Prior Approval

Prior Approval A. Prior approval must be obtained from the Division of Medicaid before a beneficiary can receive services through the Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver. To obtain approval, the Mississippi Department of Rehabilitation Services (MDRS) must complete and submit the current Division of Medicaid approved forms as follows: 1. Long Term Services and Supports (LTSS) Assessment, 2. Bill of Rights, 3. Plan of Services and Supports (PSS), 4. Emergency Preparedness Plan, 5. Informed Choice Form, 6. Physician or Nurse Practitioner Certification of Medical Stability and Nursing Facility Level of Care at initial certification, readmission certification, and as required by DOM or MDRS, and 7. Other supportive documentation as needed including, but not limited to, prescriptions and assistive technology recommendations. B. Any request to add or increase services listed on the approved PSS must be submitted to and receive prior approval from the Division of Medicaid and must include documentation substantiating the need for the requested change(s). C. A physician must verify that the beneficiary has a traumatic brain/spinal cord injury. An individual whose brain or spinal cord injury is due to a degenerative or congenital condition, or that resulted, intentionally or unintentionally, from medical intervention is not eligible to receive services through the HCB waiver program. D. MDRS is responsible for implementation of the PSS. The Division of Medicaid and MDRS are jointly responsible for monitoring the PSS and the health and welfare of the participants. The Division of Medicaid, as the administrative agency of the waiver, has the overall oversight responsibility of assuring that processes are in place for PSS implementation. Monitoring the implementation of the PSS includes on site review activity, record reviews, annual recertification reviews, beneficiary phone calls from the Medicaid agency, and other strategies as needed.