine, transfers, and equipment use and maintenance, and (9) Meal preparation and menus that provide a balanced, nutritional diet. e) A prospective DCW who has satisfactorily completed a nurse aide training program for a hospital, nursing facility, or home health agency or who was continuously employed for twelve (12) months during the last three (3) years as a nurse aide, orderly, nursing assistant or an equivalent position by one of the above medical facilities is deemed to meet the training requirements. Competency certification for these personal care providers by the beneficiary/representative and Case Manager is required. A DCW that has satisfactorily provided personal care services for four (4) weeks prior to coverage under the TBI/SCI waiver program, with such service certified by and verified by the beneficiary/representative and Case Manager, is deemed to meet the training requirement. f) Waiver services provided by legal guardians or legal representatives, including but not limited to, spouses, parents/stepparents of minor children, conservators, guardians, individuals who hold the beneficiary's power of attorney or those designated as the beneficiary's representative payee for Social Security benefits cannot be reimbursed by the Division under the waiver. For the purposes of this requirement, relatives are defined as any individual related by blood or marriage to the beneficiary. Waiver services provided by non-legally responsible relatives may be reimbursed by the Division under the waiver when the following criteria are met: 1) There is documentation that there are no other willing/qualified providers available for selection. 2) The selected relative is qualified to provide services as specified in the Appendix C-1/C-3 of the TBI/SCI Waiver. 3) The beneficiary or another designated representative is available to sign verifying that services were rendered by the selected relative. 4) The selected relative agrees to render services in accordance with the scope, limitations, and professional requirements of the service during their designated hours. 5) The service provided is not a function that a relative or housemate was providing for the beneficiary without payment prior to waiver enrollment. g) The Division of Medicaid reserves the right to remove a selected relative from the provision of services at any time if there is a reasonable suspicion, or substantiation, of abuse/neglect/exploitation/fraud or if it is determined that the services are not being professionally rendered in accordance with the approved Plan of Services and Supports. If the state removes a selected relative from the provision of services, the beneficiary will be asked to select an alternate qualified provider. h) The direct care worker must meet the following requirements: 1) Be at least eighteen (18) years of age, 2) Be a high school graduate, have a General Education Development (GED) certificate or must demonstrate the ability to read the written personal care services assignment and write adequately to complete required forms and reports of visits, 3) Be able to follow verbal and written instructions, 4) Have no physical/mental impairment to prevent lifting, transferring or providing any other assistance to beneficiary, 5) Be certified as meeting the training and competence requirement by the beneficiary and the Case Manager, and 6) Be able to communicate effectively and carry out directions. i) MDRS must verify the competency for all PCAs as needed. 3. In-home respite (IHR) services must be provided by a DCW who must meet the following qualifications: a) Be chosen by the beneficiary/representative as someone with whom they are comfortable providing their personal care or chosen from a list of available, eligible/qualified DCWs. b) Must meet basic competencies that include both educational and functional requirements. c) Be certified by MDRS Case Managers which includes documentation that the DCW meets the requirements. d) Must have completed training/instruction that covers the purpose, functions, and tasks associated with the In-Home Respite Services program. 1) The educational program must be personalized with participation of the beneficiary to ensure his/her specific needs are met. 2) The cost of training/instruction of direct care workers cannot be reimbursed under the waiver. 3) The individual must demonstrate competency to perform each activity of daily living task to the beneficiary/representative and Case Manager prior to rendering any TBI/SCI waiver service. 4) In addition to the technical skills required, the DCW must demonstrate the ability to comprehend and comply with basic written and verbal instructions at a level determined by the beneficiary/representative and Case Manager to be adequate in fulfilling the responsibilities of personal care. (a) DCW training must be conducted by the beneficiary/representative and the Case Manager, or an agency permitted by law to train nurse aides, and must include: (1) The purpose and philosophy of self-directed services by the disabled, (2) Disability awareness, (3) Employee-employer relationships, (4) The need for respect for the beneficiary’s privacy and property (5) Basic elements of body functions, (6) Infection control procedures, (7) Maintaining a clean and safe environment, (8) Appropriate and safe techniques in personal hygiene and grooming to include bed, sponge, tub, or shower bath, hair care, nail and skin care, oral hygiene, dressing, bladder and bowel routine, transfers, and equipment use and maintenance. (9) Meal preparation and menus that provide a balanced, nutritional diet. e) A prospective DCW who has satisfactorily completed a nurse aide training program for a hospital, nursing facility, or home health agency or who was continuously employed for twelve (12) months during the last three (3) years as a nurse aide, orderly, nursing assistant or an equivalent position by one of the above medical facilities is deemed to meet the classroom training requirements. Competency certification for these personal care providers by the person/representative and Case Manager is required. A DCW that has satisfactorily provided In Home Respite services for four (4) weeks prior to coverage under the TBI/SCI waiver program, with such service certified by and verified by the person/representative and Case Manager, is deemed to meet the training requirement. f) Waiver services provided by legal guardians or legal representatives, including but not limited to, spouses, parents/stepparents of minor children, conservators, guardians, individuals who hold the beneficiary's power of attorney or those designated as the beneficiary's representative payee for Social Security benefits cannot be reimbursed by the Division under the waiver. For the purposes of this requirement, relatives are defined as any individual related by blood or marriage to the beneficiary. Waiver services provided by non-legally responsible relatives may be reimbursed by the Division under the waiver when the following criteria are met: 1) There is documentation that there are no other willing/qualified providers available for selection. 2) The selected relative is qualified to provide services as specified in the Appendix C-1/C-3 of the TBI/SCI Waiver. 3) The beneficiary or another designated representative is available to sign verifying that services were rendered by the selected relative. 4) The selected relative agrees to render services in accordance with the scope, limitations, and professional requirements of the service during their designated hours. 5) The service provided is not a function that a relative or housemate was providing for the beneficiary without payment prior to waiver enrollment. g) The state reserves the right to remove a selected relative from the provision of services at any time if there is suspicion, or substantiation, of abuse/neglect/exploitation/fraud or if it is determined that the services are not being professionally rendered in accordance with the approved Plan of Services and Supports. If the state removes a selected relative from the provision of services, the beneficiary will be asked to select an alternate qualified provider. h) Minimum requirements include: 1) Be at least eighteen (18) years of age, 2) Be a high school graduate, have a GED certificate, or must demonstrate the ability to read the written in-home respite services assignment and write adequately to complete forms and reports of visits, 3) Be able to follow verbal and written instructions, 4) Have no physical/mental impairment to prevent lifting, transferring or providing any other assistance to beneficiary, 5) Be certified as meeting the training and competence requirement by the beneficiary and the Case Manager, and 6) Be able to communicate effectively and carry out directions, 7) Must be a registered nurse or licensed practical nurse in accordance with the Mississippi Nurse Practice Act and other applicable laws and regulations, if providing in-home nursing respite, and i) MDRS must verify the competency for all DCWs as needed. 4. Institutional Respite must be provided in a Medicaid certified hospital, nursing facility or licensed swing bed facility. 5. Specialized Medical Equipment and Supplies must be provided by entities who meet the following qualifications: a) Have a permanent local address and phone number, b) Have a State of Mississippi sales tax number, c) Have Federal identification number or social security number, d) Have liability insurance, e) Must honor the manufacturer's guarantee or warranty as published, f) Must provide repair capability for products, and g) Meet the following additional standards if providing custom in-house seating systems, powered mobility, three-wheel scooters, and high-tech systems: 1) Must provide documented proof of attendance of training with seating and positioning, 2) Maintain a current list of power chair manufacturers represented, 3) Have on staff a technician certified as being trained to repair each power chair manufacturer represented, if offered by the manufacturer, 4) Maintain basic inventory of electronic parts to repair power chairs of manufacturers represented or demonstrate the capability to repair motors, modules, joysticks, and parts to repair the above, 5) Must be able to deliver and assemble all equipment to be ready for final adjustment and fitting, 6) Must have and present at purchase all necessary manuals and written warranties, 7) Must be able to provide instruction in proper use and care of equipment, 8) Must be capable of providing training in safe and effective operation of the equipment, as well as maintenance schedule as a component part of the purchase price, and 9) Must have available a list of key contact personnel at various manufacturers for immediate technical support or special handling of specific needs including complete parts, manuals, and accessory catalogs along with updates and current technical service bulletins. 6. Transition Assistance services must be provided by a Registered Nurse and/or Case Manager. 7. Environmental Accessibility Adaptation services must be provided by entities who meet the following: a) Meet all state or local requirements for licensure/certification including, but not limited to, building contractors, plumbers, electricians, or engineers. b) Provide services in accordance with applicable state housing and local building codes. c) Ensure the quality of work provided meets standards identified below: 1) All work must be done in a fashion that exhibits good craftsmanship. 2) All materials, equipment, and supplies must be installed clean, and in accordance with manufacturer's instructions. 3) The contractor must obtain all permits required by local governmental bodies. 4) All non-salvaged supplies and/or materials must be new and of best quality, without defects. 5) The contractor must remove all excess materials and trash, leaving the site clear of debris at completion of the project, 6) All work must be accomplished in compliance with applicable codes, ordinances, regulations and laws. 7) The specifications and drawings cannot be modified without a written change order from the case manager. 8) No accessibility barriers can be created by the modification and/or construction process.