Bill Text: MS HB538 | 2024 | Regular Session | Introduced
Bill Title: Medicaid; create Medicaid Commission to administer program and abolish Division of Medicaid.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2024-03-05 - Died In Committee [HB538 Detail]
Download: Mississippi-2024-HB538-Introduced.html
MISSISSIPPI LEGISLATURE
2024 Regular Session
To: Medicaid; Accountability, Efficiency, Transparency
By: Representative Johnson
House Bill 538
AN ACT TO AMEND SECTION 43-13-107, MISSISSIPPI CODE OF 1972, TO CREATE THE MISSISSIPPI MEDICAID COMMISSION TO ADMINISTER THE MEDICAID PROGRAM; TO PROVIDE FOR THE MEMBERSHIP AND APPOINTMENT OF THE COMMISSION; TO PROVIDE THAT THE EXECUTIVE DIRECTOR OF THE COMMISSION SHALL BE APPOINTED BY THE COMMISSION; TO ABOLISH THE DIVISION OF MEDICAID AND TRANSFER THE POWERS, DUTIES, PROPERTY AND EMPLOYEES OF THE DIVISION TO THE MEDICAID COMMISSION; TO AMEND SECTIONS 43-13-103, 43-13-105, 43-13-109, 43-13-113, 43-13-115, 43-13-116, 43-13-117, 43-13-120, 43-13-121, 43-13-123, 43-13-125, 43-13-139 AND 43-13-145, MISSISSIPPI CODE OF 1972, TO CONFORM TO THE PRECEDING PROVISIONS; TO EXTEND THE DATE OF THE REPEALER ON SECTIONS 43-13-117 AND 43-13-145; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 43-13-107, Mississippi Code of 1972, is amended as follows:
43-13-107. (1) (a)
The * * *
Mississippi Medicaid Commission is created * * *
to administer this article and perform such other duties as are prescribed by
law. The commission shall consist of seven (7) members, with four (4)
members appointed by the Governor and three (3) members appointed by the Lieutenant
Governor. All initial and later appointments to the commission shall be with
the advice and consent of the Senate.
(b) All members of the commission shall be persons who have some knowledge or practical experience in matters under the jurisdiction of the commission. No member of the commission shall be a provider or representative of any provider of Medicaid services or have any financial or other interest in any provider of Medicaid services, and no member of the commission shall be an elected official of the State of Mississippi or a political subdivision of the state.
(c) The Governor shall appoint one (1) member from each congressional district as constituted on January 1, 2024, and the Lieutenant Governor shall appoint one (1) member from each Supreme Court district as constituted on January 1, 2024. The initial members shall be appointed for staggered terms, as follows: one (1) member appointed by the Governor and one (1) member appointed by the Lieutenant Governor shall be appointed for terms that end on June 30, 2025; two (2) members appointed by the Governor and one (1) member appointed by the Lieutenant Governor shall be appointed for terms that end on June 30, 2027; and one (1) member appointed by the Governor and one (1) member appointed by the Lieutenant Governor shall be appointed for terms that end on June 30, 2029. All later appointments to the commission shall be made by the respective appointing authorities for terms of five (5) years from the expiration date of the previous term, and the appointments shall be subject to the same qualifications and geographical districts as the initial members. No person shall be appointed to the commission for more than two (2) consecutive terms.
(d) Any vacancy on the commission before the expiration of a term shall be filled by appointment of the original appointing authority for that position, with the advice and consent of the Senate. The person appointed to fill the vacancy shall serve for the remainder of the unexpired term.
(e) The members of the commission shall select one (1) member to serve as chairman of the commission. The commission shall select a chairman once every two (2) years, and any person who has previously served as chairman may be reelected as chairman.
(f) Four (4) members of the commission shall constitute a quorum for the transaction of any business of the commission. The commission shall hold regular monthly meetings, and other meetings as may be necessary for the purpose of conducting any business as may be required. All meetings shall be called by the chairman or by a majority of the members of the commission, except the first meeting, which shall be called by the Governor. Any member who does not attend three (3) consecutive regular meetings of the commission, except for illness, shall be subject to removal by a majority vote of the members of the commission.
(g) Members of the commission shall receive the per diem authorized under Section 25-3-69 for each day spent actually discharging their official duties, and shall receive reimbursement for mileage and necessary travel expenses incurred as provided in Section 25-3-41.
(h) Each member of the commission, before entering upon the discharge of the duties of the office, shall take and subscribe to the oath of office prescribed by the Mississippi Constitution and shall file the oath in the Office of the Secretary of State, and shall execute a bond in some surety company authorized to do business in the state in the penal sum of One Hundred Thousand Dollars ($100,000.00), conditioned for the faithful and impartial discharge of the duties of the office. The bonds shall be filed in the Office of the Secretary of State, and the premium on the bonds shall be paid as provided by law out of funds appropriated to the commission.
(2) (a) The * * * commission shall appoint a full-time
executive director, * * * who shall be either (i) a
physician with administrative experience in a medical care or health program,
or (ii) a person holding a graduate degree in medical care administration,
public health, hospital administration, or the equivalent, or (iii) a person
holding a bachelor's degree with at least three (3) years' experience in
management-level administration of, or policy development for, Medicaid
programs, and who shall serve at the will and pleasure of the commission.
* * *
No one who has been a member of the Mississippi Legislature during the previous
three (3) years may be executive director. The executive director shall be the
official secretary and legal custodian of the records of the * * * commission; shall be the agent
of the * * *
commission for the purpose of receiving all service of process, summons
and notices directed to the * * * commission; shall perform such
other duties as the * * *
commission may prescribe from time to time; and shall perform all other
duties that are now or may be imposed upon him or her by law.
* * *
( * * *b) The executive director shall,
before entering upon the discharge of the duties of the office, take and
subscribe to the oath of office prescribed by the Mississippi Constitution and
shall file the same in the Office of the Secretary of State, and shall execute
a bond in some surety company authorized to do business in the state in the
penal sum of One Hundred Thousand Dollars ($100,000.00), conditioned for the
faithful and impartial discharge of the duties of the office. The premium on
the bond shall be paid as provided by law out of funds appropriated to the * * * commission.
( * * *c) The executive director, * * * with
the approval of the commission and subject to the rules and regulations of
the State Personnel Board, shall employ such professional, administrative,
stenographic, secretarial, clerical and technical assistance as may be
necessary to perform the duties required in administering this article and fix
the compensation for those persons, all in accordance with a state merit system
meeting federal requirements. When the salary of the executive director is not
set by law, that salary shall be set by the State Personnel Board. * * * The provisions of Section 25-9-107(c)(xv) shall
apply to the executive director and other administrative heads of the * * * commission.
(3) (a) There is
established a Medical Care Advisory Committee, which shall be the committee
that is required by federal regulation to advise the * * * commission about health
and medical care services.
(b) The advisory committee shall consist of not less than eleven (11) members, as follows:
(i) The Governor shall appoint five (5) members, one (1) from each congressional district and one (1) from the state at large;
(ii) The Lieutenant Governor shall appoint three (3) members, one (1) from each Supreme Court district;
(iii) The Speaker of the House of Representatives shall appoint three (3) members, one (1) from each Supreme Court district.
All members appointed under this paragraph shall either be health care providers or consumers of health care services. One (1) member appointed by each of the appointing authorities shall be a board-certified physician.
(c) The respective Chairmen of the House Medicaid Committee, the House Public Health and Human Services Committee, the House Appropriations Committee, the Senate Medicaid Committee, the Senate Public Health and Welfare Committee and the Senate Appropriations Committee, or their designees, one (1) member of the State Senate appointed by the Lieutenant Governor and one (1) member of the House of Representatives appointed by the Speaker of the House, shall serve as ex officio nonvoting members of the advisory committee.
(d) In addition to the committee members required by paragraph (b), the advisory committee shall consist of such other members as are necessary to meet the requirements of the federal regulation applicable to the advisory committee, who shall be appointed as provided in the federal regulation.
(e) The chairmanship of the advisory committee shall be elected by the voting members of the committee annually and shall not serve more than two (2) consecutive years as chairman.
(f) The members of the advisory committee specified in paragraph (b) shall serve for terms that are concurrent with the terms of members of the Legislature, and any member appointed under paragraph (b) may be reappointed to the advisory committee. The members of the advisory committee specified in paragraph (b) shall serve without compensation, but shall receive reimbursement to defray actual expenses incurred in the performance of committee business as authorized by law. Legislators shall receive per diem and expenses, which may be paid from the contingent expense funds of their respective houses in the same amounts as provided for committee meetings when the Legislature is not in session.
(g) The advisory committee shall meet not less than quarterly, and advisory committee members shall be furnished written notice of the meetings at least ten (10) days before the date of the meeting.
(h) The * * * commission shall
submit to the advisory committee all amendments, modifications and changes to
the state plan for the operation of the Medicaid program, for review by the
advisory committee before the amendments, modifications or changes may be
implemented by the * * *
commission.
(i) The advisory committee, among its duties and responsibilities, shall:
(i) Advise the * * * commission with respect to
amendments, modifications and changes to the state plan for the operation of
the Medicaid program;
(ii) Advise the * * * commission with respect to
issues concerning receipt and disbursement of funds and eligibility for Medicaid;
(iii) Advise the * * * commission with respect to
determining the quantity, quality and extent of medical care provided under
this article;
(iv) Communicate
the views of the medical care professions to the * * * commission and communicate the
views of the * * *
commission to the medical care professions;
(v) Gather
information on reasons that medical care providers do not participate in the
Medicaid program and changes that could be made in the program to encourage
more providers to participate in the Medicaid program, and advise the * * * commission with respect to
encouraging physicians and other medical care providers to participate in the
Medicaid program;
(vi) Provide a written report on or before November 30 of each year to the Governor, Lieutenant Governor and Speaker of the House of Representatives.
(4) (a) There is established a Drug Use Review Board, which shall be the board that is required by federal law to:
(i) Review and initiate retrospective drug use, review including ongoing periodic examination of claims data and other records in order to identify patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care, among physicians, pharmacists and individuals receiving Medicaid benefits or associated with specific drugs or groups of drugs.
(ii) Review and initiate ongoing interventions for physicians and pharmacists, targeted toward therapy problems or individuals identified in the course of retrospective drug use reviews.
(iii) On an ongoing basis, assess data on drug use against explicit predetermined standards using the compendia and literature set forth in federal law and regulations.
(b) The board shall
consist of not less than twelve (12) members appointed by the * * * commission.
(c) The board shall meet at least quarterly, and board members shall be furnished written notice of the meetings at least ten (10) days before the date of the meeting.
(d) The board meetings shall be open to the public, members of the press, legislators and consumers. Additionally, all documents provided to board members shall be available to members of the Legislature in the same manner, and shall be made available to others for a reasonable fee for copying. However, patient confidentiality and provider confidentiality shall be protected by blinding patient names and provider names with numerical or other anonymous identifiers. The board meetings shall be subject to the Open Meetings Act (Sections 25-41-1 through 25-41-17). Board meetings conducted in violation of this section shall be deemed unlawful.
(5) (a) There is
established a Pharmacy and Therapeutics Committee, which shall be appointed by
the * * * commission.
(b) The committee shall meet as often as needed to fulfill its responsibilities and obligations as set forth in this section, and committee members shall be furnished written notice of the meetings at least ten (10) days before the date of the meeting.
(c) The committee meetings shall be open to the public, members of the press, legislators and consumers. Additionally, all documents provided to committee members shall be available to members of the Legislature in the same manner, and shall be made available to others for a reasonable fee for copying. However, patient confidentiality and provider confidentiality shall be protected by blinding patient names and provider names with numerical or other anonymous identifiers. The committee meetings shall be subject to the Open Meetings Act (Sections 25-41-1 through 25-41-17). Committee meetings conducted in violation of this section shall be deemed unlawful.
(d) After a thirty-day
public notice, * * * the commission shall present its recommendation regarding prior
approval for a therapeutic class of drugs to the committee. However, in
circumstances where the * * *division commission deems it necessary for the health
and safety of Medicaid beneficiaries, the * * * commission may present to the
committee its recommendations regarding a particular drug without a thirty-day
public notice. In making that presentation, the * * * commission shall state to the
committee the circumstances that precipitate the need for the committee to
review the status of a particular drug without a thirty-day public notice. The
committee may determine whether or not to review the particular drug under the
circumstances stated by the * * * commission without a thirty-day
public notice. If the committee determines to review the status of the
particular drug, it shall make its recommendations to the * * * commission, after which the * * * commission shall file those
recommendations for a thirty-day public comment under Section 25-43-7(1).
(e) Upon reviewing the
information and recommendations, the committee shall forward a written
recommendation approved by a majority of the committee to the * * *
commission. The decisions of the committee regarding any
limitations to be imposed on any drug or its use for a specified indication
shall be based on sound clinical evidence found in labeling, drug compendia,
and peer-reviewed clinical literature pertaining to use of the drug in
the relevant population.
(f) Upon reviewing and
considering all recommendations including recommendations of the committee,
comments, and data, the * * * executive director commission shall make a final
determination whether to require prior approval of a therapeutic class of
drugs, or modify existing prior approval requirements for a therapeutic class
of drugs.
(g) At least thirty
(30) days before the * * * commission implements new or amended prior
authorization decisions, written notice of the * * * commission's
decision shall be provided to all prescribing Medicaid providers, all Medicaid
enrolled pharmacies, and any other party who has requested the notification.
However, notice given under Section 25-43-7(1) will substitute for and meet the
requirement for notice under this subsection.
(h) Members of the committee shall dispose of matters before the committee in an unbiased and professional manner. If a matter being considered by the committee presents a real or apparent conflict of interest for any member of the committee, that member shall disclose the conflict in writing to the committee chair and recuse himself or herself from any discussions and/or actions on the matter.
SECTION 2. (1) The Division of Medicaid in the Office of the Governor is abolished, and all powers, duties and functions of the Division of Medicaid shall be transferred to the Mississippi Medicaid Commission created in Section 1 of this act. All records, property and contractual rights and obligations of, and unexpended balances of appropriations or other allocations to, the Division of Medicaid shall be transferred to the Mississippi Medicaid Commission on July 1, 2024. All employees of the Division of Medicaid on June 30, 2024, shall become employees of the Mississippi Medicaid Commission on July 1, 2024. The Division of Medicaid shall assist and cooperate with the Mississippi Medicaid Commission in order to accomplish an orderly transition under this act.
(2) Whenever the term "Governor's Office-Division of Medicaid", "Division of Medicaid" or "division," when referring to the Division of Medicaid in the Office of the Governor, is used in any statute, rule, regulation or document, it shall mean the Mississippi Medicaid Commission.
SECTION 3. Section 43-13-103, Mississippi Code of 1972, is amended as follows:
43-13-103. For the purpose
of affording health care and remedial and institutional services in accordance
with the requirements for federal grants and other assistance under Titles
XVIII, XIX and XXI of the Social Security Act, as amended, a statewide system
of medical assistance is established and shall be in effect in all political
subdivisions of the state, to be financed by state appropriations and federal
matching funds therefor, and to be administered by the * * * Mississippi Medicaid
Commission as * * *
provided in this article.
SECTION 4. Section 43-13-105, Mississippi Code of 1972, is amended as follows:
43-13-105. When used in this article, the following definitions shall apply, unless the context requires otherwise:
(a)
"Administering agency" means the * * *
Mississippi Medicaid Commission as created by this article.
(b) "Commission" or "Medicaid Commission" means the Mississippi Medicaid Commission.
(c)
"Division", * * * "Division of Medicaid" or Governor's
Office-Division of Medicaid means the * * *
Mississippi Medicaid Commission.
( * * *d) "Medical assistance"
means payment of part or all of the costs of medical and remedial care provided
under the terms of this article and in accordance with provisions of Titles XIX
and XXI of the Social Security Act, as amended.
( * * *e) "Applicant" means a
person who applies for assistance under Titles IV, XVI, XIX or XXI of the
Social Security Act, as amended, and under the terms of this article.
( * * *f) "Recipient" means a
person who is eligible for assistance under Title XIX or XXI of the Social
Security Act, as amended and under the terms of this article.
( * * *g) "State health agency"
means any agency, department, institution, board or commission of the State of
Mississippi, except the University of Mississippi Medical School, which is
supported in whole or in part by any public funds, including funds directly
appropriated from the State Treasury, funds derived by taxes, fees levied or
collected by statutory authority, or any other funds used by "state health
agencies" derived from federal sources, when any funds available to such
agency are expended either directly or indirectly in connection with, or in
support of, any public health, hospital, hospitalization or other public
programs for the preventive treatment or actual medical treatment of persons
with a physical disability, mental illness or an intellectual disability.
(h) "Executive director" or "director" means the Executive Director of the Mississippi Medicaid Commission.
* * *
SECTION 5. Section 43-13-109, Mississippi Code of 1972, is amended as follows:
43-13-109. The * * * commission, under the rules and regulations of the State
Personnel Board, may adopt reasonable rules and regulations to provide for an
open, competitive or qualifying examination for all employees of the * * * commission other than the executive
director, part-time consultants and professional staff members.
SECTION 6. Section 43-13-113, Mississippi Code of 1972, is amended as follows:
43-13-113. (1) The State
Treasurer shall receive on behalf of the state, and execute all instruments
incidental thereto, federal and other funds to be used for financing the
medical assistance plan or program adopted pursuant to this article, and place
all such funds in a special account to the credit of the * * * Mississippi
Medicaid Commission, which funds shall be expended by the * * * commission for the purposes
and under the provisions of this article, and shall be paid out by the State
Treasurer as funds appropriated to carry out the provisions of this article are
paid out by him.
The * * * commission shall issue all
checks or electronic transfers for administrative expenses, and for medical
assistance under the provisions of this article. All such checks or electronic
transfers shall be drawn upon funds made available to the * * * commission by the State * * * Fiscal Officer, upon
requisition of the executive director. It is the purpose of this
section to provide that the State * * * Fiscal Officer shall transfer,
in lump sums, amounts to the * * * commission for disbursement
under the regulations which shall be made by the * * * commission.
However, the * * *
commission, or its fiscal agent in behalf of the * * * commission, shall be
authorized in maintaining separate accounts with a Mississippi bank to handle
claim payments, refund recoveries and related Medicaid program financial
transactions, to aggressively manage the float in these accounts while awaiting
clearance of checks or electronic transfers and/or other disposition so as to
accrue maximum interest advantage of the funds in the account, and to retain
all earned interest on these funds to be applied to match federal funds for
Medicaid program operations.
(2) The * * * commission is authorized to
obtain a line of credit through the State Treasurer from the Working Cash-Stabilization
Fund or any other special source funds maintained in the State Treasury in an amount
not exceeding One Hundred Fifty Million Dollars ($150,000,000.00) to fund
shortfalls which, from time to time, may occur due to decreases in state
matching fund cash flow. The length of indebtedness under this provision shall
not carry past the end of the quarter following the loan origination. Loan
proceeds shall be received by the State Treasurer and shall be placed in a
Medicaid designated special fund account. Loan proceeds shall be expended only
for health care services provided under the Medicaid program. The * * * commission may pledge as
security for such interim financing future funds that will be received by the * * * commission. Any such loans
shall be repaid from the first available funds received by the * * * commission in the manner of
and subject to the same terms provided in this section.
* * * If the State Treasurer
makes a determination that special source funds are not sufficient to cover a
line of credit for the * * * commission, the * * * commission is authorized to
obtain a line of credit, in an amount not exceeding One Hundred Fifty Million
Dollars ($150,000,000.00), from a commercial lender or a consortium of
lenders. The length of indebtedness under this provision shall not carry past
the end of the quarter following the loan origination. The * * * commission shall obtain a
minimum of two (2) written quotes that shall be presented to the State Fiscal
Officer and State Treasurer, who shall jointly select a lender. Loan proceeds
shall be received by the State Treasurer and shall be placed in a Medicaid
designated special fund account. Loan proceeds shall be expended only for
health care services provided under the Medicaid program. The * * * commission may pledge as
security for such interim financing future funds that will be received by the * * * commission. Any such loans
shall be repaid from the first available funds received by the * * * commission in the manner of
and subject to the same terms provided in this section.
(3) Disbursement of funds to providers shall be made as follows:
(a) All providers must
submit all claims to the * * * Division of Medicaid commission's fiscal agent no
later than twelve (12) months from the date of service.
(b) The * * * commission's
fiscal agent must pay ninety percent (90%) of all clean claims within thirty
(30) days of the date of receipt.
(c) The * * * commission's fiscal
agent must pay ninety-nine percent (99%) of all clean claims within ninety (90)
days of the date of receipt.
(d) The * * * commission's
fiscal agent must pay all other claims within twelve (12) months of the date of
receipt.
(e) If a claim is
neither paid nor denied for valid and proper reasons by the end of the time
periods as specified above, the * * * commission's
fiscal agent must pay the provider interest on the claim at the rate of one and
one-half percent (1-1/2%) per month on the amount of such claim until it is
finally settled or adjudicated.
(4) The date of receipt is the date the fiscal agent receives the claim as indicated by its date stamp on the claim or, for those claims filed electronically, the date of receipt is the date of transmission.
(5) The date of payment is the date of the check or, for those claims paid by electronic funds transfer, the date of the transfer.
(6) The above specified time limitations do not apply in the following circumstances:
(a) Retroactive adjustments paid to providers reimbursed under a retrospective payment system;
(b) If a claim for payment under Medicare has been filed in a timely manner, the fiscal agent may pay a Medicaid claim relating to the same services within six (6) months after it, or the provider, receives notice of the disposition of the Medicare claim;
(c) Claims from providers under investigation for fraud or abuse; and
(d) The * * * commission and/or
its fiscal agent may make payments at any time in accordance with a court
order, to carry out hearing decisions or corrective actions taken to resolve a
dispute, or to extend the benefits of a hearing decision, corrective action, or
court order to others in the same situation as those directly affected by it.
* * *
SECTION 7. Section 43-13-115, Mississippi Code of 1972, is amended as follows:
43-13-115. Recipients of Medicaid shall be the following persons only:
(1) Those who are
qualified for public assistance grants under provisions of Title IV-A and E of
the federal Social Security Act, as amended, including those statutorily deemed
to be IV-A and low income families and children under Section 1931 of the
federal Social Security Act. For the purposes of this paragraph (1) and
paragraphs (8), (17) and (18) of this section, any reference to Title IV-A or
to Part A of Title IV of the federal Social Security Act, as amended, or the
state plan under Title IV-A or Part A of Title IV, shall be considered as a
reference to Title IV-A of the federal Social Security Act, as amended, and the
state plan under Title IV-A, including the income and resource standards and
methodologies under Title IV-A and the state plan, as they existed on July 16,
1996. The Department of Human Services shall determine Medicaid eligibility
for children receiving public assistance grants under Title IV-E. The * * * commission shall determine
eligibility for low income families under Section 1931 of the federal Social
Security Act and shall redetermine eligibility for those continuing under Title
IV-A grants.
(2) Those qualified
for Supplemental Security Income (SSI) benefits under Title XVI of the federal
Social Security Act, as amended, and those who are deemed SSI eligible as
contained in federal statute. The eligibility of individuals covered in this
paragraph shall be determined by the Social Security Administration and
certified to the * * * commission.
(3) Qualified pregnant
women who would be eligible for Medicaid as a low income family member under
Section 1931 of the federal Social Security Act if her child were born. The
eligibility of the individuals covered under this paragraph shall be determined
by the * * *
commission.
(4) [Deleted]
(5) A child born on or
after October 1, 1984, to a woman eligible for and receiving Medicaid under the
state plan on the date of the child's birth shall be deemed to have applied for
Medicaid and to have been found eligible for Medicaid under the plan on the
date of that birth, and will remain eligible for Medicaid for a period of one
(1) year so long as the child is a member of the woman's household and the
woman remains eligible for Medicaid or would be eligible for Medicaid if
pregnant. The eligibility of individuals covered in this paragraph shall be
determined by the * * * commission.
(6) Children certified
by the State Department of Human Services to the * * * commission of whom
the state and county departments of human services have custody and financial
responsibility, and children who are in adoptions subsidized in full or part by
the Department of Human Services, including special needs children in non-Title
IV-E adoption assistance, who are approvable under Title XIX of the Medicaid
program. The eligibility of the children covered under this paragraph shall be
determined by the State Department of Human Services.
(7) Persons certified
by the * * *
commission who are patients in a medical facility (nursing home,
hospital, tuberculosis sanatorium or institution for treatment of mental
diseases), and who, except for the fact that they are patients in that medical
facility, would qualify for grants under Title IV, Supplementary Security
Income (SSI) benefits under Title XVI or state supplements, and those aged,
blind and disabled persons who would not be eligible for Supplemental Security
Income (SSI) benefits under Title XVI or state supplements if they were not
institutionalized in a medical facility but whose income is below the maximum
standard set by the * * * commission, which standard shall not exceed that
prescribed by federal regulation.
(8) Children under
eighteen (18) years of age and pregnant women (including those in intact
families) who meet the financial standards of the state plan approved under
Title IV-A of the federal Social Security Act, as amended. The eligibility of
children covered under this paragraph shall be determined by the * * * commission.
(9) Individuals who are:
(a) Children born after September 30, 1983, who have not attained the age of nineteen (19), with family income that does not exceed one hundred percent (100%) of the nonfarm official poverty level;
(b) Pregnant women, infants and children who have not attained the age of six (6), with family income that does not exceed one hundred thirty-three percent (133%) of the federal poverty level; and
(c) Pregnant women and infants who have not attained the age of one (1), with family income that does not exceed one hundred eighty-five percent (185%) of the federal poverty level.
The eligibility of
individuals covered in (a), (b) and (c) of this paragraph shall be determined
by the * * *
commission.
(10) Certain disabled
children age eighteen (18) or under who are living at home, who would be
eligible, if in a medical institution, for SSI or a state supplemental payment
under Title XVI of the federal Social Security Act, as amended, and therefore
for Medicaid under the plan, and for whom the state has made a determination as
required under Section 1902(e)(3)(b) of the federal Social Security Act, as
amended. The eligibility of individuals under this paragraph shall be
determined by the * * * commission.
(11) Until the end of
the day on December 31, 2005, individuals who are sixty-five (65) years of age
or older or are disabled as determined under Section 1614(a)(3) of the federal
Social Security Act, as amended, and whose income does not exceed one hundred
thirty-five percent (135%) of the nonfarm official poverty level as defined by
the Office of Management and Budget and revised annually, and whose resources
do not exceed those established by the * * * commission. The
eligibility of individuals covered under this paragraph shall be determined by
the * * * commission. After December 31, 2005, only those
individuals covered under the 1115(c) Healthier Mississippi waiver will be
covered under this category.
Any individual who applied
for Medicaid during the period from July 1, 2004, through March 31, 2005, who
otherwise would have been eligible for coverage under this paragraph (11) if it
had been in effect at the time the individual submitted his or her application
and is still eligible for coverage under this paragraph (11) on March 31, 2005,
shall be eligible for Medicaid coverage under this paragraph (11) from March
31, 2005, through December 31, 2005. The * * * commission shall give priority
in processing the applications for those individuals to determine their
eligibility under this paragraph (11).
(12) Individuals who are qualified Medicare beneficiaries (QMB) entitled to Part A Medicare as defined under Section 301, Public Law 100-360, known as the Medicare Catastrophic Coverage Act of 1988, and whose income does not exceed one hundred percent (100%) of the nonfarm official poverty level as defined by the Office of Management and Budget and revised annually.
The eligibility of individuals
covered under this paragraph shall be determined by the * * * commission, and
those individuals determined eligible shall receive Medicare cost-sharing
expenses only as more fully defined by the Medicare Catastrophic Coverage Act
of 1988 and the Balanced Budget Act of 1997.
(13) (a) Individuals who are entitled to Medicare Part A as defined in Section 4501 of the Omnibus Budget Reconciliation Act of 1990, and whose income does not exceed one hundred twenty percent (120%) of the nonfarm official poverty level as defined by the Office of Management and Budget and revised annually. Eligibility for Medicaid benefits is limited to full payment of Medicare Part B premiums.
(b) Individuals entitled to Part A of Medicare, with income above one hundred twenty percent (120%), but less than one hundred thirty-five percent (135%) of the federal poverty level, and not otherwise eligible for Medicaid. Eligibility for Medicaid benefits is limited to full payment of Medicare Part B premiums. The number of eligible individuals is limited by the availability of the federal capped allocation at one hundred percent (100%) of federal matching funds, as more fully defined in the Balanced Budget Act of 1997.
The eligibility of
individuals covered under this paragraph shall be determined by the * * * commission.
(14) [Deleted]
(15) Disabled workers
who are eligible to enroll in Part A Medicare as required by Public Law 101-239,
known as the Omnibus Budget Reconciliation Act of 1989, and whose income does
not exceed two hundred percent (200%) of the federal poverty level as
determined in accordance with the Supplemental Security Income (SSI) program.
The eligibility of individuals covered under this paragraph shall be determined
by the * * * commission and those individuals shall be entitled
to buy-in coverage of Medicare Part A premiums only under the provisions of
this paragraph (15).
(16) In accordance
with the terms and conditions of approved Title XIX waiver from the United
States Department of Health and Human Services, persons provided home- and
community-based services who are physically disabled and certified by the * * * commission as
eligible due to applying the income and deeming requirements as if they were
institutionalized.
(17) In accordance
with the terms of the federal Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (Public Law 104-193), persons who become ineligible
for assistance under Title IV-A of the federal Social Security Act, as amended,
because of increased income from or hours of employment of the caretaker
relative or because of the expiration of the applicable earned income
disregards, who were eligible for Medicaid for at least three (3) of the six
(6) months preceding the month in which the ineligibility begins, shall be
eligible for Medicaid for up to twelve (12) months. The eligibility of the
individuals covered under this paragraph shall be determined by the * * * commission.
(18) Persons who
become ineligible for assistance under Title IV-A of the federal Social
Security Act, as amended, as a result, in whole or in part, of the collection
or increased collection of child or spousal support under Title IV-D of the
federal Social Security Act, as amended, who were eligible for Medicaid for at
least three (3) of the six (6) months immediately preceding the month in which
the ineligibility begins, shall be eligible for Medicaid for an additional four
(4) months beginning with the month in which the ineligibility begins. The
eligibility of the individuals covered under this paragraph shall be determined
by the * * *
commission.
(19) Disabled workers,
whose incomes are above the Medicaid eligibility limits, but below two hundred
fifty percent (250%) of the federal poverty level, shall be allowed to purchase
Medicaid coverage on a sliding fee scale developed by the * * * commission.
(20) Medicaid eligible children under age eighteen (18) shall remain eligible for Medicaid benefits until the end of a period of twelve (12) months following an eligibility determination, or until such time that the individual exceeds age eighteen (18).
(21)
Women of childbearing age whose family income does not exceed one hundred
eighty-five percent (185%) of the federal poverty level. The eligibility of
individuals covered under this paragraph (21) shall be determined by the * * * commission, and
those individuals determined eligible shall only receive family planning
services covered under Section 43-13-117(13) and not any other services covered
under Medicaid. However, any individual eligible under this paragraph (21) who
is also eligible under any other provision of this section shall receive the
benefits to which he or she is entitled under that other provision, in addition
to family planning services covered under Section 43-13-117(13).
The * * * commission shall
apply to the United States Secretary of Health and Human Services for a federal
waiver of the applicable provisions of Title XIX of the federal Social Security
Act, as amended, and any other applicable provisions of federal law as
necessary to allow for the implementation of this paragraph (21). The
provisions of this paragraph (21) shall be implemented from and after the date
that the * * * commission receives the federal waiver.
(22)
Persons who are workers with a potentially severe disability, as determined by
the * * *
commission, shall be allowed to purchase Medicaid coverage. The term
"worker with a potentially severe disability" means a person who is
at least sixteen (16) years of age but under sixty-five (65) years of age, who
has a physical or mental impairment that is reasonably expected to cause the
person to become blind or disabled as defined under Section 1614(a) of the
federal Social Security Act, as amended, if the person does not receive items
and services provided under Medicaid.
The eligibility of persons
under this paragraph (22) shall be conducted as a demonstration project that is
consistent with Section 204 of the Ticket to Work and Work Incentives
Improvement Act of 1999, Public Law 106-170, for a certain number of persons as
specified by the * * *
commission. The eligibility of individuals covered under this paragraph
(22) shall be determined by the * * * commission.
(23) Children
certified by the Mississippi Department of Human Services for whom the state
and county departments of human services have custody and financial
responsibility who are in foster care on their eighteenth birthday as reported
by the Mississippi Department of Human Services shall be certified Medicaid
eligible by the * * * commission until their twenty-first birthday.
(24) Individuals who
have not attained age sixty-five (65), are not otherwise covered by creditable
coverage as defined in the Public Health Services Act, and have been screened
for breast and cervical cancer under the Centers for Disease Control and
Prevention Breast and Cervical Cancer Early Detection Program established under
Title XV of the Public Health Service Act in accordance with the requirements of
that act and who need treatment for breast or cervical cancer. Eligibility of
individuals under this paragraph (24) shall be determined by the * * * commission.
(25) The * * * commission shall apply to the
Centers for Medicare and Medicaid Services (CMS) for any necessary waivers to
provide services to individuals who are sixty-five (65) years of age or
older or are disabled as determined under Section 1614(a)(3) of the federal
Social Security Act, as amended, and whose income does not exceed one hundred
thirty-five percent (135%) of the nonfarm official poverty level as defined by
the Office of Management and Budget and revised annually, and whose resources
do not exceed those established by the * * * commission, and who
are not otherwise covered by Medicare. Nothing contained in this paragraph
(25) shall entitle an individual to benefits. The eligibility of individuals
covered under this paragraph shall be determined by the * * * commission.
(26) The * * * commission shall apply to the
Centers for Medicare and Medicaid Services (CMS) for any necessary waivers to
provide services to individuals who are sixty-five (65) years of age or
older or are disabled as determined under Section 1614(a)(3) of the federal
Social Security Act, as amended, who are end stage renal disease patients on
dialysis, cancer patients on chemotherapy or organ transplant recipients on
antirejection drugs, whose income does not exceed one hundred thirty-five
percent (135%) of the nonfarm official poverty level as defined by the Office
of Management and Budget and revised annually, and whose resources do not
exceed those established by the * * * commission. Nothing contained
in this paragraph (26) shall entitle an individual to benefits. The
eligibility of individuals covered under this paragraph shall be determined by
the * * * commission.
(27) Individuals who
are entitled to Medicare Part D and whose income does not exceed one hundred
fifty percent (150%) of the nonfarm official poverty level as defined by the
Office of Management and Budget and revised annually. Eligibility for payment
of the Medicare Part D subsidy under this paragraph shall be determined by the * * * commission.
(28) The * * * commission is authorized and
directed to provide up to twelve (12) months of continuous coverage postpartum
for any individual who qualifies for Medicaid coverage under this section as a
pregnant woman, to the extent allowable under federal law and as determined by
the * * *
commission.
The * * * commission shall redetermine
eligibility for all categories of recipients described in each paragraph of
this section not less frequently than required by federal law.
SECTION 8. Section 43-13-116, Mississippi Code of 1972, is amended as follows:
43-13-116. (1) It shall be
the duty of the * * * commission to fully implement and carry out the
administrative functions of determining the eligibility of those persons who
qualify for medical assistance under Section 43-13-115.
(2) In determining Medicaid
eligibility, the * * * commission is authorized to enter into an
agreement with the Secretary of the Department of Health and Human Services for
the purpose of securing the transfer of eligibility information from the Social
Security Administration on those individuals receiving supplemental security
income benefits under the federal Social Security Act and any other information
necessary in determining Medicaid eligibility. The * * * commission is
further empowered to enter into contractual arrangements with its fiscal agent
or with the State Department of Human Services in securing electronic data
processing support as may be necessary.
(3) Administrative hearings
shall be available to any applicant who requests it because his or her claim of
eligibility for services is denied or is not acted upon with reasonable
promptness or by any recipient who requests it because he or she believes the
agency has erroneously taken action to deny, reduce, or terminate benefits.
The agency need not grant a hearing if the sole issue is a federal or state law
requiring an automatic change adversely affecting some or all recipients.
Eligibility determinations that are made by other agencies and certified to the * * * commission pursuant
to Section 43-13-115 are not subject to the administrative hearing procedures
of the * * *
commission but are subject to the administrative hearing procedures of
the agency that determined eligibility.
(a) A request may be made either for a local regional office hearing or a state office hearing when the local regional office has made the initial decision that the claimant seeks to appeal or when the regional office has not acted with reasonable promptness in making a decision on a claim for eligibility or services. The only exception to requesting a local hearing is when the issue under appeal involves either (i) a disability or blindness denial, or termination, or (ii) a level of care denial or termination for a disabled child living at home. An appeal involving disability, blindness or level of care must be handled as a state level hearing. The decision from the local hearing may be appealed to the state office for a state hearing. A decision to deny, reduce or terminate benefits that is initially made at the state office may be appealed by requesting a state hearing.
(b) A request for a hearing, either state or local, must be made in writing by the claimant or claimant's legal representative. "Legal representative" includes the claimant's authorized representative, an attorney retained by the claimant or claimant's family to represent the claimant, a paralegal representative with a legal aid services, a parent of a minor child if the claimant is a child, a legal guardian or conservator or an individual with power of attorney for the claimant. The claimant may also be represented by anyone that he or she so designates but must give the designation to the Medicaid regional office or state office in writing, if the person is not the legal representative, legal guardian, or authorized representative.
(c) The claimant may make a request for a hearing in person at the regional office but an oral request must be put into written form. Regional office staff will determine from the claimant if a local or state hearing is requested and assist the claimant in completing and signing the appropriate form. Regional office staff may forward a state hearing request to the appropriate division in the state office or the claimant may mail the form to the address listed on the form. The claimant may make a written request for a hearing by letter. A simple statement requesting a hearing that is signed by the claimant or legal representative is sufficient; however, if possible, the claimant should state the reason for the request. The letter may be mailed to the regional office or it may be mailed to the state office. If the letter does not specify the type of hearing desired, local or state, Medicaid staff will attempt to contact the claimant to determine the level of hearing desired. If contact cannot be made within three (3) days of receipt of the request, the request will be assumed to be for a local hearing and scheduled accordingly. A hearing will not be scheduled until either a letter or the appropriate form is received by the regional or state office.
(d) When both members of a couple wish to appeal an action or inaction by the agency that affects both applications or cases similarly and arose from the same issue, one or both may file the request for hearing, both may present evidence at the hearing, and the agency's decision will be applicable to both. If both file a request for hearing, two (2) hearings will be registered but they will be conducted on the same day and in the same place, either consecutively or jointly, as the couple wishes. If they so desire, only one of the couple need attend the hearing.
(e) The procedure for administrative hearings shall be as follows:
(i) The claimant has thirty (30) days from the date the agency mails the appropriate notice to the claimant of its decision regarding eligibility, services, or benefits to request either a state or local hearing. This time period may be extended if the claimant can show good cause for not filing within thirty (30) days. Good cause includes, but may not be limited to, illness, failure to receive the notice, being out of state, or some other reasonable explanation. If good cause can be shown, a late request may be accepted provided the facts in the case remain the same. If a claimant's circumstances have changed or if good cause for filing a request beyond thirty (30) days is not shown, a hearing request will not be accepted. If the claimant wishes to have eligibility reconsidered, he or she may reapply.
(ii) If a claimant or representative requests a hearing in writing during the advance notice period before benefits are reduced or terminated, benefits must be continued or reinstated to the benefit level in effect before the effective date of the adverse action. Benefits will continue at the original level until the final hearing decision is rendered. Any hearing requested after the advance notice period will not be accepted as a timely request in order for continuation of benefits to apply.
(iii) Upon receipt of a written request for a hearing, the request will be acknowledged in writing within twenty (20) days and a hearing scheduled. The claimant or representative will be given at least five (5) days' advance notice of the hearing date. The local and/or state level hearings will be held by telephone unless, at the hearing officer's discretion, it is determined that an in-person hearing is necessary. If a local hearing is requested, the regional office will notify the claimant or representative in writing of the time of the local hearing. If a state hearing is requested, the state office will notify the claimant or representative in writing of the time of the state hearing. If an in-person hearing is necessary, local hearings will be held at the regional office and state hearings will be held at the state office unless other arrangements are necessitated by the claimant's inability to travel.
(iv) All persons
attending a hearing will attend for the purpose of giving information on behalf
of the claimant or rendering the claimant assistance in some other way, or for
the purpose of representing the * * * commission.
(v) A state or local hearing request may be withdrawn at any time before the scheduled hearing, or after the hearing is held but before a decision is rendered. The withdrawal must be in writing and signed by the claimant or representative. A hearing request will be considered abandoned if the claimant or representative fails to appear at a scheduled hearing without good cause. If no one appears for a hearing, the appropriate office will notify the claimant in writing that the hearing is dismissed unless good cause is shown for not attending. The proposed agency action will be taken on the case following failure to appear for a hearing if the action has not already been effected.
(vi) The claimant or his representative has the following rights in connection with a local or state hearing:
(A) The right to examine at a reasonable time before the date of the hearing and during the hearing the content of the claimant's case record;
(B) The right to have legal representation at the hearing and to bring witnesses;
(C) The right to produce documentary evidence and establish all facts and circumstances concerning eligibility, services, or benefits;
(D) The right to present an argument without undue interference;
(E) The right to question or refute any testimony or evidence including an opportunity to confront and cross-examine adverse witnesses.
(vii) When a request for a local hearing is received by the regional office or if the regional office is notified by the state office that a local hearing has been requested, the Medicaid specialist supervisor in the regional office will review the case record, reexamine the action taken on the case, and determine if policy and procedures have been followed. If any adjustments or corrections should be made, the Medicaid specialist supervisor will ensure that corrective action is taken. If the request for hearing was timely made such that continuation of benefits applies, the Medicaid specialist supervisor will ensure that benefits continue at the level before the proposed adverse action that is the subject of the appeal. The Medicaid specialist supervisor will also ensure that all needed information, verification, and evidence is in the case record for the hearing.
(viii) When a state hearing is requested that appeals the action or inaction of a regional office, the regional office will prepare copies of the case record and forward it to the appropriate division in the state office no later than five (5) days after receipt of the request for a state hearing. The original case record will remain in the regional office. Either the original case record in the regional office or the copy forwarded to the state office will be available for inspection by the claimant or claimant's representative a reasonable time before the date of the hearing.
(ix) The Medicaid specialist supervisor will serve as the hearing officer for a local hearing unless the Medicaid specialist supervisor actually participated in the eligibility, benefits, or services decision under appeal, in which case the Medicaid specialist supervisor must appoint a Medicaid specialist in the regional office who did not actually participate in the decision under appeal to serve as hearing officer. The local hearing will be an informal proceeding in which the claimant or representative may present new or additional information, may question the action taken on the client's case, and will hear an explanation from agency staff as to the regulations and requirements that were applied to claimant's case in making the decision.
(x) After the hearing, the hearing officer will prepare a written summary of the hearing procedure and file it with the case record. The hearing officer will consider the facts presented at the local hearing in reaching a decision. The claimant will be notified of the local hearing decision on the appropriate form that will state clearly the reason for the decision, the policy that governs the decision, the claimant's right to appeal the decision to the state office, and, if the original adverse action is upheld, the new effective date of the reduction or termination of benefits or services if continuation of benefits applied during the hearing process. The new effective date of the reduction or termination of benefits or services must be at the end of the fifteen-day advance notice period from the mailing date of the notice of hearing decision. The notice to claimant will be made part of the case record.
(xi) The claimant has the right to appeal a local hearing decision by requesting a state hearing in writing within fifteen (15) days of the mailing date of the notice of local hearing decision. The state hearing request should be made to the regional office. If benefits have been continued pending the local hearing process, then benefits will continue throughout the fifteen-day advance notice period for an adverse local hearing decision. If a state hearing is timely requested within the fifteen-day period, then benefits will continue pending the state hearing process. State hearings requested after the fifteen-day local hearing advance notice period will not be accepted unless the initial thirty-day period for filing a hearing request has not expired because the local hearing was held early, in which case a state hearing request will be accepted as timely within the number of days remaining of the unexpired initial thirty-day period in addition to the fifteen-day time period. Continuation of benefits during the state hearing process, however, will only apply if the state hearing request is received within the fifteen-day advance notice period.
(xii) When a request for a state hearing is received in the regional office, the request will be made part of the case record and the regional office will prepare the case record and forward it to the appropriate division in the state office within five (5) days of receipt of the state hearing request. A request for a state hearing received in the state office will be forwarded to the regional office for inclusion in the case record and the regional office will prepare the case record and forward it to the appropriate division in the state office within five (5) days of receipt of the state hearing request.
(xiii) Upon
receipt of the hearing record, an impartial hearing officer will be assigned to
hear the case * * * by the commission. Hearing officers
will be individuals with appropriate expertise employed by the * * * commission and who have not
been involved in any way with the action or decision on appeal in the case.
The hearing officer will review the case record and if the review shows that an
error was made in the action of the agency or in the interpretation of policy,
or that a change of policy has been made, the hearing officer will discuss
these matters with the appropriate agency personnel and request that an
appropriate adjustment be made. Appropriate agency personnel will discuss the
matter with the claimant and if the claimant is agreeable to the adjustment of
the claim, then agency personnel will request in writing dismissal of the
hearing and the reason therefor, to be placed in the case record. If the
hearing is to go forward, it shall be scheduled by the hearing officer in the
manner set forth in subparagraph (iii) of this paragraph (e).
(xiv) In conducting the hearing, the state hearing officer will inform those present of the following:
(A) That the hearing will be recorded on tape and that a transcript of the proceedings will be typed for the record;
(B) The action taken by the agency which prompted the appeal;
(C) An explanation of the claimant's rights during the hearing as outlined in subparagraph (vi) of this paragraph (e);
(D) That the purpose of the hearing is for the claimant to express dissatisfaction and present additional information or evidence;
(E) That the case record is available for review by the claimant or representative during the hearing;
(F) That the
final hearing decision will be rendered by the * * * commission * * * on the basis of
facts presented at the hearing and the case record and that the claimant will
be notified by letter of the final decision.
(xv) During the
hearing, the claimant and/or representative will be allowed an opportunity to
make a full statement concerning the appeal and will be assisted, if necessary,
in disclosing all information on which the claim is based. All persons
representing the claimant and those representing the * * * commission will
have the opportunity to state all facts pertinent to the appeal. The hearing
officer may recess or continue the hearing for a reasonable time should
additional information or facts be required or if some change in the claimant's
circumstances occurs during the hearing process which impacts the appeal. When
all information has been presented, the hearing officer will close the hearing
and stop the recorder.
(xvi) Immediately
following the hearing the hearing tape will be transcribed and a copy of the
transcription forwarded to the regional office for filing in the case record.
As soon as possible, the hearing officer shall review the evidence and record
of the proceedings, testimony, exhibits, and other supporting documents, prepare
a written summary of the facts as the hearing officer finds them, and prepare a
written recommendation of action to be taken by the agency, citing appropriate
policy and regulations that govern the recommendation. The decision cannot be
based on any material, oral or written, not available to the claimant before or
during the hearing. The hearing officer's recommendation will become part of
the case record which will be submitted to the * * * commission * * * for further review
and decision.
(xvii) The * * * commission * * *, upon review of
the recommendation, proceedings and the record, may sustain the recommendation
of the hearing officer, reject the same, or remand the matter to the hearing
officer to take additional testimony and evidence, in which case, the hearing
officer thereafter shall submit to the * * * commission a new
recommendation. The * * * commission shall prepare a written
decision summarizing the facts and identifying policies and regulations that
support the decision, which shall be mailed to the claimant and the
representative, with a copy to the regional office if appropriate, as soon as
possible after submission of a recommendation by the hearing officer. The
decision notice will specify any action to be taken by the agency, specify any
revised eligibility dates or, if continuation of benefits applies, will notify
the claimant of the new effective date of reduction or termination of benefits
or services, which will be fifteen (15) days from the mailing date of the
notice of decision. The decision rendered by the * * * commission * * * is final and
binding. The claimant is entitled to seek judicial review in a court of proper
jurisdiction.
(xviii) The * * * commission must
take final administrative action on a hearing, whether state or local, within
ninety (90) days from the date of the initial request for a hearing.
(xix) A group hearing may be held for a number of claimants under the following circumstances:
(A) The * * * commission may
consolidate the cases and conduct a single group hearing when the only issue
involved is one (1) of a single law or agency policy;
(B) The claimants may request a group hearing when there is one (1) issue of agency policy common to all of them.
In all group hearings, whether
initiated by the * * * commission or by the claimants, the policies
governing fair hearings must be followed. Each claimant in a group hearing
must be permitted to present his or her own case and be represented by his or
her own representative, or to withdraw from the group hearing and have his or
her appeal heard individually. As in individual hearings, the hearing will be
conducted only on the issue being appealed, and each claimant will be expected
to keep individual testimony within a reasonable time frame as a matter of
consideration to the other claimants involved.
(xx) Any specific matter necessitating an administrative hearing not otherwise provided under this article or agency policy shall be afforded under the hearing procedures as outlined above. If the specific time frames of such a unique matter relating to requesting, granting, and concluding of the hearing is contrary to the time frames as set out in the hearing procedures above, the specific time frames will govern over the time frames as set out within these procedures.
(4) The executive director * * *,
with the approval of the commission and subject to the rules
and regulations of the State Personnel Board,
shall be authorized to employ eligibility, technical, clerical and supportive
staff as may be required in carrying out and fully implementing the
determination of Medicaid eligibility, including conducting quality control
reviews and the investigation of the improper receipt of medical assistance.
Staffing needs will be set forth in the annual appropriation act for the * * * commission. Additional office
space as needed in performing eligibility, quality control and investigative
functions shall be obtained by the * * * commission.
SECTION 9. Section 43-13-117, Mississippi Code of 1972, is amended as follows:
43-13-117. (A) Medicaid as
authorized by this article shall include payment of part or all of the costs,
at the discretion of the * * *division commission, with approval of the * * * the Centers for Medicare and
Medicaid Services, of the following types of care and services rendered to
eligible applicants who have been determined to be eligible for that care and
services, within the limits of state appropriations and federal matching funds:
(1) Inpatient hospital services.
(a) The * * * commission is authorized to implement
an All Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement
methodology for inpatient hospital services.
(b) No service
benefits or reimbursement limitations in this subsection (A)(1) shall apply to
payments under an APR-DRG or Ambulatory Payment Classification (APC) model or a
managed care program or similar model described in subsection (H) of this
section unless specifically authorized by the * * * commission.
(2) Outpatient hospital services.
(a) Emergency services.
(b) Other
outpatient hospital services. The * * * commission shall allow benefits
for other medically necessary outpatient hospital services (such as
chemotherapy, radiation, surgery and therapy), including outpatient services in
a clinic or other facility that is not located inside the hospital, but that
has been designated as an outpatient facility by the hospital, and that was in
operation or under construction on July 1, 2009, provided that the costs and
charges associated with the operation of the hospital clinic are included in
the hospital's cost report. In addition, the Medicare thirty-five-mile rule
will apply to those hospital clinics not located inside the hospital that are
constructed after July 1, 2009. Where the same services are reimbursed as
clinic services, the * * *
commission may revise the rate or methodology of outpatient
reimbursement to maintain consistency, efficiency, economy and quality of care.
(c) The * * * commission is authorized to
implement an Ambulatory Payment Classification (APC) methodology for outpatient
hospital services. The * * *division commission shall give rural hospitals that
have fifty (50) or fewer licensed beds the option to not be reimbursed for
outpatient hospital services using the APC methodology, but reimbursement for
outpatient hospital services provided by those hospitals shall be based on one
hundred one percent (101%) of the rate established under Medicare for
outpatient hospital services. Those hospitals choosing to not be reimbursed
under the APC methodology shall remain under cost-based reimbursement for a two-year
period.
(d) No service
benefits or reimbursement limitations in this subsection (A)(2) shall apply to
payments under an APR-DRG or APC model or a managed care program or similar
model described in subsection (H) of this section unless specifically
authorized by the * * *
commission.
(3) Laboratory and x-ray services.
(4) Nursing facility services.
(a) The * * * commission shall make full
payment to nursing facilities for each day, not exceeding forty-two (42) days
per year, that a patient is absent from the facility on home leave. Payment
may be made for the following home leave days in addition to the forty-two-day
limitation: Christmas, the day before Christmas, the day after Christmas,
Thanksgiving, the day before Thanksgiving and the day after Thanksgiving.
(b) From
and after July 1, 1997, the * * * commission shall implement the
integrated case-mix payment and quality monitoring system, which includes the
fair rental system for property costs and in which recapture of depreciation is
eliminated. The * * *
commission may reduce the payment for hospital leave and therapeutic
home leave days to the lower of the case-mix category as computed for the
resident on leave using the assessment being utilized for payment at that point
in time, or a case-mix score of 1.000 for nursing facilities, and shall compute
case-mix scores of residents so that only services provided at the nursing
facility are considered in calculating a facility's per diem.
(c) From and after July 1, 1997, all state-owned nursing facilities shall be reimbursed on a full reasonable cost basis.
(d) On or after
January 1, 2015, the * * *
commission shall update the case-mix payment system resource utilization
grouper and classifications and fair rental reimbursement system. The * * * commission shall develop and
implement a payment add-on to reimburse nursing facilities for ventilator-dependent
resident services.
(e) The * * * commission shall develop and
implement, not later than January 1, 2001, a case-mix payment add-on determined
by time studies and other valid statistical data that will reimburse a nursing
facility for the additional cost of caring for a resident who has a diagnosis
of Alzheimer's or other related dementia and exhibits symptoms that require
special care. Any such case-mix add-on payment shall be supported by a
determination of additional cost. The * * * commission shall also develop
and implement as part of the fair rental reimbursement system for nursing
facility beds, an Alzheimer's resident bed depreciation enhanced reimbursement
system that will provide an incentive to encourage nursing facilities to
convert or construct beds for residents with Alzheimer's or other related
dementia.
(f) The * * * commission shall develop and
implement an assessment process for long-term care services. The * * * commission may provide the
assessment and related functions directly or through contract with the area
agencies on aging.
The * * * commission shall apply for
necessary federal waivers to assure that additional services providing
alternatives to nursing facility care are made available to applicants for
nursing facility care.
(5) Periodic screening
and diagnostic services for individuals under age twenty-one (21) years as are
needed to identify physical and mental defects and to provide health care
treatment and other measures designed to correct or ameliorate defects and
physical and mental illness and conditions discovered by the screening
services, regardless of whether these services are included in the state plan.
The * * *
commission may include in its periodic screening and diagnostic program
those discretionary services authorized under the federal regulations adopted
to implement Title XIX of the federal Social Security Act, as amended. The * * * commission, in obtaining
physical therapy services, occupational therapy services, and services for
individuals with speech, hearing and language disorders, may enter into a
cooperative agreement with the State Department of Education for the provision
of those services to handicapped students by public school districts using
state funds that are provided from the appropriation to the Department of
Education to obtain federal matching funds through the * * * commission. The * * * commission, in obtaining
medical and mental health assessments, treatment, care and services for
children who are in, or at risk of being put in, the custody of the Mississippi
Department of Human Services may enter into a cooperative agreement with the
Mississippi Department of Human Services for the provision of those services
using state funds that are provided from the appropriation to the Department of
Human Services to obtain federal matching funds through the * * * commission.
(6) Physician
services. Fees for physician's services that are covered only by Medicaid
shall be reimbursed at ninety percent (90%) of the rate established on January
1, 2018, and as may be adjusted each July thereafter, under Medicare. The * * * commission may provide for a
reimbursement rate for physician's services of up to one hundred percent (100%)
of the rate established under Medicare for physician's services that are provided
after the normal working hours of the physician, as determined in accordance
with regulations of the * * *division commission. The * * * commission may reimburse
eligible providers, as determined by the * * * commission, for certain primary
care services at one hundred percent (100%) of the rate established under
Medicare. The * * *
commission shall reimburse obstetricians and gynecologists for certain
primary care services as defined by the * * * commission at one hundred
percent (100%) of the rate established under Medicare.
(7) (a) Home health
services for eligible persons, not to exceed in cost the prevailing cost of
nursing facility services. All home health visits must be precertified as
required by the * * *
commission. In addition to physicians, certified registered nurse
practitioners, physician assistants and clinical nurse specialists are
authorized to prescribe or order home health services and plans of care, sign
home health plans of care, certify and recertify eligibility for home health
services and conduct the required initial face-to-face visit with the recipient
of the services.
(b) [Repealed]
(8) Emergency medical
transportation services as determined by the * * * commission.
(9) Prescription drugs
and other covered drugs and services as determined by the * * * commission.
The * * * commission shall establish a
mandatory preferred drug list. Drugs not on the mandatory preferred drug list
shall be made available by utilizing prior authorization procedures established
by the * * *
commission.
The * * * commission may seek to
establish relationships with other states in order to lower acquisition costs
of prescription drugs to include single-source and innovator multiple-source
drugs or generic drugs. In addition, if allowed by federal law or regulation,
the * * *
commission may seek to establish relationships with and negotiate with
other countries to facilitate the acquisition of prescription drugs to include
single-source and innovator multiple-source drugs or generic drugs, if that
will lower the acquisition costs of those prescription drugs.
The * * * commission may allow for a
combination of prescriptions for single-source and innovator multiple-source
drugs and generic drugs to meet the needs of the beneficiaries.
The * * * commission may
approve specific maintenance drugs for beneficiaries with certain medical
conditions, which may be prescribed and dispensed in three-month supply
increments.
Drugs prescribed for a
resident of a psychiatric residential treatment facility must be provided in
true unit doses when available. The * * * commission may require that
drugs not covered by Medicare Part D for a resident of a long-term care
facility be provided in true unit doses when available. Those drugs that were
originally billed to the * * *division commission but are not used by a resident in
any of those facilities shall be returned to the billing pharmacy for credit to
the * * *
commission, in accordance with the guidelines of the State Board of
Pharmacy and any requirements of federal law and regulation. Drugs shall be
dispensed to a recipient and only one (1) dispensing fee per month may be
charged. The * * *
commission shall develop a methodology for reimbursing for restocked
drugs, which shall include a restock fee as determined by the * * * commission not exceeding Seven
Dollars and Eighty-two Cents ($7.82).
Except for those specific
maintenance drugs approved by the * * * commission, the * * * commission shall not reimburse
for any portion of a prescription that exceeds a thirty-one-day supply of the
drug based on the daily dosage.
The * * * commission is authorized to
develop and implement a program of payment for additional pharmacist services
as determined by the * * *
commission.
All claims for drugs for
dually eligible Medicare/Medicaid beneficiaries that are paid for by Medicare
must be submitted to Medicare for payment before they may be processed by the * * * commission's online payment
system.
The * * * commission shall develop a
pharmacy policy in which drugs in tamper-resistant packaging that are
prescribed for a resident of a nursing facility but are not dispensed to the
resident shall be returned to the pharmacy and not billed to Medicaid, in
accordance with guidelines of the State Board of Pharmacy.
The * * * commission shall develop and
implement a method or methods by which the * * * commission will provide on a
regular basis to Medicaid providers who are authorized to prescribe drugs,
information about the costs to the Medicaid program of single-source drugs and
innovator multiple-source drugs, and information about other drugs that may be
prescribed as alternatives to those single-source drugs and innovator multiple-source
drugs and the costs to the Medicaid program of those alternative drugs.
Notwithstanding any law or
regulation, information obtained or maintained by the * * * commission regarding the
prescription drug program, including trade secrets and manufacturer or labeler
pricing, is confidential and not subject to disclosure except to other state
agencies.
The dispensing fee for each
new or refill prescription, including nonlegend or over-the-counter drugs
covered by the * * *
commission, shall be not less than Three Dollars and Ninety-one Cents
($3.91), as determined by the * * * commission.
The * * * commission shall not reimburse
for single-source or innovator multiple-source drugs if there are equally effective
generic equivalents available and if the generic equivalents are the least
expensive.
It is the intent of the Legislature that the pharmacists providers be reimbursed for the reasonable costs of filling and dispensing prescriptions for Medicaid beneficiaries.
The * * * commission shall allow certain
drugs, including physician-administered drugs, and implantable drug system
devices, and medical supplies, with limited distribution or limited access for
beneficiaries and administered in an appropriate clinical setting, to be
reimbursed as either a medical claim or pharmacy claim, as determined by the * * * commission.
It is the intent of the
Legislature that the * * *
commission and any managed care entity described in subsection (H) of
this section encourage the use of Alpha-Hydroxyprogesterone Caproate (17P) to
prevent recurrent preterm birth.
(10) Dental and
orthodontic services to be determined by the * * * commission.
The * * * commission shall increase the
amount of the reimbursement rate for diagnostic and preventative dental
services for each of the fiscal years 2022, 2023 and 2024 by five percent (5%)
above the amount of the reimbursement rate for the previous fiscal year. The * * * commission shall increase the
amount of the reimbursement rate for restorative dental services for each of
the fiscal years 2023, 2024 and 2025 by five percent (5%) above the amount of
the reimbursement rate for the previous fiscal year. It is the intent of the Legislature
that the reimbursement rate revision for preventative dental services will be
an incentive to increase the number of dentists who actively provide Medicaid
services. This dental services reimbursement rate revision shall be known as
the "James Russell Dumas Medicaid Dental Services Incentive Program."
The Medical Care Advisory
Committee * * * shall annually determine the effect of
this incentive by evaluating the number of dentists who are Medicaid providers,
the number who and the degree to which they are actively billing Medicaid, the
geographic trends of where dentists are offering what types of Medicaid
services and other statistics pertinent to the goals of this legislative
intent. This data shall annually be presented to the Chair of the Senate
Medicaid Committee and the Chair of the House Medicaid Committee.
The * * * commission shall include dental
services as a necessary component of overall health services provided to
children who are eligible for services.
(11) Eyeglasses for
all Medicaid beneficiaries who have (a) had surgery on the eyeball or ocular
muscle that results in a vision change for which eyeglasses or a change in
eyeglasses is medically indicated within six (6) months of the surgery and is
in accordance with policies established by the * * * commission, or (b) one (1) pair
every five (5) years and in accordance with policies established by the * * * commission. In either
instance, the eyeglasses must be prescribed by a physician skilled in diseases
of the eye or an optometrist, whichever the beneficiary may select.
(12) Intermediate care facility services.
(a) The * * * commission shall make full
payment to all intermediate care facilities for individuals with intellectual
disabilities for each day, not exceeding sixty-three (63) days per year, that a
patient is absent from the facility on home leave. Payment may be made for the
following home leave days in addition to the sixty-three-day limitation:
Christmas, the day before Christmas, the day after Christmas, Thanksgiving, the
day before Thanksgiving and the day after Thanksgiving.
(b) All state-owned intermediate care facilities for individuals with intellectual disabilities shall be reimbursed on a full reasonable cost basis.
(c) Effective
January 1, 2015, the * * *
commission shall update the fair rental reimbursement system for
intermediate care facilities for individuals with intellectual disabilities.
(13) Family planning services, including drugs, supplies and devices, when those services are under the supervision of a physician or nurse practitioner.
(14) Clinic services. Preventive, diagnostic, therapeutic, rehabilitative or palliative services that are furnished by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. Clinic services include, but are not limited to:
(a) Services provided by ambulatory surgical centers (ACSs) as defined in Section 41-75-1(a); and
(b) Dialysis center services.
(15) Home- and community-based services for the elderly and disabled, as provided under Title XIX of the federal Social Security Act, as amended, under waivers, subject to the availability of funds specifically appropriated for that purpose by the Legislature.
(16) Mental health
services. Certain services provided by a psychiatrist shall be reimbursed at
up to one hundred percent (100%) of the Medicare rate. Approved therapeutic
and case management services (a) provided by an approved regional mental
health/intellectual disability center established under Sections 41-19-31
through 41-19-39, or by another community mental health service provider
meeting the requirements of the Department of Mental Health to be an approved
mental health/intellectual disability center if determined necessary by the
Department of Mental Health, using state funds that are provided in the
appropriation to the * * *
commission to match federal funds, or (b) provided by a facility that is
certified by the State Department of Mental Health to provide therapeutic and
case management services, to be reimbursed on a fee for service basis, or (c)
provided in the community by a facility or program operated by the Department
of Mental Health. Any such services provided by a facility described in
subparagraph (b) must have the prior approval of the * * * commission to be reimbursable
under this section.
(17) Durable medical
equipment services and medical supplies. Precertification of durable medical
equipment and medical supplies must be obtained as required by the * * * commission. The * * * commission may
require durable medical equipment providers to obtain a surety bond in the
amount and to the specifications as established by the Balanced Budget Act of
1997. A maximum dollar amount of reimbursement for noninvasive ventilators or
ventilation treatments properly ordered and being used in an appropriate care
setting shall not be set by any health maintenance organization, coordinated
care organization, provider-sponsored health plan, or other organization paid
for services on a capitated basis by the * * * commission under any managed
care program or coordinated care program implemented by the * * * commission under this section.
Reimbursement by these organizations to durable medical equipment suppliers for
home use of noninvasive and invasive ventilators shall be on a continuous monthly
payment basis for the duration of medical need throughout a patient's valid
prescription period.
(18) (a)
Notwithstanding any other provision of this section to the contrary, as
provided in the Medicaid state plan amendment or amendments as defined in
Section 43-13-145(10), the * * * commission shall make
additional reimbursement to hospitals that serve a disproportionate share of
low-income patients and that meet the federal requirements for those payments
as provided in Section 1923 of the federal Social Security Act and any applicable
regulations. It is the intent of the Legislature that the * * * commission shall draw down all
available federal funds allotted to the state for disproportionate share
hospitals. However, from and after January 1, 1999, public hospitals participating
in the Medicaid disproportionate share program may be required to participate
in an intergovernmental transfer program as provided in Section 1903 of the
federal Social Security Act and any applicable regulations.
(b) (i) 1. The * * * commission may establish a
Medicare Upper Payment Limits Program, as defined in Section 1902(a)(30) of the
federal Social Security Act and any applicable federal regulations, or an
allowable delivery system or provider payment initiative authorized under 42
CFR 438.6(c), for hospitals, nursing facilities and physicians employed or
contracted by hospitals.
2. The * * * commission shall establish a
Medicaid Supplemental Payment Program, as permitted by the federal Social
Security Act and a comparable allowable delivery system or provider payment
initiative authorized under 42 CFR 438.6(c), for emergency ambulance
transportation providers in accordance with this subsection (A)(18)(b).
(ii) The * * * commission shall assess each hospital,
nursing facility, and emergency ambulance transportation provider for the sole
purpose of financing the state portion of the Medicare Upper Payment Limits
Program or other program(s) authorized under this subsection (A)(18)(b). The
hospital assessment shall be as provided in Section 43-13-145(4)(a), and the
nursing facility and the emergency ambulance transportation assessments, if
established, shall be based on Medicaid utilization or other appropriate
method, as determined by the * * * commission, consistent with
federal regulations. The assessments will remain in effect as long as the
state participates in the Medicare Upper Payment Limits Program or other
program(s) authorized under this subsection (A)(18)(b). In addition to the
hospital assessment provided in Section 43-13-145(4)(a), hospitals with
physicians participating in the Medicare Upper Payment Limits Program or other
program(s) authorized under this subsection (A)(18)(b) shall be required to
participate in an intergovernmental transfer or assessment, as determined by
the * * *
commission, for the purpose of financing the state portion of the
physician UPL payments or other payment(s) authorized under this subsection
(A)(18)(b).
(iii) Subject
to approval by the Centers for Medicare and Medicaid Services (CMS) and the
provisions of this subsection (A)(18)(b), the * * * commission shall make
additional reimbursement to hospitals, nursing facilities, and emergency
ambulance transportation providers for the Medicare Upper Payment Limits
Program or other program(s) authorized under this subsection (A)(18)(b), and,
if the program is established for physicians, shall make additional
reimbursement for physicians, as defined in Section 1902(a)(30) of the federal
Social Security Act and any applicable federal regulations, provided the
assessment in this subsection (A)(18)(b) is in effect.
(iv)
Notwithstanding any other provision of this article to the contrary, effective
upon implementation of the Mississippi Hospital Access Program (MHAP) provided
in subparagraph (c)(i) below, the hospital portion of the inpatient Upper
Payment Limits Program shall transition into and be replaced by the MHAP
program. However, the * * *
commission is authorized to develop and implement an alternative fee-for-service
Upper Payment Limits model in accordance with federal laws and regulations if
necessary to preserve supplemental funding. Further, the * * * commission, in consultation
with the hospital industry shall develop alternative models for distribution of
medical claims and supplemental payments for inpatient and outpatient hospital
services, and such models may include, but shall not be limited to the
following: increasing rates for inpatient and outpatient services; creating a
low-income utilization pool of funds to reimburse hospitals for the costs of
uncompensated care, charity care and bad debts as permitted and approved
pursuant to federal regulations and the Centers for Medicare and Medicaid
Services; supplemental payments based upon Medicaid utilization, quality,
service lines and/or costs of providing such services to Medicaid beneficiaries
and to uninsured patients. The goals of such payment models shall be to ensure
access to inpatient and outpatient care and to maximize any federal funds that
are available to reimburse hospitals for services provided. Any such documents
required to achieve the goals described in this paragraph shall be submitted to
the Centers for Medicare and Medicaid Services, with a proposed effective date
of July 1, 2019, to the extent possible, but in no event shall the effective
date of such payment models be later than July 1, 2020. The Chairmen of the
Senate and House Medicaid Committees shall be provided a copy of the proposed
payment model(s) prior to submission. Effective July 1, 2018, and until such
time as any payment model(s) as described above become effective, the * * * commission, in consultation
with the hospital industry, is authorized to implement a transitional program
for inpatient and outpatient payments and/or supplemental payments (including,
but not limited to, MHAP and directed payments), to redistribute available
supplemental funds among hospital providers, provided that when compared to a
hospital's prior year supplemental payments, supplemental payments made
pursuant to any such transitional program shall not result in a decrease of
more than five percent (5%) and shall not increase by more than the amount
needed to maximize the distribution of the available funds.
(v) 1. To
preserve and improve access to ambulance transportation provider services, the * * * commission shall seek CMS
approval to make ambulance service access payments as set forth in this
subsection (A)(18)(b) for all covered emergency ambulance services rendered on
or after July 1, 2022, and shall make such ambulance service access payments
for all covered services rendered on or after the effective date of CMS
approval.
2. The * * * commission shall calculate the
ambulance service access payment amount as the balance of the portion of the
Medical Care Fund related to ambulance transportation service provider
assessments plus any federal matching funds earned on the balance, up to, but
not to exceed, the upper payment limit gap for all emergency ambulance service
providers.
3. a. Except for ambulance services exempt from the assessment provided in this paragraph (18)(b), all ambulance transportation service providers shall be eligible for ambulance service access payments each state fiscal year as set forth in this paragraph (18)(b).
b. In addition to any other funds paid to ambulance transportation service providers for emergency medical services provided to Medicaid beneficiaries, each eligible ambulance transportation service provider shall receive ambulance service access payments each state fiscal year equal to the ambulance transportation service provider's upper payment limit gap. Subject to approval by the Centers for Medicare and Medicaid Services, ambulance service access payments shall be made no less than on a quarterly basis.
c. As used in this paragraph (18)(b)(v), the term "upper payment limit gap" means the difference between the total amount that the ambulance transportation service provider received from Medicaid and the average amount that the ambulance transportation service provider would have received from commercial insurers for those services reimbursed by Medicaid.
4. An
ambulance service access payment shall not be used to offset any other payment
by the * * *
commission for emergency or nonemergency services to Medicaid
beneficiaries.
(c) (i) Not later
than December l, 2015, the * * * commission shall, subject to
approval by the Centers for Medicare and Medicaid Services (CMS), establish,
implement and operate a Mississippi Hospital Access Program (MHAP) for the
purpose of protecting patient access to hospital care through hospital
inpatient reimbursement programs provided in this section designed to maintain
total hospital reimbursement for inpatient services rendered by in-state
hospitals and the out-of-state hospital that is authorized by federal law to
submit intergovernmental transfers (IGTs) to the State of Mississippi and is
classified as Level I trauma center located in a county contiguous to the state
line at the maximum levels permissible under applicable federal statutes and
regulations, at which time the current inpatient Medicare Upper Payment Limits
(UPL) Program for hospital inpatient services shall transition to the MHAP.
(ii) Subject
to approval by the Centers for Medicare and Medicaid Services (CMS), the MHAP
shall provide increased inpatient capitation (PMPM) payments to managed care
entities contracting with the * * * commission pursuant to
subsection (H) of this section to support availability of hospital services or
such other payments permissible under federal law necessary to accomplish the
intent of this subsection.
(iii) The
intent of this subparagraph (c) is that effective for all inpatient hospital
Medicaid services during state fiscal year 2016, and so long as this provision
shall remain in effect hereafter, the * * * commission shall to the fullest
extent feasible replace the additional reimbursement for hospital inpatient
services under the inpatient Medicare Upper Payment Limits (UPL) Program with
additional reimbursement under the MHAP and other payment programs for
inpatient and/or outpatient payments which may be developed under the authority
of this paragraph.
(iv) The * * * commission shall assess each
hospital as provided in Section 43-13-145(4)(a) for the purpose of financing
the state portion of the MHAP, supplemental payments and such other purposes as
specified in Section 43-13-145. The assessment will remain in effect as long
as the MHAP and supplemental payments are in effect.
(19) (a) Perinatal
risk management services. The * * * commission shall promulgate
regulations to be effective from and after October 1, 1988, to establish a
comprehensive perinatal system for risk assessment of all pregnant and infant
Medicaid recipients and for management, education and follow-up for those who
are determined to be at risk. Services to be performed include case management,
nutrition assessment/counseling, psychosocial assessment/counseling and health
education. The * * *
commission shall contract with the State Department of Health to provide
services within this paragraph (Perinatal High Risk Management/Infant Services
System (PHRM/ISS)). The State Department of Health shall be reimbursed on a
full reasonable cost basis for services provided under this subparagraph (a).
(b) Early
intervention system services. The * * * commission shall cooperate with
the State Department of Health, acting as lead agency, in the development and
implementation of a statewide system of delivery of early intervention
services, under Part C of the Individuals with Disabilities Education Act
(IDEA). The State Department of Health shall certify annually in writing to
the * * * commission the dollar amount of state early
intervention funds available that will be utilized as a certified match for
Medicaid matching funds. Those funds then shall be used to provide expanded
targeted case management services for Medicaid eligible children with special
needs who are eligible for the state's early intervention system.
Qualifications for persons providing service coordination shall be determined
by the State Department of Health and the * * * commission.
(20) Home- and
community-based services for physically disabled approved services as allowed
by a waiver from the United States Department of Health and Human Services for
home- and community-based services for physically disabled people using state
funds that are provided from the appropriation to the State Department of
Rehabilitation Services and used to match federal funds under a cooperative
agreement between the * * *
commission and the department, provided that funds for these services
are specifically appropriated to the Department of Rehabilitation Services.
(21) Nurse
practitioner services. Services furnished by a registered nurse who is
licensed and certified by the Mississippi Board of Nursing as a nurse
practitioner, including, but not limited to, nurse anesthetists, nurse
midwives, family nurse practitioners, family planning nurse practitioners,
pediatric nurse practitioners, obstetrics-gynecology nurse practitioners and
neonatal nurse practitioners, under regulations adopted by the * * * commission. Reimbursement for
those services shall not exceed ninety percent (90%) of the reimbursement rate
for comparable services rendered by a physician. The * * * commission may provide for a
reimbursement rate for nurse practitioner services of up to one hundred percent
(100%) of the reimbursement rate for comparable services rendered by a
physician for nurse practitioner services that are provided after the normal
working hours of the nurse practitioner, as determined in accordance with
regulations of the * * *
commission.
(22) Ambulatory
services delivered in federally qualified health centers, rural health centers
and clinics of the local health departments of the State Department of Health
for individuals eligible for Medicaid under this article based on reasonable
costs as determined by the * * * commission. Federally
qualified health centers shall be reimbursed by the Medicaid prospective
payment system as approved by the Centers for Medicare and Medicaid Services.
The * * *
commission shall recognize federally qualified health centers (FQHCs),
rural health clinics (RHCs) and community mental health centers (CMHCs) as both
an originating and distant site provider for the purposes of telehealth
reimbursement. The * * *
commission is further authorized and directed to reimburse FQHCs, RHCs
and CMHCs for both distant site and originating site services when such
services are appropriately provided by the same organization.
(23) Inpatient psychiatric services.
(a) Inpatient
psychiatric services to be determined by the * * * commission for recipients under
age twenty-one (21) that are provided under the direction of a physician in an
inpatient program in a licensed acute care psychiatric facility or in a
licensed psychiatric residential treatment facility, before the recipient
reaches age twenty-one (21) or, if the recipient was receiving the services immediately
before he or she reached age twenty-one (21), before the earlier of the date he
or she no longer requires the services or the date he or she reaches age twenty-two
(22), as provided by federal regulations. From and after January 1, 2015, the * * * commission shall update the
fair rental reimbursement system for psychiatric residential treatment
facilities. Precertification of inpatient days and residential treatment days
must be obtained as required by the * * * commission. From and after July
1, 2009, all state-owned and state-operated facilities that provide inpatient
psychiatric services to persons under age twenty-one (21) who are eligible for
Medicaid reimbursement shall be reimbursed for those services on a full reasonable
cost basis.
(b) The * * * commission may reimburse for
services provided by a licensed freestanding psychiatric hospital to Medicaid
recipients over the age of twenty-one (21) in a method and manner consistent
with the provisions of Section 43-13-117.5.
(24) [Deleted]
(25) [Deleted]
(26) Hospice care. As used in this paragraph, the term "hospice care" means a coordinated program of active professional medical attention within the home and outpatient and inpatient care that treats the terminally ill patient and family as a unit, employing a medically directed interdisciplinary team. The program provides relief of severe pain or other physical symptoms and supportive care to meet the special needs arising out of physical, psychological, spiritual, social and economic stresses that are experienced during the final stages of illness and during dying and bereavement and meets the Medicare requirements for participation as a hospice as provided in federal regulations.
(27) Group health plan premiums and cost-sharing if it is cost-effective as defined by the United States Secretary of Health and Human Services.
(28) Other health insurance premiums that are cost-effective as defined by the United States Secretary of Health and Human Services. Medicare eligible must have Medicare Part B before other insurance premiums can be paid.
(29) The * * * commission may
apply for a waiver from the United States Department of Health and Human
Services for home- and community-based services for developmentally disabled
people using state funds that are provided from the appropriation to the State
Department of Mental Health and/or funds transferred to the department by a
political subdivision or instrumentality of the state and used to match federal
funds under a cooperative agreement between the * * * commission and the department,
provided that funds for these services are specifically appropriated to the
Department of Mental Health and/or transferred to the department by a political
subdivision or instrumentality of the state.
(30) Pediatric skilled
nursing services as determined by the * * * commission and in a manner
consistent with regulations promulgated by the Mississippi State Department of
Health.
(31) Targeted case
management services for children with special needs, under waivers from the
United States Department of Health and Human Services, using state funds that
are provided from the appropriation to the Mississippi Department of Human Services
and used to match federal funds under a cooperative agreement between the * * * commission and the department.
(32) Care and services provided in Christian Science Sanatoria listed and certified by the Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc., rendered in connection with treatment by prayer or spiritual means to the extent that those services are subject to reimbursement under Section 1903 of the federal Social Security Act.
(33) Podiatrist services.
(34) Assisted living services as provided through home- and community-based services under Title XIX of the federal Social Security Act, as amended, subject to the availability of funds specifically appropriated for that purpose by the Legislature.
(35) Services and
activities authorized in Sections 43-27-101 and 43-27-103, using state funds
that are provided from the appropriation to the Mississippi Department of Human
Services and used to match federal funds under a cooperative agreement between
the * * *
commission and the department.
(36) Nonemergency
transportation services for Medicaid-eligible persons as determined by the * * * commission. The PEER Committee
shall conduct a performance evaluation of the nonemergency transportation
program to evaluate the administration of the program and the providers of
transportation services to determine the most cost-effective ways of providing
nonemergency transportation services to the patients served under the program.
The performance evaluation shall be completed and provided to the members of
the Senate Medicaid Committee and the House Medicaid Committee not later than
January 1, 2019, and every two (2) years thereafter.
(37) [Deleted]
(38) Chiropractic services. A chiropractor's manual manipulation of the spine to correct a subluxation, if x-ray demonstrates that a subluxation exists and if the subluxation has resulted in a neuromusculoskeletal condition for which manipulation is appropriate treatment, and related spinal x-rays performed to document these conditions. Reimbursement for chiropractic services shall not exceed Seven Hundred Dollars ($700.00) per year per beneficiary.
(39) Dually eligible
Medicare/Medicaid beneficiaries. The * * * commission shall pay the
Medicare deductible and coinsurance amounts for services available under
Medicare, as determined by the * * * commission. From and after
July 1, 2009, the * * *
commission shall reimburse crossover claims for inpatient hospital
services and crossover claims covered under Medicare Part B in the same manner
that was in effect on January 1, 2008, unless specifically authorized by the
Legislature to change this method.
(40) [Deleted]
(41) Services provided
by the State Department of Rehabilitation Services for the care and
rehabilitation of persons with spinal cord injuries or traumatic brain
injuries, as allowed under waivers from the United States Department of Health
and Human Services, using up to seventy-five percent (75%) of the funds that
are appropriated to the Department of Rehabilitation Services from the Spinal
Cord and Head Injury Trust Fund established under Section 37-33-261 and used to
match federal funds under a cooperative agreement between the * * * commission and the department.
(42) [Deleted]
(43) The * * * commission shall provide
reimbursement, according to a payment schedule developed by the * * * commission, for smoking
cessation medications for pregnant women during their pregnancy and other
Medicaid-eligible women who are of child-bearing age.
(44) Nursing facility services for the severely disabled.
(a) Severe disabilities include, but are not limited to, spinal cord injuries, closed-head injuries and ventilator-dependent patients.
(b) Those services must be provided in a long-term care nursing facility dedicated to the care and treatment of persons with severe disabilities.
(45) Physician
assistant services. Services furnished by a physician assistant who is
licensed by the State Board of Medical Licensure and is practicing with physician
supervision under regulations adopted by the board, under regulations adopted
by the * * *
commission. Reimbursement for those services shall not exceed ninety percent
(90%) of the reimbursement rate for comparable services rendered by a physician.
The * * *
commission may provide for a reimbursement rate for physician assistant
services of up to one hundred percent (100%) or the reimbursement rate for comparable
services rendered by a physician for physician assistant services that are
provided after the normal working hours of the physician assistant, as
determined in accordance with regulations of the * * * commission.
(46) The * * * commission shall make
application to the federal Centers for Medicare and Medicaid Services (CMS)
for a waiver to develop and provide services for children with serious
emotional disturbances as defined in Section 43-14-1(1), which may include home-
and community-based services, case management services or managed care services
through mental health providers certified by the Department of Mental Health.
The * * *
commission may implement and provide services under this waivered
program only if funds for these services are specifically appropriated for this
purpose by the Legislature, or if funds are voluntarily provided by affected
agencies.
(47) (a) The * * * commission may develop and
implement disease management programs for individuals with high-cost chronic
diseases and conditions, including the use of grants, waivers, demonstrations
or other projects as necessary.
(b) Participation in any disease management program implemented under this paragraph (47) is optional with the individual. An individual must affirmatively elect to participate in the disease management program in order to participate, and may elect to discontinue participation in the program at any time.
(48) Pediatric long-term acute care hospital services.
(a) Pediatric long-term acute care hospital services means services provided to eligible persons under twenty-one (21) years of age by a freestanding Medicare-certified hospital that has an average length of inpatient stay greater than twenty-five (25) days and that is primarily engaged in providing chronic or long-term medical care to persons under twenty-one (21) years of age.
(b) The services under this paragraph (48) shall be reimbursed as a separate category of hospital services.
(49) The * * * commission may establish
copayments and/or coinsurance for any Medicaid services for which copayments
and/or coinsurance are allowable under federal law or regulation.
(50) Services provided by the State Department of Rehabilitation Services for the care and rehabilitation of persons who are deaf and blind, as allowed under waivers from the United States Department of Health and Human Services to provide home- and community-based services using state funds that are provided from the appropriation to the State Department of Rehabilitation Services or if funds are voluntarily provided by another agency.
(51) Upon determination of Medicaid eligibility and in association with annual redetermination of Medicaid eligibility, beneficiaries shall be encouraged to undertake a physical examination that will establish a base-line level of health and identification of a usual and customary source of care (a medical home) to aid utilization of disease management tools. This physical examination and utilization of these disease management tools shall be consistent with current United States Preventive Services Task Force or other recognized authority recommendations.
For persons who are
determined ineligible for Medicaid, the * * * commission will provide
information and direction for accessing medical care and services in the area
of their residence.
(52) Notwithstanding
any provisions of this article, the * * * commission may pay enhanced
reimbursement fees related to trauma care, as determined by the * * * commission in conjunction with
the State Department of Health, using funds appropriated to the State Department
of Health for trauma care and services and used to match federal funds under a
cooperative agreement between the * * * commission and the State
Department of Health. The * * * commission, in conjunction with
the State Department of Health, may use grants, waivers, demonstrations,
enhanced reimbursements, Upper Payment Limits Programs, supplemental payments,
or other projects as necessary in the development and implementation of this
reimbursement program.
(53) Targeted case
management services for high-cost beneficiaries may be developed by the * * * commission for all services
under this section.
(54) [Deleted]
(55) Therapy
services. The plan of care for therapy services may be developed to cover a
period of treatment for up to six (6) months, but in no event shall the plan of
care exceed a six-month period of treatment. The projected period of treatment
must be indicated on the initial plan of care and must be updated with each
subsequent revised plan of care. Based on medical necessity, the * * * commission shall approve
certification periods for less than or up to six (6) months, but in no event
shall the certification period exceed the period of treatment indicated on the
plan of care. The appeal process for any reduction in therapy services shall
be consistent with the appeal process in federal regulations.
(56) Prescribed
pediatric extended care centers services for medically dependent or
technologically dependent children with complex medical conditions that require
continual care as prescribed by the child's attending physician, as determined
by the * * *
commission.
(57) No Medicaid benefit shall restrict coverage for medically appropriate treatment prescribed by a physician and agreed to by a fully informed individual, or if the individual lacks legal capacity to consent by a person who has legal authority to consent on his or her behalf, based on an individual's diagnosis with a terminal condition. As used in this paragraph (57), "terminal condition" means any aggressive malignancy, chronic end-stage cardiovascular or cerebral vascular disease, or any other disease, illness or condition which a physician diagnoses as terminal.
(58) Treatment
services for persons with opioid dependency or other highly addictive substance
use disorders. The * * *
commission is authorized to reimburse eligible providers for treatment
of opioid dependency and other highly addictive substance use disorders, as
determined by the * * *
commission. Treatment related to these conditions shall not count
against any physician visit limit imposed under this section.
(59) The * * * commission shall allow
beneficiaries between the ages of ten (10) and eighteen (18) years to receive
vaccines through a pharmacy venue. The * * * commission and the State
Department of Health shall coordinate and notify OB-GYN providers that the
Vaccines for Children program is available to providers free of charge.
(60) Border city university-affiliated pediatric teaching hospital.
(a) Payments may only be made to a border city university-affiliated pediatric teaching hospital if the Centers for Medicare and Medicaid Services (CMS) approve an increase in the annual request for the provider payment initiative authorized under 42 CFR Section 438.6(c) in an amount equal to or greater than the estimated annual payment to be made to the border city university-affiliated pediatric teaching hospital. The estimate shall be based on the hospital's prior year Mississippi managed care utilization.
(b) As used in
this paragraph (60), the term "border city university-affiliated pediatric
teaching hospital" means an out-of-state hospital located within a city
bordering the eastern bank of the Mississippi River and the State of
Mississippi that submits to the * * * commission a copy of a current and
effective affiliation agreement with an accredited university and other
documentation establishing that the hospital is university-affiliated, is
licensed and designated as a pediatric hospital or pediatric primary hospital
within its home state, maintains at least five (5) different pediatric
specialty training programs, and maintains at least one hundred (100) operated
beds dedicated exclusively for the treatment of patients under the age of twenty-one
(21) years.
(c) The cost of providing services to Mississippi Medicaid beneficiaries under the age of twenty-one (21) years who are treated by a border city university-affiliated pediatric teaching hospital shall not exceed the cost of providing the same services to individuals in hospitals in the state.
(d) It is the intent of the Legislature that payments shall not result in any in-state hospital receiving payments lower than they would otherwise receive if not for the payments made to any border city university-affiliated pediatric teaching hospital.
(e) This paragraph
(60) shall stand repealed on July 1, * * * 2027.
(B) Planning and development districts participating in the home- and community-based services program for the elderly and disabled as case management providers shall be reimbursed for case management services at the maximum rate approved by the Centers for Medicare and Medicaid Services (CMS).
(C) The * * * commission may pay to those
providers who participate in and accept patient referrals from the * * * commission's emergency room
redirection program a percentage, as determined by the * * * commission, of savings achieved
according to the performance measures and reduction of costs required of that
program. Federally qualified health centers may participate in the emergency
room redirection program, and the * * * commission may pay those
centers a percentage of any savings to the Medicaid program achieved by the
centers' accepting patient referrals through the program, as provided in this
subsection (C).
(D) (1) As used in this subsection (D), the following terms shall be defined as provided in this paragraph, except as otherwise provided in this subsection:
(a) "Committees" means the Medicaid Committees of the House of Representatives and the Senate, and "committee" means either one of those committees.
(b) "Rate change" means an increase, decrease or other change in the payments or rates of reimbursement, or a change in any payment methodology that results in an increase, decrease or other change in the payments or rates of reimbursement, to any Medicaid provider that renders any services authorized to be provided to Medicaid recipients under this article.
(2) Whenever the * * * commission proposes
a rate change, the * * *
commission shall give notice to the chairmen of the committees at least
thirty (30) calendar days before the proposed rate change is scheduled to take
effect. The * * *
commission shall furnish the chairmen with a concise summary of each
proposed rate change along with the notice, and shall furnish the chairmen with
a copy of any proposed rate change upon request. The * * * commission also shall provide a
summary and copy of any proposed rate change to any other member of the
Legislature upon request.
(3) If the chairman of
either committee or both chairmen jointly object to the proposed rate change or
any part thereof, the chairman or chairmen shall notify the * * * commission and provide the
reasons for their objection in writing not later than seven (7) calendar days
after receipt of the notice from the * * * commission. The chairman or
chairmen may make written recommendations to the * * * commission for changes to be
made to a proposed rate change.
(4) (a) The chairman
of either committee or both chairmen jointly may hold a committee meeting to
review a proposed rate change. If either chairman or both chairmen decide to
hold a meeting, they shall notify the * * * commission of their intention
in writing within seven (7) calendar days after receipt of the notice from the * * * commission, and shall set the
date and time for the meeting in their notice to the * * * commission, which shall not be
later than fourteen (14) calendar days after receipt of the notice from the * * * commission.
(b) After the
committee meeting, the committee or committees may object to the proposed rate
change or any part thereof. The committee or committees shall notify the * * * commission and the reasons for
their objection in writing not later than seven (7) calendar days after the
meeting. The committee or committees may make written recommendations to the * * * commission for changes to be
made to a proposed rate change.
(5) If both chairmen
notify the * * *
commission in writing within seven (7) calendar days after receipt of
the notice from the * * *
commission that they do not object to the proposed rate change and will
not be holding a meeting to review the proposed rate change, the proposed rate
change will take effect on the original date as scheduled by the * * * commission or on such other
date as specified by the * * *division commission.
(6) (a) If there are
any objections to a proposed rate change or any part thereof from either or
both of the chairmen or the committees, the * * * commission may withdraw the
proposed rate change, make any of the recommended changes to the proposed rate
change, or not make any changes to the proposed rate change.
(b) If the * * * commission does not make any
changes to the proposed rate change, it shall notify the chairmen of that fact
in writing, and the proposed rate change shall take effect on the original date
as scheduled by the * * *
commission or on such other date as specified by the * * * commission.
(c) If the * * * commission makes any changes to
the proposed rate change, the * * * commission shall notify the
chairmen of its actions in writing, and the revised proposed rate change shall
take effect on the date as specified by the * * * commission.
(7) Nothing in this
subsection (D) shall be construed as giving the chairmen or the committees any
authority to veto, nullify or revise any rate change proposed by the * * * commission. The authority of
the chairmen or the committees under this subsection shall be limited to
reviewing, making objections to and making recommendations for changes to rate
changes proposed by the * * *division commission.
(E) Notwithstanding any
provision of this article, no new groups or categories of recipients and new
types of care and services may be added without enabling legislation from the
Mississippi Legislature, except that the * * * commission may authorize those
changes without enabling legislation when the addition of recipients or
services is ordered by a court of proper authority.
(F) The executive director
shall keep the * * *
commission advised on a timely basis of the funds available for
expenditure and the projected expenditures. Notwithstanding any other
provisions of this article, if current or projected expenditures of the * * * commission are reasonably anticipated
to exceed the amount of funds appropriated to the * * * commission for any fiscal year,
the * * * commission shall
take all appropriate measures to reduce costs, which may include, but are not
limited to:
(1) Reducing or discontinuing any or all services that are deemed to be optional under Title XIX of the Social Security Act;
(2) Reducing reimbursement rates for any or all service types;
(3) Imposing additional assessments on health care providers; or
(4) Any additional
cost-containment measures deemed appropriate by the * * * commission.
To the extent allowed under federal law, any reduction to services or reimbursement rates under this subsection (F) shall be accompanied by a reduction, to the fullest allowable amount, to the profit margin and administrative fee portions of capitated payments to organizations described in paragraph (1) of subsection (H).
Beginning in fiscal year
2010 and in fiscal years thereafter, when Medicaid expenditures are projected
to exceed funds available for the fiscal year, the * * * commission shall submit the
expected shortfall information to the PEER Committee not later than December 1
of the year in which the shortfall is projected to occur. PEER shall review
the computations of the * * *division commission and report its findings to the
Legislative Budget Office not later than January 7 in any year.
(G) Notwithstanding any
other provision of this article, it shall be the duty of each provider
participating in the Medicaid program to keep and maintain books, documents and
other records as prescribed by the * * * commission in
accordance with federal laws and regulations.
(H) (1) Notwithstanding any
other provision of this article, the * * * commission is authorized to
implement (a) a managed care program, (b) a coordinated care program, (c) a
coordinated care organization program, (d) a health maintenance organization
program, (e) a patient-centered medical home program, (f) an accountable care
organization program, (g) provider-sponsored health plan, or (h) any
combination of the above programs. As a condition for the approval of any
program under this subsection (H)(1), the * * * commission shall require that
no managed care program, coordinated care program, coordinated care
organization program, health maintenance organization program, or provider-sponsored
health plan may:
(a) Pay providers at a rate that is less than the Medicaid All Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement rate;
(b) Override the medical decisions of hospital physicians or staff regarding patients admitted to a hospital for an emergency medical condition as defined by 42 US Code Section 1395dd. This restriction (b) does not prohibit the retrospective review of the appropriateness of the determination that an emergency medical condition exists by chart review or coding algorithm, nor does it prohibit prior authorization for nonemergency hospital admissions;
(c) Pay providers
at a rate that is less than the normal Medicaid reimbursement rate. It is the
intent of the Legislature that all managed care entities described in this
subsection (H), in collaboration with the * * * commission, develop and
implement innovative payment models that incentivize improvements in health
care quality, outcomes, or value, as determined by the * * * commission. Participation in
the provider network of any managed care, coordinated care, provider-sponsored
health plan, or similar contractor shall not be conditioned on the provider's
agreement to accept such alternative payment models;
(d) Implement a
prior authorization and utilization review program for medical services, transportation
services and prescription drugs that is more stringent than the prior
authorization processes used by the * * * commission in its
administration of the Medicaid program. Not later than December 2, 2021, the
contractors that are receiving capitated payments under a managed care delivery
system established under this subsection (H) shall submit a report to the
Chairmen of the House and Senate Medicaid Committees on the status of the prior
authorization and utilization review program for medical services,
transportation services and prescription drugs that is required to be
implemented under this subparagraph (d);
(e) [Deleted]
(f) Implement a
preferred drug list that is more stringent than the mandatory preferred drug
list established by the * * *division commission under subsection (A)(9) of this
section;
(g) Implement a policy which denies beneficiaries with hemophilia access to the federally funded hemophilia treatment centers as part of the Medicaid Managed Care network of providers.
Each health maintenance
organization, coordinated care organization, provider-sponsored health plan, or
other organization paid for services on a capitated basis by the * * * commission under any managed
care program or coordinated care program implemented by the * * * commission under this section
shall use a clear set of level of care guidelines in the determination of
medical necessity and in all utilization management practices, including the
prior authorization process, concurrent reviews, retrospective reviews and
payments, that are consistent with widely accepted professional standards of
care. Organizations participating in a managed care program or coordinated
care program implemented by the * * * commission may not use any
additional criteria that would result in denial of care that would be determined
appropriate and, therefore, medically necessary under those levels of care
guidelines.
(2) Notwithstanding
any provision of this section, the recipients eligible for enrollment into a
Medicaid Managed Care Program authorized under this subsection (H) may include
only those categories of recipients eligible for participation in the Medicaid
Managed Care Program as of January 1, 2021, the Children's Health Insurance Program
(CHIP), and the CMS-approved Section 1115 demonstration waivers in operation as
of January 1, 2021. No expansion of Medicaid Managed Care Program contracts
may be implemented by the * * *division commission without enabling legislation from
the Mississippi Legislature.
(3) (a) Any
contractors receiving capitated payments under a managed care delivery system
established in this section shall provide to the Legislature and the * * * commission statistical data to
be shared with provider groups in order to improve patient access, appropriate
utilization, cost savings and health outcomes not later than October 1 of each
year. Additionally, each contractor shall disclose to the Chairmen of the
Senate and House Medicaid Committees the administrative expenses costs for the
prior calendar year, and the number of full-equivalent employees located in the
State of Mississippi dedicated to the Medicaid and CHIP lines of business as of
June 30 of the current year.
(b) The * * * commission and the contractors
participating in the managed care program, a coordinated care program or a
provider-sponsored health plan shall be subject to annual program reviews or
audits performed by the Office of the State Auditor, the PEER Committee, the
Department of Insurance and/or independent third parties.
(c) Those reviews shall include, but not be limited to, at least two (2) of the following items:
(i) The financial benefit to the State of Mississippi of the managed care program,
(ii) The difference between the premiums paid to the managed care contractors and the payments made by those contractors to health care providers,
(iii) Compliance with performance measures required under the contracts,
(iv) Administrative expense allocation methodologies,
(v) Whether nonprovider payments assigned as medical expenses are appropriate,
(vi) Capitated arrangements with related party subcontractors,
(vii) Reasonableness of corporate allocations,
(viii) Value-added benefits and the extent to which they are used,
(ix) The effectiveness of subcontractor oversight, including subcontractor review,
(x) Whether health care outcomes have been improved, and
(xi) The most common claim denial codes to determine the reasons for the denials.
The audit reports shall be
considered public documents and shall be posted in their entirety on the * * * commission's website.
(4) All health
maintenance organizations, coordinated care organizations, provider-sponsored
health plans, or other organizations paid for services on a capitated basis by
the * * *
commission under any managed care program or coordinated care program
implemented by the * * *
commission under this section shall reimburse all providers in those
organizations at rates no lower than those provided under this section for
beneficiaries who are not participating in those programs.
(5) No health
maintenance organization, coordinated care organization, provider-sponsored
health plan, or other organization paid for services on a capitated basis by
the * * *
commission under any managed care program or coordinated care program
implemented by the * * *
commission under this section shall require its providers or
beneficiaries to use any pharmacy that ships, mails or delivers prescription
drugs or legend drugs or devices.
(6) (a) Not later than December 1, 2021, the contractors who are receiving capitated payments under a managed care delivery system established under this subsection (H) shall develop and implement a uniform credentialing process for providers. Under that uniform credentialing process, a provider who meets the criteria for credentialing will be credentialed with all of those contractors and no such provider will have to be separately credentialed by any individual contractor in order to receive reimbursement from the contractor. Not later than December 2, 2021, those contractors shall submit a report to the Chairmen of the House and Senate Medicaid Committees on the status of the uniform credentialing process for providers that is required under this subparagraph (a).
(b) If those
contractors have not implemented a uniform credentialing process as described
in subparagraph (a) by December 1, 2021, the * * * commission shall develop and
implement, not later than July 1, 2022, a single, consolidated credentialing
process by which all providers will be credentialed. Under the * * * commission's single,
consolidated credentialing process, no such contractor shall require its
providers to be separately credentialed by the contractor in order to receive
reimbursement from the contractor, but those contractors shall recognize the
credentialing of the providers by the * * * commission's credentialing
process.
(c) The * * * commission shall require a
uniform provider credentialing application that shall be used in the
credentialing process that is established under subparagraph (a) or (b). If
the contractor or * * *
commission, as applicable, has not approved or denied the provider
credentialing application within sixty (60) days of receipt of the completed
application that includes all required information necessary for credentialing,
then the contractor or * * *
commission, upon receipt of a written request from the applicant and
within five (5) business days of its receipt, shall issue a temporary provider
credential/enrollment to the applicant if the applicant has a valid Mississippi
professional or occupational license to provide the health care services to which
the credential/enrollment would apply. The contractor or the * * * commission shall not issue a
temporary credential/enrollment if the applicant has reported on the
application a history of medical or other professional or occupational
malpractice claims, a history of substance abuse or mental health issues, a
criminal record, or a history of medical or other licensing board, state or
federal disciplinary action, including any suspension from participation in a
federal or state program. The temporary credential/enrollment shall be
effective upon issuance and shall remain in effect until the provider's
credentialing/enrollment application is approved or denied by the contractor or * * * commission. The contractor or * * * commission shall render a final
decision regarding credentialing/enrollment of the provider within sixty (60)
days from the date that the temporary provider credential/enrollment is issued
to the applicant.
(d) If the
contractor or * * *
commission does not render a final decision regarding
credentialing/enrollment of the provider within the time required in
subparagraph (c), the provider shall be deemed to be credentialed by and
enrolled with all of the contractors and eligible to receive reimbursement from
the contractors.
(7) (a) Each contractor that is receiving capitated payments under a managed care delivery system established under this subsection (H) shall provide to each provider for whom the contractor has denied the coverage of a procedure that was ordered or requested by the provider for or on behalf of a patient, a letter that provides a detailed explanation of the reasons for the denial of coverage of the procedure and the name and the credentials of the person who denied the coverage. The letter shall be sent to the provider in electronic format.
(b) After a
contractor that is receiving capitated payments under a managed care delivery
system established under this subsection (H) has denied coverage for a claim
submitted by a provider, the contractor shall issue to the provider within
sixty (60) days a final ruling of denial of the claim that allows the provider
to have a state fair hearing and/or agency appeal with the * * * commission. If a contractor
does not issue a final ruling of denial within sixty (60) days as required by
this subparagraph (b), the provider's claim shall be deemed to be automatically
approved and the contractor shall pay the amount of the claim to the provider.
(c) After a
contractor has issued a final ruling of denial of a claim submitted by a
provider, the * * *
commission shall conduct a state fair hearing and/or agency appeal on
the matter of the disputed claim between the contractor and the provider within
sixty (60) days, and shall render a decision on the matter within thirty (30)
days after the date of the hearing and/or appeal.
(8) It is the
intention of the Legislature that the * * * commission evaluate the
feasibility of using a single vendor to administer pharmacy benefits provided
under a managed care delivery system established under this subsection (H).
Providers of pharmacy benefits shall cooperate with the * * * commission in any transition to
a carve-out of pharmacy benefits under managed care.
(9) The * * * commission shall evaluate the
feasibility of using a single vendor to administer dental benefits provided
under a managed care delivery system established in this subsection (H).
Providers of dental benefits shall cooperate with the * * * commission in any transition to
a carve-out of dental benefits under managed care.
(10) It is the intent of the Legislature that any contractor receiving capitated payments under a managed care delivery system established in this section shall implement innovative programs to improve the health and well-being of members diagnosed with prediabetes and diabetes.
(11) It is the intent of the Legislature that any contractors receiving capitated payments under a managed care delivery system established under this subsection (H) shall work with providers of Medicaid services to improve the utilization of long-acting reversible contraceptives (LARCs). Not later than December 1, 2021, any contractors receiving capitated payments under a managed care delivery system established under this subsection (H) shall provide to the Chairmen of the House and Senate Medicaid Committees and House and Senate Public Health Committees a report of LARC utilization for State Fiscal Years 2018 through 2020 as well as any programs, initiatives, or efforts made by the contractors and providers to increase LARC utilization. This report shall be updated annually to include information for subsequent state fiscal years.
(12) The * * * commission is authorized to
make not more than one (1) emergency extension of the contracts that are in
effect on July 1, 2021, with contractors who are receiving capitated payments
under a managed care delivery system established under this subsection (H), as
provided in this paragraph (12). The maximum period of any such extension
shall be one (1) year, and under any such extensions, the contractors shall be
subject to all of the provisions of this subsection (H). The extended contracts
shall be revised to incorporate any provisions of this subsection (H).
(I) [Deleted]
(J) There shall be no cuts in inpatient and outpatient hospital payments, or allowable days or volumes, as long as the hospital assessment provided in Section 43-13-145 is in effect. This subsection (J) shall not apply to decreases in payments that are a result of: reduced hospital admissions, audits or payments under the APR-DRG or APC models, or a managed care program or similar model described in subsection (H) of this section.
(K) In the negotiation and
execution of such contracts involving services performed by actuarial firms,
the * * * commission may negotiate a
limitation on liability to the state of prospective contractors.
(L) The * * * commission shall
reimburse for services provided to eligible Medicaid beneficiaries by a
licensed birthing center in a method and manner to be determined by the * * * commission in accordance with
federal laws and federal regulations. The * * * commission shall seek any
necessary waivers, make any required amendments to its State Plan or revise any
contracts authorized under subsection (H) of this section as necessary to
provide the services authorized under this subsection. As used in this
subsection, the term "birthing centers" shall have the meaning as
defined in Section 41-77-1(a), which is a publicly or privately owned facility,
place or institution constructed, renovated, leased or otherwise established
where nonemergency births are planned to occur away from the mother's usual
residence following a documented period of prenatal care for a normal
uncomplicated pregnancy which has been determined to be low risk through a
formal risk-scoring examination.
(M) This section shall
stand repealed on July 1, * * *2024 2027.
SECTION 10. Section 43-13-120, Mississippi Code of 1972, is amended as follows:
43-13-120. (1) Any person
who is a Medicaid recipient and is receiving medical assistance for services
provided in a long-term care facility under the provisions of Section 43-13-117 * * *, who dies intestate and leaves no known heirs, shall have
deemed, through his acceptance of such medical assistance, the * * * commission as his
beneficiary to all such funds in an amount not to exceed Two Hundred Fifty
Dollars ($250.00) which are in his possession at the time of his death. Such
funds, together with any accrued interest thereon, shall be reported by the
long-term care facility to the State Treasurer in the manner provided in
subsection (2).
(2) The report of such funds shall be verified, shall be on a form prescribed or approved by the Treasurer, and shall include (a) the name of the deceased person and his last known address prior to entering the long-term care facility; (b) the name and last known address of each person who may possess an interest in such funds; and (c) any other information which the Treasurer prescribes by regulation as necessary for the administration of this section. The report shall be filed with the Treasurer prior to November 1 of each year in which the long-term care facility has provided services to a person or persons having funds to which this section applies.
(3) Within one hundred
twenty (120) days from November 1 of each year in which a report is made
pursuant to subsection (2), the Treasurer shall cause notice to be published in
a newspaper having general circulation in the county of this state in which is
located the last known address of the person or persons named in the report who
may possess an interest in such funds, or if no such person is named in the
report, in the county in which is located the last known address of the
deceased person prior to entering the long-term care facility. If no address
is given in the report or if the address is outside of this state, the notice
shall be published in a newspaper having general circulation in the county in
which the facility is located. The notice shall contain (a) the name of the
deceased person; (b) his last known address prior to entering the facility; (c)
the name and last known address of each person named in the report who may
possess an interest in such funds; and (d) a statement that any person
possessing an interest in such funds must make a claim therefor to the
Treasurer within ninety (90) days after such publication date or the funds will
become the property of the State of Mississippi. In any year in which the
Treasurer publishes a notice of abandoned property under Section 89-12-27, the
Treasurer may combine the notice required by this section with the notice of
abandoned property. The cost to the Treasurer of publishing the notice
required by this section shall be paid by the * * * commission.
(4) Each long-term care
facility that makes a report of funds of a deceased person under this section
shall pay over and deliver such funds, together with any accrued interest
thereon, to the Treasurer not later than ten (10) days after notice of such
funds has been published by the Treasurer as provided in subsection (3). If a
claim to such funds is not made by any person having an interest therein within
ninety (90) days of the published notice, the Treasurer shall place such funds
in the special account in the State Treasury to the credit of the * * *
commission to be expended by the * * * commission for the
purposes provided under Mississippi Medicaid Law.
(5) This section shall not be applicable to any Medicaid patient in a long-term care facility of a state institution listed in Section 41-7-73, who has a personal deposit fund as provided for in Section 41-7-90.
SECTION 11. Section 43-13-121, Mississippi Code of 1972, is amended as follows:
43-13-121. (1) The commission shall administer the Medicaid program under the provisions of this article, and may do the following:
(a) Adopt and
promulgate reasonable rules, regulations and standards * * * and in
accordance with the Administrative Procedures Law, Section 25-43-1.101 et seq.:
(i) Establishing methods and procedures as may be necessary for the proper and efficient administration of this article;
(ii) Providing
Medicaid to all qualified recipients under the provisions of this article as
the * * *
commission may determine and within the limits of appropriated funds;
(iii) Establishing
reasonable fees, charges and rates for medical services and drugs; in doing so,
the * * *
commission shall fix all of those fees, charges and rates at the minimum
levels absolutely necessary to provide the medical assistance authorized by
this article, and shall not change any of those fees, charges or rates except
as may be authorized in Section 43-13-117;
(iv) Providing for fair and impartial hearings;
(v) Providing safeguards for preserving the confidentiality of records; and
(vi) For detecting and processing fraudulent practices and abuses of the program;
(b) Receive and expend
state, federal and other funds in accordance with court judgments or
settlements and agreements between the State of Mississippi and the federal
government, the rules and regulations promulgated by the * * * commission,
and within the limitations and
restrictions of this article and within the limits of funds available for that
purpose;
(c) Subject to the limits imposed by this article and subject to the provisions of subsection (8) of this section, to submit a Medicaid plan to the United States Department of Health and Human Services for approval under the provisions of the federal Social Security Act, to act for the state in making negotiations relative to the submission and approval of that plan, to make such arrangements, not inconsistent with the law, as may be required by or under federal law to obtain and retain that approval and to secure for the state the benefits of the provisions of that law.
No agreements, specifically
including the general plan for the operation of the Medicaid program in this
state, shall be made by and between the * * * commission and the United
States Department of Health and Human Services unless the Attorney General of
the State of Mississippi has reviewed the agreements, specifically including
the operational plan, and has certified in writing to the * * *
commission that the agreements, including the plan of operation, have
been drawn strictly in accordance with the terms and requirements of this
article;
(d) In accordance with the purposes and intent of this article and in compliance with its provisions, provide for aged persons otherwise eligible for the benefits provided under Title XVIII of the federal Social Security Act by expenditure of funds available for those purposes;
(e) To make reports to the United States Department of Health and Human Services as from time to time may be required by that federal department and to the Mississippi Legislature as provided in this section;
(f) Define and determine the scope, duration and amount of Medicaid that may be provided in accordance with this article and establish priorities therefor in conformity with this article;
(g) Cooperate and contract with other state agencies for the purpose of coordinating Medicaid provided under this article and eliminating duplication and inefficiency in the Medicaid program;
(h) Adopt and use an
official seal of the * * *
commission;
(i) Sue in its own name on behalf of the State of Mississippi and employ legal counsel on a contingency basis with the approval of the Attorney General;
(j) To recover any and
all payments incorrectly made by the * * * commission to a recipient or
provider from the recipient or provider receiving the payments. The * * * commission shall be authorized
to collect any overpayments to providers sixty (60) days after the conclusion
of any administrative appeal unless the matter is appealed to a court of proper
jurisdiction and bond is posted. Any appeal filed after July 1, 2015, shall be
to the Chancery Court of the First Judicial District of Hinds County,
Mississippi, within sixty (60) days after the date that the * * * commission has notified the
provider by certified mail sent to the proper address of the provider on file
with the * * *
commission and the provider has signed for the certified mail notice, or
sixty (60) days after the date of the final decision if the provider does not
sign for the certified mail notice. To recover those payments, the * * * commission may use the
following methods, in addition to any other methods available to the * * * commission:
(i) The * * * commission shall report to the
Department of Revenue the name of any current or former Medicaid recipient who
has received medical services rendered during a period of established Medicaid
ineligibility and who has not reimbursed the * * * commission for the related
medical service payment(s). The Department of Revenue shall withhold from the
state tax refund of the individual, and pay to the * * * commission, the amount of the
payment(s) for medical services rendered to the ineligible individual that have
not been reimbursed to the * * * commission for the related
medical service payment(s).
(ii) The * * * commission shall report to the
Department of Revenue the name of any Medicaid provider to whom payments were
incorrectly made that the * * *division commission has not been able to recover by
other methods available to the * * * commission. The Department of
Revenue shall withhold from the state tax refund of the provider, and pay to
the * * *
commission, the amount of the payments that were incorrectly made to the
provider that have not been recovered by other available methods;
(k) To recover any and
all payments by the * * *
commission fraudulently obtained by a recipient or provider.
Additionally, if recovery of any payments fraudulently obtained by a recipient
or provider is made in any court, then, upon motion of the * * * commission, the judge of the
court may award twice the payments recovered as damages;
(l) Have full,
complete and plenary power and authority to conduct such investigations as it
may deem necessary and requisite of alleged or suspected violations or abuses
of the provisions of this article or of the regulations adopted under this
article, including, but not limited to, fraudulent or unlawful act or deed by
applicants for Medicaid or other benefits, or payments made to any person, firm
or corporation under the terms, conditions and authority of this article, to
suspend or disqualify any provider of services, applicant or recipient for
gross abuse, fraudulent or unlawful acts for such periods, including
permanently, and under such conditions as the * * * commission deems proper and
just, including the imposition of a legal rate of interest on the amount
improperly or incorrectly paid. Recipients who are found to have misused or
abused Medicaid benefits may be locked into one (1) physician and/or one (1)
pharmacy of the recipient's choice for a reasonable amount of time in order to
educate and promote appropriate use of medical services, in accordance with
federal regulations. If an administrative hearing becomes necessary, the * * * commission may, if the provider
does not succeed in his or her defense, tax the costs of the administrative
hearing, including the costs of the court reporter or stenographer and
transcript, to the provider. The convictions of a recipient or a provider in a
state or federal court for abuse, fraudulent or unlawful acts under this
chapter shall constitute an automatic disqualification of the recipient or
automatic disqualification of the provider from participation under the
Medicaid program.
A conviction, for the purposes of this chapter, shall include a judgment entered on a plea of nolo contendere or a nonadjudicated guilty plea and shall have the same force as a judgment entered pursuant to a guilty plea or a conviction following trial. A certified copy of the judgment of the court of competent jurisdiction of the conviction shall constitute prima facie evidence of the conviction for disqualification purposes;
(m) Establish and
provide such methods of administration as may be necessary for the proper and
efficient operation of the Medicaid program, fully utilizing computer equipment
as may be necessary to oversee and control all current expenditures for
purposes of this article, and to closely monitor and supervise all recipient
payments and vendors rendering services under this article.
Notwithstanding any other provision of state law, the * * * commission is authorized to
enter into a ten-year contract(s) with a vendor(s) to provide services
described in this paragraph (m). Notwithstanding any provision of law to the
contrary, the * * *
commission is authorized to extend its Medicaid Management Information
System, including all related components and services, and Decision Support
System, including all related components and services, contracts in effect on
June 30, 2020, for a period not to exceed two (2) years without complying with state
procurement regulations;
(n) To cooperate and contract with the federal government for the purpose of providing Medicaid to Vietnamese and Cambodian refugees, under the provisions of Public Law 94-23 and Public Law 94-24, including any amendments to those laws, only to the extent that the Medicaid assistance and the administrative cost related thereto are one hundred percent (100%) reimbursable by the federal government. For the purposes of Section 43-13-117, persons receiving Medicaid under Public Law 94-23 and Public Law 94-24, including any amendments to those laws, shall not be considered a new group or category of recipient; and
(o) The * * * commission shall impose
penalties upon Medicaid only, Title XIX participating long-term care facilities
found to be in noncompliance with * * * commission and certification
standards in accordance with federal and state regulations, including interest
at the same rate calculated by the United States Department of Health and Human
Services and/or the Centers for Medicare and Medicaid Services (CMS) under
federal regulations.
(2) The * * * commission also shall exercise
such additional powers and perform such other duties as may be conferred upon
the * * *
commission by act of the Legislature.
(3) The * * * commission, and the State
Department of Health as the agency for licensure of health care facilities and
certification and inspection for the Medicaid and/or Medicare programs, shall
contract for or otherwise provide for the consolidation of on-site inspections
of health care facilities that are necessitated by the respective programs and
functions of the * * *
commission and the department.
(4) The * * * commission and its hearing
officers shall have power to preserve and enforce order during hearings; to issue
subpoenas for, to administer oaths to and to compel the attendance and
testimony of witnesses, or the production of books, papers, documents and other
evidence, or the taking of depositions before any designated individual
competent to administer oaths; to examine witnesses; and to do all things
conformable to law that may be necessary to enable them effectively to
discharge the duties of their office. In compelling the attendance and testimony
of witnesses, or the production of books, papers, documents and other evidence,
or the taking of depositions, as authorized by this section, the * * * commission or its hearing
officers may designate an individual employed by the * * * commission or some other
suitable person to execute and return that process, whose action in executing
and returning that process shall be as lawful as if done by the sheriff or some
other proper officer authorized to execute and return process in the county
where the witness may reside. In carrying out the investigatory powers under
the provisions of this article, the executive director or other * * * person or persons designated by
the commission may examine, obtain, copy or reproduce the books, papers,
documents, medical charts, prescriptions and other records relating to medical
care and services furnished by the provider to a recipient or designated
recipients of Medicaid services under investigation. In the absence of the
voluntary submission of the books, papers, documents, medical charts,
prescriptions and other records, the * * * commission may issue and serve subpoenas instantly
upon the provider, his or her agent, servant or employee for the production of
the books, papers, documents, medical charts, prescriptions or other records
during an audit or investigation of the provider. If any provider or his or
her agent, servant or employee refuses to produce the records after being duly
subpoenaed, the * * * commission may certify those facts and institute
contempt proceedings in the manner, time and place as authorized by law for
administrative proceedings. As an additional remedy, the * * * commission may recover all
amounts paid to the provider covering the period of the audit or investigation,
inclusive of a legal rate of interest and a reasonable attorney's fee and costs
of court if suit becomes necessary. * * * Commission staff shall have immediate
access to the provider's physical location, facilities, records, documents,
books, and any other records relating to medical care and services rendered to
recipients during regular business hours.
(5) If any person in
proceedings before the * * *
commission disobeys or resists any lawful order or process, or
misbehaves during a hearing or so near the place thereof as to obstruct the
hearing, or neglects to produce, after having been ordered to do so, any
pertinent book, paper or document, or refuses to appear after having been
subpoenaed, or upon appearing refuses to take the oath as a witness, or after
having taken the oath refuses to be examined according to law, the * * * commission shall
certify the facts to any court having jurisdiction in the place in which it is
sitting, and the court shall thereupon, in a summary manner, hear the evidence
as to the acts complained of, and if the evidence so warrants, punish that
person in the same manner and to the same extent as for a contempt committed
before the court, or commit that person upon the same condition as if the doing
of the forbidden act had occurred with reference to the process of, or in the
presence of, the court.
(6) In suspending or
terminating any provider from participation in the Medicaid program, the * * * commission shall preclude the
provider from submitting claims for payment, either personally or through any
clinic, group, corporation or other association to the * * * commission or its fiscal agents
for any services or supplies provided under the Medicaid program except for
those services or supplies provided before the suspension or termination. No
clinic, group, corporation or other association that is a provider of services
shall submit claims for payment to the * * * commission or its fiscal agents
for any services or supplies provided by a person within that organization who
has been suspended or terminated from participation in the Medicaid program
except for those services or supplies provided before the suspension or
termination. When this provision is violated by a provider of services that is
a clinic, group, corporation or other association, the * * * commission may suspend or
terminate that organization from participation. Suspension may be applied by
the * * *
commission to all known affiliates of a provider, provided that each
decision to include an affiliate is made on a case-by-case basis after giving
due regard to all relevant facts and circumstances. The violation, failure or
inadequacy of performance may be imputed to a person with whom the provider is
affiliated where that conduct was accomplished within the course of his or her
official duty or was effectuated by him or her with the knowledge or approval
of that person.
(7) The * * * commission may deny or revoke
enrollment in the Medicaid program to a provider if any of the following are
found to be applicable to the provider, his or her agent, a managing employee
or any person having an ownership interest equal to five percent (5%) or
greater in the provider:
(a) Failure to
truthfully or fully disclose any and all information required, or the
concealment of any and all information required, on a claim, a provider
application or a provider agreement, or the making of a false or misleading
statement to the * * *
commission relative to the Medicaid program.
(b) Previous or
current exclusion, suspension, termination from or the involuntary withdrawing
from participation in the Medicaid program, any other state's Medicaid program,
Medicare or any other public or private health or health insurance program. If
the * * *
commission ascertains that a provider has been convicted of a felony
under federal or state law for an offense that the * * * commission determines is
detrimental to the best interest of the program or of Medicaid beneficiaries,
the * * *
commission may refuse to enter into an agreement with that provider, or
may terminate or refuse to renew an existing agreement.
(c) Conviction under federal or state law of a criminal offense relating to the delivery of any goods, services or supplies, including the performance of management or administrative services relating to the delivery of the goods, services or supplies, under the Medicaid program, any other state's Medicaid program, Medicare or any other public or private health or health insurance program.
(d) Conviction under federal or state law of a criminal offense relating to the neglect or abuse of a patient in connection with the delivery of any goods, services or supplies.
(e) Conviction under federal or state law of a criminal offense relating to the unlawful manufacture, distribution, prescription or dispensing of a controlled substance.
(f) Conviction under federal or state law of a criminal offense relating to fraud, theft, embezzlement, breach of fiduciary responsibility or other financial misconduct.
(g) Conviction under federal or state law of a criminal offense punishable by imprisonment of a year or more that involves moral turpitude, or acts against the elderly, children or infirm.
(h) Conviction under federal or state law of a criminal offense in connection with the interference or obstruction of any investigation into any criminal offense listed in paragraphs (c) through (i) of this subsection.
(i) Sanction for a violation of federal or state laws or rules relative to the Medicaid program, any other state's Medicaid program, Medicare or any other public health care or health insurance program.
(j) Revocation of license or certification.
(k) Failure to pay recovery properly assessed or pursuant to an approved repayment schedule under the Medicaid program.
(l) Failure to meet any condition of enrollment.
(8) (a) As used in this subsection (8), the following terms shall be defined as provided in this paragraph, except as otherwise provided in this subsection:
(i) "Committees" means the Medicaid Committees of the House of Representatives and the Senate, and "committee" means either one of those committees.
(ii) "State Plan" means the agreement between the State of Mississippi and the federal government regarding the nature and scope of Mississippi's Medicaid Program.
(iii) "State Plan Amendment" means a change to the State Plan, which must be approved by the Centers for Medicare and Medicaid Services (CMS) before its implementation.
(b) Whenever
the * * * commission proposes a State Plan Amendment, the * * * commission shall give notice to
the chairmen of the committees at least thirty (30) calendar days before the
proposed State Plan Amendment is filed with CMS. The * * * commission shall furnish the
chairmen with a concise summary of each proposed State Plan Amendment along
with the notice, and shall furnish the chairmen with a copy of any proposed State Plan Amendment upon request. The * * * commission also shall provide a
summary and copy of any proposed State Plan Amendment to any other member of
the Legislature upon request.
(c) If the chairman of
either committee or both chairmen jointly object to the proposed State Plan
Amendment or any part thereof, the chairman or chairmen shall notify the * * * commission and provide the
reasons for their objection in writing not later than seven (7) calendar days
after receipt of the notice from the * * * commission. The chairman or
chairmen may make written recommendations to the * * * commission for changes to be
made to a proposed State Plan Amendment.
(d) (i) The chairman
of either committee or both chairmen jointly may hold a committee meeting to
review a proposed State Plan Amendment. If either chairman or both chairmen
decide to hold a meeting, they shall notify the * * * commission of their intention
in writing within seven (7) calendar days after receipt of the notice from the * * * commission, and shall set the
date and time for the meeting in their notice to the * * * commission, which shall not be
later than fourteen (14) calendar days after receipt of the notice from the * * * commission.
(ii) After the
committee meeting, the committee or committees may object to the proposed State
Plan Amendment or any part thereof. The committee or committees shall notify
the * * *
commission and the reasons for their objection in writing not later than
seven (7) calendar days after the meeting. The committee or committees may
make written recommendations to the * * * commission for changes to be
made to a proposed State Plan Amendment.
(e) If both chairmen
notify the * * *
commission in writing within seven (7) calendar days after receipt of
the notice from the * * *
commission that they do not object to the proposed State Plan Amendment
and will not be holding a meeting to review the proposed State Plan Amendment,
the * * *
commission may proceed to file the proposed State Plan Amendment with
CMS.
(f) (i) If there are
any objections to a proposed rate change or any part thereof from either or
both of the chairmen or the committees, the * * * commission may withdraw the
proposed State Plan Amendment, make any of the recommended changes to the
proposed State Plan Amendment, or not make any changes to the proposed State
Plan Amendment.
(ii) If the * * * commission does not make any
changes to the proposed State Plan Amendment, it shall notify the chairmen of
that fact in writing, and may proceed to file the State Plan Amendment with CMS.
(iii) If the * * * commission makes any changes to
the proposed State Plan Amendment, the * * * commission shall notify the
chairmen of its actions in writing, and may proceed to file the State Plan
Amendment with CMS.
(g) Nothing in this
subsection (8) shall be construed as giving the chairmen or the committees any
authority to veto, nullify or revise any State Plan Amendment proposed by the * * * commission. The authority of
the chairmen or the committees under this subsection shall be limited to
reviewing, making objections to and making recommendations for changes to State
Plan Amendments proposed by the * * * commission.
(i) If the * * * commission does not make any
changes to the proposed State Plan Amendment, it shall notify the chairmen of
that fact in writing, and may proceed to file the proposed State Plan Amendment
with CMS.
(ii) If the * * * commission makes any changes to
the proposed State Plan Amendment, the * * * commission shall notify the
chairmen of the changes in writing, and may proceed to file the proposed State
Plan Amendment with CMS.
(h)
Nothing in this subsection (8) shall be construed as giving the chairmen of the
committees any authority to veto, nullify or revise any State Plan Amendment
proposed by the * * *
commission. The authority of the chairmen of the committees under this
subsection shall be limited to reviewing, making objections to and making
recommendations for suggested changes to State Plan Amendments proposed by the * * * commission.
SECTION 12. Section 43-13-123, Mississippi Code of 1972, is amended as follows:
43-13-123. The
determination of the method of providing payment of claims under this article
shall be made by the * * *
commission, * * * which methods may be:
(a) By contract with insurance companies licensed to do business in the State of Mississippi or with nonprofit hospital service corporations, medical or dental service corporations, authorized to do business in Mississippi to underwrite on an insured premium approach, such medical assistance benefits as may be available, and any carrier selected under the provisions of this article is expressly authorized and empowered to undertake the performance of the requirements of that contract.
(b) By contract with an insurance company licensed to do business in the State of Mississippi or with nonprofit hospital service, medical or dental service organizations, or other organizations including data processing companies, authorized to do business in Mississippi to act as fiscal agent.
The * * * commission shall obtain
services to be provided under either of the above-described provisions in
accordance with the * * * Public Procurement Review Board procurement
regulations.
The authorization of the foregoing methods shall not preclude other methods of providing payment of claims through direct operation of the program by the state or its agencies.
SECTION 13. Section 43-13-125, Mississippi Code of 1972, is amended as follows:
43-13-125. (1) If Medicaid
is provided to a recipient under this article for injuries, disease or sickness
caused under circumstances creating a cause of action in favor of the recipient
against any person, firm, corporation, political subdivision or other state
agency, then the * * *
commission shall be entitled to recover the proceeds that may result
from the exercise of any rights of recovery that the recipient may have against
any such person, firm, corporation, political subdivision or other state
agency, to the extent of the * * * commission's
interest on behalf of the recipient. The recipient shall execute and deliver
instruments and papers to do whatever is necessary to secure those rights and
shall do nothing after Medicaid is provided to prejudice the subrogation rights
of the * * *
commission. Court orders or agreements for reimbursement of Medicaid's
interest shall direct those payments to the * * * commission, which
shall be authorized to endorse any and all, including, but not limited to,
multipayee checks, drafts, money orders, or other negotiable instruments
representing Medicaid payment recoveries that are received. In accordance with
Section 43-13-305, endorsement of multipayee checks, drafts, money orders or
other negotiable instruments by the * * * commission shall be
deemed endorsed by the recipient. All payments must be remitted to the * * * commission within sixty (60)
days from the date of a settlement or the entry of a final judgment; failure to
do so hereby authorizes the * * * commission to assert its rights
under Sections 43-13-307 and 43-13-315, plus interest.
The * * * commission
may compromise or settle any such claim and execute a release of any claim it
has by virtue of this section at the * * * commission's sole discretion.
Nothing in this section shall be construed to require the * * * commission to
compromise any such claim.
(2) The acceptance of
Medicaid under this article or the making of a claim under this article shall
not affect the right of a recipient or his or her legal representative to
recover Medicaid's interest as an element of damages in any action at law; however,
a copy of the pleadings shall be certified to the * * * commission at the time of the
institution of suit, and proof of that notice shall be filed of record in that
action. The * * *
commission may, at any time before the trial on the facts, join in that
action or may intervene in that action. Any amount recovered by a recipient or
his or her legal representative shall be applied as follows:
(a) The reasonable
costs of the collection, including attorney's fees, as approved and allowed by
the court in which that action is pending, or in case of settlement without
suit, by the legal representative of the * * * commission;
(b) The amount of
Medicaid's interest on behalf of the recipient; or such amount as may be
arrived at by the legal representative of the * * * commission and the recipient's
attorney; and
(c) Any excess shall be awarded to the recipient.
(3) No compromise of any
claim by the recipient or his or her legal representative shall be binding upon
or affect the rights of the * * * commission against the third
party unless the * * * commission has entered
into the compromise in writing. The recipient or his or her legal
representative maintain the absolute duty to notify the * * * commission of the institution
of legal proceedings, and the third party and his or her insurer maintain the absolute
duty to notify the * * *
commission of a proposed compromise for which the * * * commission has an interest.
The aforementioned absolute duties may not be delegated or assigned by contract
or otherwise. Any compromise effected by the recipient or his or her legal
representative with the third party in the absence of advance notification to
and approved by the * * *
commission shall constitute conclusive evidence of the liability of the
third party, and the * * *
commission, in litigating its claim against the third party, shall be
required only to prove the amount and correctness of its claim relating to the
injury, disease or sickness. If the recipient or his or her legal
representative fails to notify the * * * commission of the institution
of legal proceedings against a third party for which the * * * commission has a cause of
action, the facts relating to negligence and the liability of the third party,
if judgment is rendered for the recipient, shall constitute conclusive evidence
of liability in a subsequent action maintained by the * * * commission and only the amount
and correctness of the * * *
commission's claim relating to injuries, disease or sickness shall be
tried before the court. The * * * commission shall be authorized
in bringing that action against the third party and his or her insurer jointly
or against the insurer alone.
(4) Nothing in this section
shall be construed to diminish or otherwise restrict the subrogation rights of
the * * * commission against a third party for Medicaid
provided by the * * * commission to the recipient as a result of
injuries, disease or sickness caused under circumstances creating a cause of
action in favor of the recipient against such a third party.
(5) Any amounts recovered
by the * * *
commission under this section shall, by the * * * commission, be placed to the
credit of the funds appropriated for benefits under this article proportionate
to the amounts provided by the state and federal governments respectively.
SECTION 14. Section 43-13-139, Mississippi Code of 1972, is amended as follows:
43-13-139. Nothing
contained in this article shall be construed to prevent the * * * commission, in * * * its discretion, from discontinuing
or limiting medical assistance to any individuals who are classified or deemed
to be within any optional group or optional category of recipients as
prescribed under Title XIX of the federal Social Security Act or the implementing
federal regulations. If the Congress or the United States Department of Health
and Human Services ceases to provide federal matching funds for any group or
category of recipients or any type of care and services, the * * * commission shall cease state
funding for such group or category or such type of care and services,
notwithstanding any provision of this article. If any state plan amendment
submitted to comply with the provisions of Section 43-13-117 is disapproved by
the United States Department of Health and Human Services, the * * * commission may operate under
the state plan as previously approved by the United States Department of Health
and Human Services in order to preserve federal matching funds. The * * * commission shall provide notice
of the disapproval to the Chairmen of the House and Senate Medicaid Committees.
SECTION 15. Section 43-13-145, Mississippi Code of 1972, is amended as follows:
43-13-145. (1) (a) Upon
each nursing facility licensed by the State of Mississippi, there is levied an
assessment in an amount set by the * * * commission, equal to the
maximum rate allowed by federal law or regulation, for each licensed and
occupied bed of the facility.
(b) A nursing facility is exempt from the assessment levied under this subsection if the facility is operated under the direction and control of:
(i) The United States Veterans Administration or other agency or department of the United States government; or
(ii) The State Veterans Affairs Board.
(2) (a) Upon each
intermediate care facility for individuals with intellectual disabilities
licensed by the State of Mississippi, there is levied an assessment in an
amount set by the * * *
commission, equal to the maximum rate allowed by federal law or
regulation, for each licensed and occupied bed of the facility.
(b) An intermediate care facility for individuals with intellectual disabilities is exempt from the assessment levied under this subsection if the facility is operated under the direction and control of:
(i) The United States Veterans Administration or other agency or department of the United States government;
(ii) The State Veterans Affairs Board; or
(iii) The University of Mississippi Medical Center.
(3) (a) Upon each
psychiatric residential treatment facility licensed by the State of
Mississippi, there is levied an assessment in an amount set by the * * * commission, equal to the
maximum rate allowed by federal law or regulation, for each licensed and
occupied bed of the facility.
(b) A psychiatric residential treatment facility is exempt from the assessment levied under this subsection if the facility is operated under the direction and control of:
(i) The United States Veterans Administration or other agency or department of the United States government;
(ii) The University of Mississippi Medical Center; or
(iii) A state
agency or a state facility that either provides its own state match through
intergovernmental transfer or certification of funds to the * * * commission.
(4) Hospital assessment.
(a) (i) Subject to
and upon fulfillment of the requirements and conditions of paragraph (f) below,
and notwithstanding any other provisions of this section, an annual assessment
on each hospital licensed in the state is imposed on each non-Medicare hospital
inpatient day as defined below at a rate that is determined by dividing the sum
prescribed in this subparagraph (i), plus the nonfederal share necessary to
maximize the Disproportionate Share Hospital (DSH) and Medicare Upper Payment
Limits (UPL) Program payments and hospital access payments and such other
supplemental payments as may be developed pursuant to Section 43-13-117(A)(18),
by the total number of non-Medicare hospital inpatient days as defined below
for all licensed Mississippi hospitals, except as provided in paragraph (d)
below. If the state-matching funds percentage for the Mississippi Medicaid
program is sixteen percent (16%) or less, the sum used in the formula under
this subparagraph (i) shall be Seventy-four Million Dollars ($74,000,000.00).
If the state-matching funds percentage for the Mississippi Medicaid program is
twenty-four percent (24%) or higher, the sum used in the formula under this
subparagraph (i) shall be One Hundred Four Million Dollars ($104,000,000.00).
If the state-matching funds percentage for the Mississippi Medicaid program is
between sixteen percent (16%) and twenty-four percent (24%), the sum used in
the formula under this subparagraph (i) shall be a pro rata amount determined
as follows: the current state-matching funds percentage rate minus sixteen
percent (16%) divided by eight percent (8%) multiplied by Thirty Million
Dollars ($30,000,000.00) and add that amount to Seventy-four Million Dollars
($74,000,000.00). However, no assessment in a quarter under this subparagraph
(i) may exceed the assessment in the previous quarter by more than Three
Million Seven Hundred Fifty Thousand Dollars ($3,750,000.00) (which would be
Fifteen Million Dollars ($15,000,000.00) on an annualized basis). The * * * commission shall publish the
state-matching funds percentage rate applicable to the Mississippi Medicaid
program on the tenth day of the first month of each quarter and the assessment
determined under the formula prescribed above shall be applicable in the
quarter following any adjustment in that state-matching funds percentage rate.
The * * *
commission shall notify each hospital licensed in the state as to any
projected increases or decreases in the assessment determined under this
subparagraph (i). However, if the Centers for Medicare and Medicaid Services
(CMS) does not approve the provision in Section 43-13-117(39) requiring the * * * commission to reimburse
crossover claims for inpatient hospital services and crossover claims covered
under Medicare Part B for dually eligible beneficiaries in the same manner that
was in effect on January 1, 2008, the sum that otherwise would have been used
in the formula under this subparagraph (i) shall be reduced by Seven Million
Dollars ($7,000,000.00).
(ii) In addition to the assessment provided under subparagraph (i), an additional annual assessment on each hospital licensed in the state is imposed on each non-Medicare hospital inpatient day as defined below at a rate that is determined by dividing twenty-five percent (25%) of any provider reductions in the Medicaid program as authorized in Section 43-13-117(F) for that fiscal year up to the following maximum amount, plus the nonfederal share necessary to maximize the Disproportionate Share Hospital (DSH) and inpatient Medicare Upper Payment Limits (UPL) Program payments and inpatient hospital access payments, by the total number of non-Medicare hospital inpatient days as defined below for all licensed Mississippi hospitals: in fiscal year 2010, the maximum amount shall be Twenty-four Million Dollars ($24,000,000.00); in fiscal year 2011, the maximum amount shall be Thirty-two Million Dollars ($32,000,000.00); and in fiscal year 2012 and thereafter, the maximum amount shall be Forty Million Dollars ($40,000,000.00). Any such deficit in the Medicaid program shall be reviewed by the PEER Committee as provided in Section 43-13-117(F).
(iii) In addition
to the assessments provided in subparagraphs (i) and (ii), an additional annual
assessment on each hospital licensed in the state is imposed pursuant to the
provisions of Section 43-13-117(F) if the cost-containment measures described
therein have been implemented and there are insufficient funds in the Health
Care Trust Fund to reconcile any remaining deficit in any fiscal year. If the * * * commission institutes any other
additional cost-containment measures on any program or programs authorized
under the Medicaid program pursuant to Section 43-13-117(F), hospitals shall be
responsible for twenty-five percent (25%) of any such additional imposed
provider cuts, which shall be in the form of an additional assessment not to exceed
the twenty-five percent (25%) of provider expenditure reductions. Such additional
assessment shall be imposed on each non-Medicare hospital inpatient day in the
same manner as assessments are imposed under subparagraphs (i) and (ii).
(b) Definitions.
(i) [Deleted]
(ii) For purposes of this subsection (4):
1. "Non-Medicare
hospital inpatient day" means total hospital inpatient days including
subcomponent days less Medicare inpatient days including subcomponent days from
the hospital's most recent Medicare cost report for the second calendar year
preceding the beginning of the state fiscal year, on file with CMS per the CMS
HCRIS database, or cost report submitted to the * * * commission if the HCRIS
database is not available to the * * * commission, as of June 1 of
each year.
a. Total hospital inpatient days shall be the sum of Worksheet S-3, Part 1, column 8 row 14, column 8 row 16, and column 8 row 17, excluding column 8 rows 5 and 6.
b. Hospital Medicare inpatient days shall be the sum of Worksheet S-3, Part 1, column 6 row 14, column 6 row 16.00, and column 6 row 17, excluding column 6 rows 5 and 6.
c. Inpatient days shall not include residential treatment or long-term care days.
2. "Subcomponent inpatient day" means the number of days of care charged to a beneficiary for inpatient hospital rehabilitation and psychiatric care services in units of full days. A day begins at midnight and ends twenty-four (24) hours later. A part of a day, including the day of admission and day on which a patient returns from leave of absence, counts as a full day. However, the day of discharge, death, or a day on which a patient begins a leave of absence is not counted as a day unless discharge or death occur on the day of admission. If admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one (1) subcomponent inpatient day.
(c) The assessment
provided in this subsection is intended to satisfy and not be in addition to
the assessment and intergovernmental transfers provided in Section 43-13-117(A)(18).
Nothing in this section shall be construed to authorize any state agency, * * * commission or department, or
county, municipality or other local governmental unit to license for revenue,
levy or impose any other tax, fee or assessment upon hospitals in this state
not authorized by a specific statute.
(d) Hospitals operated by the United States Department of Veterans Affairs and state-operated facilities that provide only inpatient and outpatient psychiatric services shall not be subject to the hospital assessment provided in this subsection.
(e) Multihospital systems, closure, merger, change of ownership and new hospitals.
(i) If a hospital conducts, operates or maintains more than one (1) hospital licensed by the State Department of Health, the provider shall pay the hospital assessment for each hospital separately.
(ii) Notwithstanding any other provision in this section, if a hospital subject to this assessment operates or conducts business only for a portion of a fiscal year, the assessment for the state fiscal year shall be adjusted by multiplying the assessment by a fraction, the numerator of which is the number of days in the year during which the hospital operates, and the denominator of which is three hundred sixty-five (365). Immediately upon ceasing to operate, the hospital shall pay the assessment for the year as so adjusted (to the extent not previously paid).
(iii) The * * * commission shall determine the
tax for new hospitals and hospitals that undergo a change of ownership in
accordance with this section, using the best available information, as
determined by the * * *
commission.
(f) Applicability.
The hospital assessment imposed by this subsection shall not take effect and/or shall cease to be imposed if:
(i) The assessment is determined to be an impermissible tax under Title XIX of the Social Security Act; or
(ii) CMS revokes
its approval of the * * *
commission's 2009 Medicaid State Plan Amendment for the methodology for
DSH payments to hospitals under Section 43-13-117(A)(18).
(5) Each health care
facility that is subject to the provisions of this section shall keep and
preserve such suitable books and records as may be necessary to determine the
amount of assessment for which it is liable under this section. The books and
records shall be kept and preserved for a period of not less than five (5)
years, during which time those books and records shall be open for examination
during business hours by the * * * commission, the Department of
Revenue, the Office of the Attorney General and the State Department of Health.
(6) [Deleted]
(7) All assessments collected under this section shall be deposited in the Medical Care Fund created by Section 43-13-143.
(8) The assessment levied under this section shall be in addition to any other assessments, taxes or fees levied by law, and the assessment shall constitute a debt due the State of Mississippi from the time the assessment is due until it is paid.
(9) (a) If a health care
facility that is liable for payment of an assessment levied by the * * * commission does not pay the
assessment when it is due, the * * * commission shall give written
notice to the health care facility demanding payment of the assessment within
ten (10) days from the date of delivery of the notice. If the health care
facility fails or refuses to pay the assessment after receiving the notice and
demand from the * * *
commission, the * * *
commission shall withhold from any Medicaid reimbursement payments that
are due to the health care facility the amount of the unpaid assessment and a
penalty of ten percent (10%) of the amount of the assessment, plus the legal
rate of interest until the assessment is paid in full. If the health care
facility does not participate in the Medicaid program, the * * * commission shall turn over to
the Office of the Attorney General the collection of the unpaid assessment by
civil action. In any such civil action, the Office of the Attorney General
shall collect the amount of the unpaid assessment and a penalty of ten percent
(10%) of the amount of the assessment, plus the legal rate of interest until
the assessment is paid in full.
(b) As an additional
or alternative method for collecting unpaid assessments levied by the * * * commission, if a health care
facility fails or refuses to pay the assessment after receiving notice and
demand from the * * *
commission, the * * *
commission may file a notice of a tax lien with the chancery clerk of
the county in which the health care facility is located, for the amount of the
unpaid assessment and a penalty of ten percent (10%) of the amount of the
assessment, plus the legal rate of interest until the assessment is paid in
full. Immediately upon receipt of notice of the tax lien for the assessment,
the chancery clerk shall forward the notice to the circuit clerk who shall
enter the notice of the tax lien as a judgment upon the judgment roll and show
in the appropriate columns the name of the health care facility as judgment
debtor, the name of the * * *division commission as judgment creditor, the amount of
the unpaid assessment, and the date and time of enrollment. The judgment shall
be valid as against mortgagees, pledgees, entrusters, purchasers, judgment
creditors and other persons from the time of filing with the clerk. The amount
of the judgment shall be a debt due the State of Mississippi and remain a lien
upon the tangible property of the health care facility until the judgment is
satisfied. The judgment shall be the equivalent of any enrolled judgment of a
court of record and shall serve as authority for the issuance of writs of
execution, writs of attachment or other remedial writs.
(10) (a) To further the
provisions of Section 43-13-117(A)(18), the * * * commission shall
submit to the Centers for Medicare and Medicaid Services (CMS) any documents regarding
the hospital assessment established under subsection (4) of this section. In
addition to defining the assessment established in subsection (4) of this
section if necessary, the documents shall describe any supplement payment
programs and/or payment methodologies as authorized in Section 43-13-117(A)(18)
if necessary.
(b) All hospitals satisfying the minimum federal DSH eligibility requirements (Section 1923(d) of the Social Security Act) may, subject to OBRA 1993 payment limitations, receive a DSH payment. This DSH payment shall expend the balance of the federal DSH allotment and associated state share not utilized in DSH payments to state-owned institutions for treatment of mental diseases. The payment to each hospital shall be calculated by applying a uniform percentage to the uninsured costs of each eligible hospital, excluding state-owned institutions for treatment of mental diseases; however, that percentage for a state-owned teaching hospital located in Hinds County shall be multiplied by a factor of two (2).
(11) The * * * commission shall implement DSH
and supplemental payment calculation methodologies that result in the
maximization of available federal funds.
(12) The DSH payments shall be paid on or before December 31, March 31, and June 30 of each fiscal year, in increments of one-third (1/3) of the total calculated DSH amounts. Supplemental payments developed pursuant to Section 43-13-117(A)(18) shall be paid monthly.
(13) Payment.
(a) The hospital assessment as described in subsection (4) for the nonfederal share necessary to maximize the Medicare Upper Payments Limits (UPL) Program payments and hospital access payments and such other supplemental payments as may be developed pursuant to Section 43-3-117(A)(18) shall be assessed and collected monthly no later than the fifteenth calendar day of each month.
(b) The hospital assessment as described in subsection (4) for the nonfederal share necessary to maximize the Disproportionate Share Hospital (DSH) payments shall be assessed and collected on December 15, March 15 and June 15.
(c) The annual hospital assessment and any additional hospital assessment as described in subsection (4) shall be assessed and collected on September 15 and on the 15th of each month from December through June.
(14) If for any reason any part of the plan for annual DSH and supplemental payment programs to hospitals provided under subsection (10) of this section and/or developed pursuant to Section 43-13-117(A)(18) is not approved by CMS, the remainder of the plan shall remain in full force and effect.
(15) Nothing in this
section shall prevent the * * *Division of Medicaid commission from facilitating
participation in Medicaid supplemental hospital payment programs by a hospital
located in a county contiguous to the State of Mississippi that is also
authorized by federal law to submit intergovernmental transfers (IGTs) to the
State of Mississippi to fund the state share of the hospital's supplemental
and/or MHAP payments.
(16) This section shall
stand repealed on July 1, * * *2024 2027.
SECTION 16. This act shall take effect and be in force from and after July 1, 2024.
