Home care billing · MS
Home care billing in Mississippi
Short answer
Home care billing in Mississippi is fee-for-service for most long-term care. CMS's 2024 tables show MississippiCAN covering home health and private duty nursing, but not state plan personal care, HCBS waiver services or hospice, and full duals are not enrolled.
Waiver services start only after the Division of Medicaid, or the Department of Mental Health for the ID/DD Waiver, approves the Plan of Services and Supports. Under Rule 1.14, claims for EVV services go to the fiscal agent through the state's EVV system, and every claim is due within 365 days of service. A dedicated Remitwright biller matches each claim to the approved plan and its visits, serving Mississippi agencies remotely. Rules for other states are on the home care billing by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Key facts for Mississippi home care billing
| Fact | In Mississippi | Source |
|---|---|---|
| Programs that pay | Elderly and Disabled Waiver (0272.R07.00); Independent Living Waiver (0255.R07.00); Traumatic Brain Injury and Spinal Cord Injury Waiver (0366.R05.00); Intellectual Disabilities and Developmental Disabilities Waiver (0282.R06.00); Assisted Living Waiver (0355.R05.00); Community Support Program (1915(i)) and state plan in-home services | 1 |
| How it is delivered | Split by service | 2 |
| Medicare home health and hospice | Palmetto GBA, Jurisdiction M | 8 |
Programs that pay for home care in Mississippi1
Elderly and Disabled Waiver (0272.R07.00)
Adult day care, case management, in-home respite, personal care, extended home health, community transition, environmental safety, home delivered meals, institutional respite, medication management, physical therapy and speech therapy, for people 65 and older and people 21 to 64 with physical disabilities who meet a nursing facility level of care.
Part 208 has the Division of Medicaid administer and operate the E&D Waiver, with two-person case management teams monitoring each Plan of Services and Supports.
Independent Living Waiver (0255.R07.00)
Personal care attendant services, environmental accessibility adaptations, specialized medical equipment and supplies and transition assistance, for people 16 to 64 with physical or other disabilities and people 65 and older who meet a nursing facility level of care.
Operated jointly by the Division of Medicaid and the Mississippi Department of Rehabilitation Services, with the fiscal agent processing claims and issuing payments.
Traumatic Brain Injury and Spinal Cord Injury Waiver (0366.R05.00)
Personal care attendant services, respite, environmental accessibility adaptations, specialized medical equipment and supplies and transition assistance, for people of any age with a brain injury or physical disability who meet a nursing facility level of care.
Also operated jointly with the Mississippi Department of Rehabilitation Services; a waiver enrollee cannot receive services through another waiver at the same time.
Intellectual Disabilities and Developmental Disabilities Waiver (0282.R06.00)
Adult day services, in-home respite, in-home nursing respite, community respite, prevocational services, supervised living, supported living and shared supported living, support coordination, supported employment and job discovery, specialized medical supplies, therapy services, behavior support, crisis intervention and crisis support, home and community supports, host home and transition assistance, for people of any age with autism, intellectual or developmental disabilities who meet an ICF/IID level of care.
The Department of Mental Health runs the waiver day to day, and services may be provided only when DMH approves them and the support coordinator authorizes them in the approved Plan of Services and Supports.
Assisted Living Waiver (0355.R05.00)
Adult residential care and assisted living services, for people 65 and older, people 21 to 64 with physical or other disabilities and adults with an acquired traumatic brain injury who meet a nursing facility level of care.
Community Support Program (1915(i)) and state plan in-home services
Supported living and in-home respite under the 1915(i) Community Support Program, and state plan private duty nursing, personal care, and home health skilled nursing, aide, physical therapy and speech-language pathology visits.
These are the non-waiver services that Rule 1.14 of Title 23, Part 200 places under EVV alongside the waiver services.
How the program is delivered
Split by service. MississippiCAN, the statewide coordinated care program run under 1932(a) authority since January 1, 2011, covers home health and private duty nursing for its members, but CMS's 2024 tables do not list state plan personal care, HCBS waiver services, hospice or nursing facility services in its benefit, and full duals are not enrolled. Those services are billed fee-for-service to the Division of Medicaid's fiscal agent.2 The Division of Medicaid now lists Magnolia Health Plan, Molina Healthcare and TrueCare as its managed care plans; the 2024 CMS table named Magnolia, UnitedHealthcare Community Plan and Molina. A claim that a plan paid and later recouped because the member moved to fee-for-service goes to the Division within 365 days of service, or within 90 days of the recoupment when that falls later.
Electronic visit verification
Rule 1.14 of Title 23, Part 200, a new rule effective December 1, 2025, makes EVV data a condition of payment for the listed personal care and home health services. Agencies either use the state-provided EVV provider portal through HHAeXchange or a Division-approved contracted system that sends its data to the state aggregator within 14 days of collection, and claims for EVV services go to the fiscal agent through the state's EVV system unless the Division approves another route in writing.4 Manual entry is allowed only when the system is unavailable or exigent circumstances make it impossible, with the date and time of entry, the reason and the person entering it recorded, and suspected falsification is reported to Program Integrity within two business days. CMS lists Mississippi not compliant for personal care EVV and non-compliant for home health EVV. Its December 31, 2020 letter found the E&D Waiver compliant for personal care while the state plan benefit, the ID/DD, TBI/SCI and Independent Living waivers and the 1915(i) option were not.
Services under EVV4
- Elderly and Disabled Waiver personal care and in-home respite
- ID/DD Waiver home and community supports, in-home nursing respite, in-home respite and supported living
- Independent Living Waiver personal care attendant services
- TBI/SCI Waiver personal care attendant, in-home companion respite and in-home nursing respite
- 1915(i) Community Support Program supported living and in-home respite
- State plan private duty nursing, personal care, and home health skilled nursing, aide, physical therapy and speech-language pathology
Authorizations
By the Division of Medicaid, or the Department of Mental Health for the ID/DD Waiver, before any service starts. For the E&D Waiver the case management provider submits the LTSS assessment, the Bill of Rights, the Plan of Services and Supports, the emergency preparedness plan and the informed choice form for prior approval, and any service added to or increased on the plan needs its own prior approval with documentation of the need.5 ID/DD Waiver services must be approved by DMH and authorized by the support coordinator in the approved Plan of Services and Supports, and DMH certifies the ICF/IID level of care before services begin. Claims must reflect services rendered as authorized by the plan, and the Division runs post-utilization reviews to confirm each service was on the approved plan.
Where the claims go
To the fiscal agent, no later than 365 calendar days from the date of service under Rule 1.6, and for EVV services through the state's EVV system. A newly enrolled provider can bill only for services on or after its enrollment effective date, and a claim that misses the window cannot be billed to the beneficiary.6 Rule 1.6 also allows 180 days after the notice of a timely Medicare disposition and 90 days after a plan recoupment that lands past day 365. Part 208 holds some waiver services, among them E&D case management, adult day care, institutional respite and home delivered meals and most ID/DD services, to billing no sooner than the first day of the following month. Rule 1.8 allows an administrative review within 30 days of a denial in listed cases, including retroactive eligibility when the prior authorization and the claim came within 90 days of the eligibility add date. MississippiCAN claims follow each plan's manual.
Medicare home health and hospice in Mississippi
Palmetto GBA, LLC processes Medicare home health and hospice claims for Mississippi as the Jurisdiction M A/B MAC, a home health and hospice region that also takes in Alabama, Arkansas, Louisiana, Tennessee, Texas and ten more states.8 For Medicaid, MississippiCAN covers home health for its members, Rule 1.14 puts home health skilled nursing, aide, physical therapy and speech-language pathology visits under EVV, and the E&D Waiver adds extended home health services paid on the statewide uniform fee schedule. CMS's December 29, 2023 letter found Mississippi non-compliant for home health EVV in the state plan benefit and the 1915(c) waivers, recorded the state's plan to finish EVV upgrades in early 2024, and began federal match reductions that year.
Common rejections in Mississippi, and the fix
Waiver service delivered before prior approval
The fixRule 1.7 of Part 208 requires the Division's prior approval before an E&D Waiver beneficiary receives any service, and an added or increased service needs its own approval. The biller holds claims until the approved Plan of Services and Supports is on file and the start date matches.
Units outside the approved Plan of Services and Supports
The fixClaims must reflect services rendered as authorized by the plan, and post-utilization reviews check them against it. The biller totals units per service against the plan before release and asks the case manager or support coordinator for an approved change before more is delivered.
EVV service billed outside the state's EVV system
The fixRule 1.14 sends claims for EVV services to the fiscal agent through the state's EVV system unless the Division approves otherwise in writing. The biller bills those services from HHAeXchange, or from the approved system after its data reaches the aggregator.
Visit data from a contracted EVV system that never reached the aggregator
The fixAn approved provider-contracted system has to send visit data to the state aggregator within 14 days of collection. The biller checks the aggregator for each visit before billing and has the agency resend any visit that is missing.
Claim received more than 365 days after the date of service
The fixRule 1.6 sets the window, and the beneficiary cannot be billed for a missed one. The biller files as soon as visits are verified and keeps the Medicare disposition notice or plan recoupment date for the 180-day and 90-day exceptions.
Monthly waiver service billed before the month ended
The fixPart 208 bars billing some E&D services, such as case management, adult day care, institutional respite and home delivered meals, and most ID/DD services until the first day of the month after the service. The biller queues those lines for the following month.
Personal care or waiver claim sent to a MississippiCAN plan
The fixCMS's 2024 tables leave state plan personal care and HCBS waiver services out of the MississippiCAN benefit. The biller sends those claims fee-for-service to the fiscal agent and bills the plan only for covered services such as home health.
Remitwright serves Mississippi home care and home health agencies remotely, inside the agency software you already use, with a dedicated biller.
FAQ
Questions from Mississippi agencies
Do we bill a MississippiCAN plan or the fiscal agent for personal care and waiver services?
Can we use our own EVV system instead of HHAeXchange?
Who approves Elderly and Disabled Waiver services?
When can we bill for E&D or ID/DD waiver services each month?
How long do we have to file a Mississippi Medicaid claim?
What if the EVV system is down during a visit?
Which programs pay for home care in Mississippi?
Which services fall under EVV in Mississippi?
Which Medicare contractor pays home health and hospice claims in Mississippi?
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