CurrentMississippi Division of MedicaidPolicy N/A
Rule 1.3: Provider Enrollment (E&D Waiver)
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Rules governing provider enrollment and provider-type specific requirements for Mississippi Division of Medicaid Home and Community-Based Services (HCBS) Elderly & Disabled (E&D) Waiver providers, including operational, staffing, facility, vehicle, and compliance obligations for entities seeking to enroll and maintain enrollment.
Policy Summary
PayerMississippi Division of Medicaid
PolicyRule 1.3: Provider Enrollment (E&D Waiver)
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateAug 1, 2026
Last ReviewAug 1, 2026
Next Review DateN/A
Key ActionAttend mandatory orientation, score at least 85 on the orientation exam, and submit a completed proposal package to the Office of Long-Term Care for Division approval.
SourceLink
POLICY UPDATE CHANGES
No material clinical or coverage changes in this revision.
85orientation exam score
1 yearminimum prior service
6 monthsagreement timeframe
2 yrsbackground check freq
bi‑annualvehicle inspection
60 milessupervisor distance
Provider Enrollment and Service Criteria
inv-01: General provider enrollment criteria
General enrollment and operational criteria applicable to all E&D Waiver providers unless exempted in writing by the Division of Medicaid.
Providers must meet all applicable requirements in Miss. Admin. Code Title 23, Part 200, Chapter 4 in addition to the requirements below.
Attend mandatory orientation and achieve a minimum score of 85 on the orientation examination prior to application.
Submit a completed proposal package to the Office of Long-Term Care for Division approval and, if approved, enter into a provider agreement with the Division of Medicaid within six (6) months of receiving an approved proposal package letter.
Be established as a business entity and have provided the specified service(s) for at least one (1) year prior to application.
Submit proposed changes to location, supervisory staffing, or organizational contact information to the Division of Medicaid for approval prior to implementation; report ownership/organizational structure changes in writing within ten (10) business days as required.
Maintain an advisory committee representative of the community and beneficiary population that meets quarterly, maintains agenda and minutes, and provides public notice at least 24 hours prior to meetings.
Provide proof of financial solvency by: (a) establishing and maintaining a business line of credit sufficient to cover at least three (3) months of operations at all branch locations; (b) submitting the most current filed business tax return with verification of filing (e.g., 8879 or IRS 9325 SID); and (c) providing an itemized expense report reflecting monthly income and expenditures for the prior twelve (12) months.
Establish and maintain a physical office with a non-residential Mississippi address for a minimum of six (6) months prior to enrollment; office must meet signage, ADA, zoning, fire, OSHA and health code requirements; provide private space for confidential beneficiary discussions; lockable HIPAA-compliant file storage; regular business hours (Mon–Fri 8am–5pm); dedicated office telephone and secure electronic transmission capability.
Successfully pass any required facility inspection by the Division of Medicaid appropriate to provider type prior to enrollment.
Conduct national criminal background checks with fingerprints on all employees and volunteers who participate in face-to-face interactions with beneficiaries prior to employment and every two (2) years thereafter; maintain results in personnel files.
Perform registry checks before employment and monthly thereafter to ensure employees/volunteers are not listed on the Mississippi Nurse Aide Abuse Registry or the OIG Exclusion Database; do not employ individuals appearing on those registries.
Not employ or have associated individuals convicted of specified serious felonies (e.g., possession/sale of drugs, murder, sexual offenses listed in Miss. Code Ann. §45-33-23(h), child abuse, arson, burglary, aggravated assault, felonious abuse/battery of a vulnerable adult) to participate in face-to-face interactions with beneficiaries.
Maintain written criteria for service provision, including emergency service procedures, and maintain policy and procedure manuals compliant with state and federal laws and Division regulations; maintain personnel management processes and current training plans documenting required hire and annual trainings.
Maintain personnel files for every employee and volunteer containing credentialing documentation, training records, performance reviews and any other required information; keep an accurate historical employee listing including hire/termination dates and identification numbers.
Maintain a roster of qualified personnel necessary to provide authorized services until employment termination; roster must include designated workspace addresses for supervisory staff.
Comply with all applicable federal and state regulations, including tax and labor laws, and ensure PHI/PII is handled consistent with HIPAA requirements.
At enrollment, providers must not be owned or operated by any individual or entity currently under investigation by the Division's Office of Program Integrity, the Medicaid Fraud Control Unit, or other government entity, and must not have violations of Miss. Admin. Code or the Medicaid Provider Agreement in the previous 18 months.
In the event of a change of ownership, submit a proposal packet for review and approval within thirty-five (35) days and meet requirements of Miss. Admin. Code, Part 200, Rule 4.3; enrollment effective date may be retroactive to licensure date when applicable.
inv-02: Case management provider criteria
Case management provider staffing, training, certification, and supervisory requirements.
Operate as a statewide network and maintain policies and procedures compliant with all state and federal laws and Division regulations.
Each case management team must consist of two (2) persons who are Mississippi licensed social workers (LSWs) and/or Mississippi registered nurses (RNs) meeting the specified qualifications.
RN requirements (one of)
- Maintain an active, unencumbered Mississippi license or a compact privilege to practice in Mississippi.
- Have at least two (2) years of documented nursing experience in direct care for aged and/or disabled persons OR at least ninety (90) days of training regarding direction of E&D Waiver services under supervision of an established E&D Waiver case manager with two (2) years of E&D Waiver experience.
- Be certified to complete the comprehensive Long-Term Services & Supports (LTSS) assessment.
LSW requirements (one of)
- Maintain an active social work license in Mississippi and have a bachelor's degree in social work or other health-related field.
- Have at least two (2) years of documented experience in direct care services for aged and/or disabled clients OR at least ninety (90) days of supervised training regarding direction of waiver services under an established waiver case manager with two (2) years of waiver experience.
- Be certified to complete the comprehensive LTSS assessment.
Each team must have an assigned case management supervisor who cannot carry an active caseload of beneficiaries.
All case management supervisors and case managers must successfully complete a mandatory training course upon hire and annually thereafter covering specified topics and must pass a scored examination prior to rendering services. Required topics include: Vulnerable Persons Act (identifying/preventing/reporting abuse, neglect & exploitation); Person-Centered Thinking including Participant Rights and Dignity; Assisting with ADLs/IADLs; Crisis Prevention/Intervention and Emergency Preparedness; Caring for Participants with Cognitive or Behavioral Conditions; Signs and Symptoms of Illness including Seizures; HIPAA Compliance and Confidentiality; Safety including preventing/reporting accidents/incidents and operation of assistive devices; Professional Documentation Practices; Universal Precautions & Infection Control; and Medicaid Administrative Code and the E&D Waiver.
inv-03: Adult Day Care (ADC) provider criteria
Adult Day Care (ADC) provider facility, staffing, training, vehicle, and operational requirements and standards.
Serve only in counties determined and approved by the Division of Medicaid based on location, distance, and travel time.
Maintain sufficient staffing with current first aid and CPR certification; at least two (2) persons (one paid employee) must be on-site whenever beneficiaries are present.
Maintain employee-to-attendee ratios of at least 1:6 in standard programs and 1:4 for programs serving a high percentage of severely impaired attendees.
Provide orientation upon hire and ongoing training including a minimum of four (4) in-service training sessions per year; at hire and annually staff must be trained on listed ADC topics (e.g., purpose/goals of ADC, facility policies, roles/responsibilities, beneficiary rights, body mechanics/transfers, CPR/first aid/infection control, emergency plans, nutrition/food safety, mandatory reporting, behavioral interventions, person-centered thinking, and E&D Waiver requirements).
Meet physical and social needs of beneficiaries and maintain compliance with state and federal guidelines for services provided.
Facility requirements: provide at least sixty (60) square feet of temperature-regulated multipurpose program space per day service attendee; rest area separate from activity areas with supervised call button; private staff workspace with separate restroom and break space; locked storage for toxic substances; at least two ADA-compliant exits meeting specified criteria; safe, well-lit environment free of hazards; sufficient ADA-accessible seating; MSDH permit for onsite kitchen or contracted MSDH-licensed caterer for onsite meals; one meal and two snacks must be included as service component (HDMs cannot substitute).
Provide sufficient, adequately lit parking, including ADA compliant and van-accessible spaces per specified ratios.
Vehicles: maintain a sufficient number of vehicles to transport beneficiaries; each vehicle must be accessible for boarding without difficulty; equipped with two-way communication or cell phone; meet local/state/federal and ADA vehicle requirements; have functioning HVAC; provide and store seat belts appropriately with at least two seat belt extensions; carry a seat belt cutter accessible to driver; have accurate speedometer and odometer; two exterior side mirrors and interior monitoring mirror; be clean and free of hazards; display provider business name and telephone number on both sides; not display signage implying Medicaid transport; display vehicle license number and local phone number inside; provide written complaint procedures; prohibit smoking with interior 'NO SMOKING' sign; carry vehicle information packet (registration, insurance, accident procedures/forms); be equipped with first aid kit, fire extinguisher, spill kit; maintain insurance per law; be inspected by certified mechanic prior to application, upon initial use, and bi-annually thereafter; maintain records of bi-annual inspections for Division review; be driven only by authorized employees compliant with requirements.
Staffing and management: have a written plan of operation approved by the governing board; maintain required employees including a full-time administrator (qualified by master's +1 year supervisory experience OR bachelor's +3 years OR comparable training/experience), an on-site full-time program director if administrator not on-site (with specified qualifications), a licensed nurse available on-site minimum eight (8) hours per week with at least one (1) year applicable experience, a full-time onsite activities coordinator with bachelor's +1 year experience OR associate +2 years, a full-time program assistant with HS diploma +1 year experience, a ServSafe certified employee for onsite food preparation, and a driver who meets driver-specific requirements including being >=18 years old with current driver's license, courteous/clean appearance, wearing visible name tag, and providing required assistance and safety practices.
inv-04: Provider enrollment and staffing criteria
Provider and staff qualification and operational criteria required for payment or participation as waiver service providers.
Personal care attendants must be at least eighteen (18) years old; have a high school diploma or GED or demonstrate literacy sufficient to read assignments and complete required forms; successfully complete a mandatory training course upon hire covering specified topics and pass a scored examination prior to rendering services; attend the training annually; pass a facility-administered initial hands-on skills assessment; possess valid state identification and reliable transportation; have current first aid/CPR certification; annually attest to absence of major communicable disease; be physically and mentally able to perform assigned tasks.
Personal care supervisors/directors must have a designated workspace (addresses captured on roster) within 60 miles of the provider office or as designated by supervisor and must meet supervisory experience/education options: at least two (2) years supervisory experience with elderly/disabled; education/licensure pathways include bachelor's degree plus two (2) years experience, RN/LPN plus two (2) years experience, or high school diploma/GED plus four (4) years experience (as detailed in provider-specific sections).
In-home respite employees must be at least eighteen (18) years old; have a high school diploma or GED or demonstrate literacy; successfully complete a curriculum training course upon hire and annually thereafter covering specified topics and pass a scored exam prior to rendering services; pass a facility-administered initial hands-on skills assessment; demonstrate ability to work with aged and disabled individuals, possess valid state ID and reliable transportation, and have first aid/CPR certification.
Non-legally responsible relatives may be paid providers when they meet Appendix C-1/C-3 qualifications, the beneficiary or representative signs verification of services, the relative signs an agreement to render services consistent with scope and limitations, and the Division may remove the relative from service at its discretion.
Home Delivered Meal providers must have MSDH certification, a qualified operational lead, adequate staffing, employees trained in MSDH-approved meal preparation and serving techniques, and must submit policies/procedures and a business plan for Division approval and provide documentation of compliance; coordinate delivery times with beneficiaries.
Extended Home Health, Physical Therapy, and Speech providers must participate in Medicare Title XVIII where applicable, furnish state licenses/certifications, comply with state and federal laws, provide CON if applicable, and employ properly licensed practitioners with non-restrictive Mississippi licenses.
Community Transition Service (CTS) providers must document at least two (2) years of successfully transitioning individuals into the community or eight (8) years working with individuals in the community; have documentation of attending Division-approved person-centered training; attend quarterly and annual CTS trainings with at least one attendee; have written after-hours crisis procedures; and employ qualified community navigators and supervisors meeting specified licensure/education/experience requirements (e.g., community navigator options include LSW with valid Mississippi license and minimum one (1) year relevant experience; case manager certified by DMH with >=1 year experience; RN with valid Mississippi license and >=1 year experience; or an individual with a bachelor's degree and >=1 year relevant experience).
All providers: the Division may require execution of a participation agreement with the Division of Medicaid and may terminate or suspend providers immediately for noncompliance, require corrective action plans, and take enforcement action consistent with Division authority.
Licensure, Certification, and Operational Thresholds
Licensure and certification requirements for therapy and home health agenciesmixed
| No codes listed |
inv-06: Driving record/drug test thresholds — moving violations/accidents and failed drug test removal triggers
Removal triggersADC driver must be removed from service if they fail an annual random drug test; or are convicted of two moving violations or accidents related to transportation in the previous five (5) years as verified by an annual MVR; or have a suspended or revoked driver's license for moving traffic violations in the previous five (5) years.
Moving violations thresholdTwo (2) moving violations or accidents related to transportation in the prior five (5) years (verified by annual MVR) triggers removal from service.
Drug test thresholdFailure of an annual random drug test requires removal from service.
License suspension/revocationSuspended or revoked driver's license for moving traffic violations in the previous five (5) years (verified by annual MVR) requires removal.
Related statutory convictionsConviction of any federal or state crime listed in Miss. Code Ann § 43-13-121 requires removal from service.
Enrollment Steps, Reporting, and Operational Duties
Prior Authorization
Complete mandatory orientation, pass exam, and submit proposal package
Attend mandatory orientation, achieve a minimum score of 85 on the orientation exam, and submit a completed proposal package to the Office of Long-Term Care for Division approval; after approval, be approved for enrollment by Provider Enrollment and enter into a provider agreement within six months of receiving the approved proposal package letter.
- Mandatory orientation required at time of application.
- Orientation exam minimum score: 85.
- Submit completed proposal package to the Office of Long-Term Care.
- Enter into provider agreement within six (6) months of approved proposal letter.
Documentation Required
Submit financial solvency documentation and tax/expense records
Provide proof of financial solvency by establishing and maintaining a business line of credit sufficient to cover at least three months of operational costs at all branch locations; submit the most current filed business tax return with verification (e.g., Form 8879 or IRS Form 9325 with SID) and an itemized monthly expense report for the prior 12 months.
- Business line of credit from an FDIC- or NCUA-insured financial institution covering ≥ three months of operations.
- Copy of most current filed business tax return plus confirmation of filing (Form 8879 or IRS 9325 with SID).
- Itemized expense reports reflecting income and expenditures for each month for the past 12 months.
Documentation Required
Obtain Division approval for location/staffing/contact changes and timely report ownership changes
Submit any proposed changes to physical location, supervisory staffing, or organizational contact information to the Division of Medicaid for approval before implementing the change, and report changes in ownership or organizational structure in writing within ten (10) business days.
- Proposed changes to location, supervisory staffing, or organizational contacts require Division approval prior to implementation.
- Report ownership or organizational structure changes in writing within 10 business days.
Documentation Required
Require visible employee name tags identifying employee and employer
Ensure all employees wear a visible, easily read name tag that identifies both the employee and the employer while on duty.
- Name tag must be visible and easily readable.
- Name tag must identify the employee and the employer.
Documentation Required
ADC driver operational duties and prohibitions
ADC drivers must provide appropriate assistance to beneficiaries (including curb-to-curb, door-to-door, and hand-to-hand assistance), secure mobility devices, assist with seating and seat belts, park safely, notify the provider of emergencies, and report accidents or incidents; they must not leave beneficiaries unattended, be impaired by substances, smoke in the vehicle, wear headphones except hands-free for provider communication, touch passengers except as necessary, or provide services without completing required background checks.
- Provide curb-to-curb, door-to-door, and hand-to-hand assistance as required.
- Confirm beneficiary is safely inside before departing and properly secure mobility devices.
- Assist with seating and ensure seat belts are fastened properly.
- Park in a safe location and avoid parking that requires beneficiaries to cross streets.
- Notify the ADC provider immediately of emergencies, accidents, or vehicle breakdowns and report incidents as soon as practicable.
- Prohibitions: leaving beneficiaries unattended; use of alcohol, narcotics, or impairing prescriptions; smoking in vehicle or in presence of beneficiary; wearing headphones (except hands-free for provider communication); touching passengers except as necessary; providing services without completing national/state background checks.
Denial Risk
Grounds for ADC driver removal (drug test and driving thresholds)
Remove an ADC driver from service if they fail an annual random drug test, have two moving violations or accidents related to transportation in the prior five years (as verified by an annual MVR), have a suspended or revoked license for moving traffic violations in the prior five years, or are convicted of any federal or state crime listed in Miss. Code Ann § 43-13-121.
- Fail an annual random drug test → removal from service.
- Two moving violations or accidents in previous five years (verified by annual MVR) → removal from service.
- Suspended or revoked driver's license for moving violations in previous five years (verified by annual MVR) → removal from service.
- Conviction of crimes listed in Miss. Code Ann § 43-13-121 → removal from service.
Denial Risk
Division enforcement authority: suspension, termination, and corrective action plans
The Division of Medicaid may immediately suspend or terminate providers for noncompliance and may require corrective action plans; failure to submit or comply with a corrective action plan may result in suspension or termination of the provider agreement.
- Division authority to suspend or terminate providers immediately for noncompliance.
- Division may require corrective action plans (CAPs) and escalate to suspension/termination for failure to comply.
Key Terms
inv-14: E&D Waiver provider — definition entry
DefinitionE&D Waiver provider — A provider participating in the Home and Community-Based Services (HCBS) Elderly & Disabled (E&D) Waiver who must meet the applicable requirements in Miss. Admin. Code Title 23, Part 200, Chapter 4 and the provider-type specific requirements in Rule 1.3 at the time of application and at all times thereafter.
Enrollment basicsMust attend mandatory orientation, score at least 85 on the orientation exam, and submit a completed proposal package to the Office of Long-Term Care for Division approval.
Operational expectationMust be established as a business entity and provide the specified service(s) for a minimum of one (1) year prior to application (unless exempted in writing by the Division).
inv-15: Case management team — definition entry
DefinitionCase management team — The multidisciplinary staff responsible for waiver case management, including case managers and supervisors who meet required education, licensure, training, and experience standards and who complete mandatory training and scored examinations prior to rendering services.
Supervisor roleEach team must have an assigned case management supervisor who cannot carry an active caseload and who ensures mandatory initial and annual training completion for staff.
Training requirementsAll case management supervisors and case managers must complete mandatory training upon hire covering specified topics (e.g., Vulnerable Persons Act, Person Centered Thinking, ADLs/IADLs, Crisis Prevention/Intervention) and pass a scored exam; training is required annually thereafter.
inv-16: non-legally responsible relative — definition entry
DefinitionNon-legally responsible relative — Any individual related by blood or marriage to the beneficiary who is not a legal guardian or legal representative (this excludes spouses, parents/stepparents of minor children, conservators, guardians, power of attorney holders, and representative payees).
Payment eligibilityDivision may allow payments to non-legally responsible relatives only when the relative meets the qualifications specified in Appendix C-1/C-3 of the CMS-approved waiver application and the beneficiary or designated representative signs verification that services were rendered.
Agreement requirementThe selected relative must sign, prior to providing services, an agreement to render services in accordance with the scope, limitations, and professional requirements during their designated hours; the Division reserves the right to remove the relative from providing services at any time.
Policy Summary
PayerMississippi Division of Medicaid
PolicyRule 1.3: Provider Enrollment (E&D Waiver)
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateAug 1, 2026
Last ReviewAug 1, 2026
Next Review DateN/A
Key ActionAttend mandatory orientation, score at least 85 on the orientation exam, and submit a completed proposal package to the Office of Long-Term Care for Division approval.
SourceLink
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