32 Miss. Code. R. 1-21.0

Current through December 10, 2024

Section 32-1-21.0 - AUTHORIZATION OF SERVICES

All services purchased for OSDP/IL clients will be authorized in AACE either simultaneously with, or prior to, such purchases. Only a Counselor or other member of the OSDP/IL professional staff will authorize the purchase of services. Authorizations will be issued only after a case has been placed in Application Status. Authorizations are to be signed by the Counselor in the top and bottom sections where indicated.

All authorizations for specialized medical supply (SMS), home modifications, and durable medical equipment (DME) must be forwarded to, and reviewed by, the District Managers prior to submission to the State Office for payment.

District Managers are responsible for making sure all authorizations are submitted with the necessary documentation including remittance forms, final inspections, a current envision sheet and approval to pay vendors.

Any authorization with missing documentation will be sent back to the District Manager for correction. (Authorizations will not be held at the State Office due to missing or incorrect information.)

All authorizations for SMS will be reviewed by the counselor, and then forwarded to the vendor, on the first day of each month.

Authorizations for SMS should not be printed for more than one month at a time for the following reasons:

a) The client's needs may change; therefore, the authorization will need to be amended.

b) Change in counselors. If transferred, a counselor cannot amend another counselor's authorization.

c) Overstock in supplies. If client has too many supplies, the authorization should not be submitted for the following month; thus saving money.

The file copy will be placed in an outstanding authorization holding file until the original copy is received back from the vendor, paid in AACE or the authorization is cancelled.

All SMS payments must be paid in AACE then forwarded to State Office by the 15^th of each month. This includes the original signed authorization and two copies.

When making payments in AACE, enter all corresponding invoice numbers on the AACE payment page.

All authorizations for SMS or DME must include client's Medicaid, Medicare and private insurance information directly on the authorization. Remember:

a) Medicare will not pay for adult diapers or blue pads, so an Explanation of Benefits (EOB) is not needed.

b) State Medicaid will not pay for adult diapers or blue pads for anyone 21 and above so an EOB is not needed. Please check the client's date of birth.

c) State Medicaid will pay for catheters, leg bags, adult diapers, blue pads, etc for all clients under 21. Please check client's date of birth.

When using waiver funds, a copy of the approved Plan of Care (POC) should be attached to Madison's copy of the authorization. Keep in mind, the services must be approved on the most recent POC.

Check the dates of services rendered to the authorization date. If the date of service is prior to the authorization date, verify that a draft authorization was done, and note on the statement of account that a draft is in the file.

If for some reason the authorization was not issued in the electronic case file prior to or simultaneously with provision of services, the following should occur:

a) An authorization must be initiated and placed in DRAFT status.

b) The DRAFT authorization should then be forwarded to the District Manager with an explanation as to why the authorization that was verbally authorized was not issued simultaneously in the electronic file, AACE. This explanation can be entered in the comments section of the authorization.

c) The District Manager then must review the authorization and explanation and either approve or disapprove the issuance of the authorization.

d) If the District Manager approves the authorization, the authorization can then be issued in AACE and mailed to the vendor.

e) When the Authorization/Statement of Account is signed and returned to the Counselor prior to submitting to finance, DRAFT in file must be entered/written on the authorization. The dates of services should be recorded as the actual date the service was provided which in most case is prior to the authorization begin dates.

When bills are received from vendors to verify the service was authorized and this is a valid expense, the authorization number should be recorded on the bill, and the Counselor should initial the bill.

When checking the status of a vendor payment, the counselor must:

a) Check with his/her District Manager on the status of a vendor's payment;

b) Managers will check to see if the authorization was received by the State Office;

c) Managers can check with Finance after the above has been checked.

32 Miss. Code. R. 1-21.0