Covered Services

Covered Services A. The Division of Medicaid limits reimbursement to a Rural Health Clinic (RHC) to no more than four (4) encounters per beneficiary per day, provided that each encounter represents a different type of visit, as the Division of Medicaid only reimburses for one (1) medically necessary encounter per beneficiary per day for each of the following visit: 1. Medical, 2. Mental health, 3. Dental, or 4. Vision. B. Visits with more than one (1) health professional and multiple visits with the same health professional that take place on the same day at a single location constitute a single encounter, except when the beneficiary: 1. Suffers an illness or injury subsequent to the first visit that requires additional diagnosis or treatment on the same day, or 2. Has multiple visit types on the same day. C. An RHC’s PPS rate covers the beneficiary’s visit to the RHC, which is inclusive of all services and supplies and drugs and biologicals which are not usually self-administered by the beneficiary, furnished as an incident to a professional service. 1. The RHC cannot refer the beneficiary to another provider that will bill the Division of Medicaid for the covered service, supply, drug or biological which is included in the RHC’s encounter. 2. Drugs are included in the PPS rate, if purchased at a discounted price through a discount agreement except for Clinician Administered Drugs and Implantable Drug System Devices (CADD). D. The Division of Medicaid covers CADD drugs separately from an RHC encounter. 1. CADD drugs are listed on the Division of Medicaid’s website. 2. CADD drugs do not count toward monthly prescription drug limits applicable to covered outpatient drugs. E. The Division of Medicaid covers ambulatory services performed by an RHC employee or contractual worker for an RHC beneficiary at the following sites: 1. The RHC, or 2. Beneficiary’s residence. F. The Division of Medicaid covers the services of an outside laboratory for laboratory services not listed in Miss. Admin. Code Part 212, Rule 1.2.C. separate from the encounter rate. G. The Division of Medicaid covers an RHC as an originating and/or distant site telehealth provider. H. The Division of Medicaid covers the delivery of RHC services in a school-based clinic operated by an RHC and staffed with a physician, nurse practitioner and/or physician assistant. I. RHC mobile units are covered services when the requirements of Miss. Admin. Code Title 23, Part 212, Rule 1.2 are met. J. Diabetes Self-Management Training (DSMT) is a covered service that is included in the PPS rate for a core service for an RHC but is not considered a core service. K. Vaccine administration is a covered service that is included in the PPS rate for a core service for an RHC but is not considered a core service.