CurrentMississippi Division of MedicaidPolicy N/A

MYPAC (Mississippi Youth Programs Around the Clock) Therapeutic Services Coverage Criteria

Customize your policy alerts

Sign up for all Mississippi Division of Medicaid policy alerts

Know when Mississippi Division of Medicaid releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Defines coverage, service components, provider qualifications, prior authorization, and payment methodology for MYPAC therapeutic services for EPSDT-eligible beneficiaries who meet PRTF level of care in Mississippi.

Policy Summary

PayerMississippi Division of Medicaid

PolicyMYPAC Therapeutic Services Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateNov 1, 2023

Last ReviewNov 1, 2023

Next Review DateN/A

Key ActionObtain prior authorization from the UM/QIO and include services in an approved treatment plan signed by an authorized team member.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

EPSDTpopulation served

PRTFclinical level referenced

Prior authutilization control

Certification req'dprovider qualification

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentMississippi Division of MedicaidPolicy N/A

MYPAC (Mississippi Youth Programs Around the Clock) Therapeutic Services Coverage Criteria

Customize your policy alerts

Sign up for all Mississippi Division of Medicaid policy alerts

Know when Mississippi Division of Medicaid releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerMississippi Division of Medicaid

PolicyMYPAC Therapeutic Services Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateNov 1, 2023

Last ReviewNov 1, 2023

Next Review DateN/A

Key ActionObtain prior authorization from the UM/QIO and include services in an approved treatment plan signed by an authorized team member.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

EPSDTpopulation served

PRTFclinical level referenced

Prior authutilization control

Certification req'dprovider qualification

Coverage and Medical Necessity

MYPAC Medical Necessity and Coverage Criteria

Covered when ALL of the following are met:

MYPAC coverage criteria: 1) Beneficiary is EPSDT-eligible; 2) Beneficiary meets the level of care provided in a psychiatric residential treatment facility (PRTF); 3) Services are provided in the home or community for family stabilization to permit remaining in the community; 4) Services are included in a treatment plan and approved by an authorized team member; 5) Services are prior authorized as medically necessary by the UM/QIO; 6) Services are provided by Mississippi Department of Mental Health certified providers within the scope of their license/certification.

Derived from policy service description and administrative requirements.

This policy addresses coverage of Mississippi Youth Programs Around the Clock (MYPAC) Therapeutic Services for beneficiaries who are EPSDT-eligible and who meet the psychiatric residential treatment facility (PRTF) level of care. Coverage applies when services are provided in the home or community with the clinical aim of family stabilization, crisis diffusion, and preventing out-of-home placement so the beneficiary may remain in the community.

The source document does not include explicit statements listing services as not medically necessary. The policy text focuses on the conditions and components under which MYPAC Therapeutic Services are covered for EPSDT-eligible beneficiaries meeting PRTF-level criteria.

PRTF-Level of Care — Eligibility for Community/Home-based Services

Permitted MYPAC Treatment Modalities

Comprehensive community/home-based behavioral health services (MYPAC)

MYPAC service components: Includes treatment plan development and review; medication management (evaluation and monitoring of psychotropic medications); intensive individual therapy; family therapy (including participation of non-Medicaid individuals when beneficial and tailored to the beneficiary's needs); group therapy; peer support services; community support services including identification of strengths and barriers, individualized therapeutic interventions, monitoring/evaluation of interventions, psychoeducation on medication management, direct crisis de-escalation interventions, relapse prevention, facilitation of the Individual Service Plan/Recovery Support Plan, and skill-building groups (social skills, self-esteem, anger control, conflict resolution, daily living skills).

Service components listed verbatim in policy.

Provider Responsibilities and Authorization

Prior Authorization

Prior authorization and treatment plan approval required

MYPAC therapeutic services require prior authorization as medically necessary by the UM/QIO and must be included in an approved treatment plan signed or approved by an authorized team member.

Prior authorization must be obtained from the UM/QIO before services are provided.
The approved treatment plan must be signed/approved by an authorized team member (psychiatrist, physician, psychologist, LCSW, LPC, LMFT, PMHNP, or PA).

Denial Risk

Denial risk if prior authorization not obtained

Failure to obtain required prior authorization may result in denial of payment for MYPAC therapeutic services.

Services must be prior authorized as medically necessary by the UM/QIO; lack of prior authorization may lead to denial.

Payment Units, Rates, and Coding Notes

Payment units and notesmixed

No codes listed

Per diem effective date

Per diem effective datePer diem rate effective July 1, 2021

Legislative update restrictionPer diem will not be updated without authorization by the state legislature

ContextPer diem applies to MYPAC Therapeutic services for EPSDT-eligible beneficiaries meeting PRTF level of care

Visit Limits and Rate Notes

MYPAC therapeutic services — Payment units & rate basis

Payment unitsReimbursed at an hourly rate and an additional rate per 15 minutes of service provision

Per diem referencePer diem rate also established for MYPAC services (see per diem effective date)

Rate basisRates based on actuarial analysis of historical utilization, payment, and cost data for EPSDT beneficiaries meeting PRTF level of care

Key Definitions

MYPAC Therapeutic services — Definition & scope

DefinitionMYPAC Therapeutic services are treatment provided in the home or community to EPSDT-eligible beneficiaries who require the level of care provided in a psychiatric residential treatment facility (PRTF) for family stabilization and crisis diffusion.

Clinical purposeStabilize living arrangement, promote reunification, and prevent utilization of out-of-home therapeutic resources to allow the individual to remain at home and in the community

Service componentsIncludes treatment plan development/review, medication management, intensive individual therapy, family therapy, group therapy, peer support, community support services, psychoeducation, relapse prevention

Provider qualificationsMust be provided by Mississippi DMH certified providers within scope of license/certification

Peer support services — Definition

Background and Program Context

MYPAC Therapeutic Services are community- or home-based interventions provided to EPSDT-eligible beneficiaries who require the PRTF level of care. The services are intended to diffuse an active crisis, evaluate contributing factors, and intervene to reduce recurrence. The clinical goals include stabilizing the beneficiary's living arrangement, promoting reunification with family, and preventing use of out-of-home therapeutic resources. Service components are comprehensive and include treatment plan development and review, medication management, intensive individual therapy, family therapy (including involvement of non-Medicaid family members when clinically appropriate), and other community-based supports as described in the policy.