Reimbursement

Reimbursement A. The Division of Medicaid reimburses expanded rehabilitative services based on a statewide uniform fee schedule. B. The Division of Medicaid does not reimburse for the duplication of services. 1. Providers are responsible for coordinating services with the beneficiary and guardian/legal representative to avoid service duplication when the beneficiary is receiving mental health services at more than one (1) location from more than one (1) provider. 2. When duplicate service claims are filed the provider billing the first claim is reimbursed. C. The Division of Medicaid reimburses a monthly fee for medically necessary wraparound facilitation as part of a targeted case management benefit for EPSDT-eligible beneficiaries with a serious emotional disturbance (SED) that meet the level of care provided in a psychiatric residential treatment facility (PRTF). D. The Division of Medicaid reimburses an hourly rate and additional time in fifteen (15) minute units for Mississippi Youth Program Around the Clock (MYPAC) Therapeutic Services. 1. Beneficiaries must be provided a choice of the following: a) MYPAC therapeutic services or individual therapeutic services, b) The provider of the services and c) The team members included in service planning. 2. The Division of Medicaid does not reimburse for services included in MYPAC Therapeutic Services individually during the time period the beneficiary has chosen to receive MYPAC Therapeutic Services. 3. Service provision must, at a minimum, be one (1) hour per day to be reimbursed for the services. a) The initial hour must be billed as four (4) fifteen (15) minute units. b) After the initial hour, fifteen (15) minute units may be billed based on actual time of service provision as medically necessary and with appropriate documentation.