Bill Text: MS HB728 | 2015 | Regular Session | Comm Sub
Bill Title: Provider sponsored health plans; authorize formation of/provide certification process.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2015-02-12 - Died On Calendar [HB728 Detail]
Download: Mississippi-2015-HB728-Comm_Sub.html
MISSISSIPPI LEGISLATURE
2015 Regular Session
To: Insurance
By: Representative Chism
House Bill 728
(COMMITTEE SUBSTITUTE)
AN ACT TO AUTHORIZE THE FORMATION OF PROVIDER-SPONSORED HEALTH PLANS; TO DEFINE THE TERM "PROVIDER-SPONSORED HEALTH PLAN"; TO REQUIRE THE DEPARTMENT OF INSURANCE TO ESTABLISH A PROCESS FOR THE CERTIFICATION OF PROVIDER-SPONSORED HEALTH PLANS; TO PROVIDE CERTAIN MINIMUM REQUIREMENTS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. (1) In order to encourage and facilitate collaboration between Mississippi Medicaid providers and managed care entities contracting on a capitated basis with the Division of Medicaid pursuant to Section 43-13-117(H), to align incentives in support of integrated and coordinated health care delivery, and to encourage the development of appropriate population or community health strategies to better serve Medicaid beneficiaries and the state's health care delivery system as a whole, the Legislature hereby authorizes and encourages the creation of provider-sponsored health plans as defined in Section 2 of this act.
(2) Whereas, for the reasons stated in subsection (1), the authorization and development of provider-sponsored health plans as defined in Section 2 of this act is vital to the continued delivery and improvement of health care in this state and otherwise in the best interests of the state and its citizens, and notwithstanding any other provision of law to the contrary, a provider-sponsored health plan, and its owners, officers, directors, committee members, agents, representatives, and employees, when performing the functions authorized by this act, in carrying out the terms of any contract with or program of the Division of Medicaid, and in collaborating and communicating with hospitals, physicians, and other providers for such purposes, shall be considered to be acting pursuant to clearly expressed state policy as established in Sections 1 through 4 of this act under the supervision of the State of Mississippi and shall be immune from liability under state or federal antitrust laws while so acting. The Division of Medicaid shall establish and make available to all applicants for certification under Section 3 of this act guidelines setting forth the manner in which the Division of Medicaid shall actively supervise a provider-sponsored health plan's activities and the type of cooperation that a provider-sponsored health plan must provide to facilitate such supervision.
SECTION 2. As used in this act, "Provider-Sponsored Health Plan" means a Mississippi not-for-profit corporation formed for the purposes of operating a not-for-profit health plan or managed care entity, with its principle place of business within the State of Mississippi, and which is owned and governed exclusively by (a) not-for-profit Mississippi hospital or physician industry or trade association in which the majority of the hospitals or physicians within the state are members, or (b) a combination of (i) not-for-profit Mississippi hospital or physician industry or trade associations that represent a majority of the hospitals or physicians within the state, and (ii) licensed Mississippi hospitals or physicians who participate in the Mississippi Medicaid Program. At least one purpose of the provider-sponsored health plan shall be to contract with the Division of Medicaid to provide managed care services on a capitated basis pursuant to Section 43-13-117(H). To qualify as a provider-sponsored health plan under this section, the entity must further meet the requirements of Section 4 of this act.
SECTION 3. The Department of Insurance shall establish a process for the certification of provider-sponsored health plans authorized pursuant to this chapter. No such plan shall be offered or provided to persons residing in this state unless it has been certified by the department. Any provider-sponsored health plan certified by the department must be recertified annually, and the department shall establish procedures to ensure the continued compliance with the requirements of Section 4 of this act through the recertification process. The department shall terminate the certificate of any provider-sponsored health care plan if such plan no longer meets the applicable requirements for certification. The department shall provide any such plan with an opportunity for a hearing on the proposed termination. The department shall establish a fee to cover the costs of issuing and renewing such certifications to be used solely for the administration of this act.
SECTION 4. Provider-sponsored health plans shall meet the following additional minimum requirements:
(a) Demonstrate that the provider-sponsored health plan is controlled in accordance with Section 2 of this act and has provided for substantial representation in governance and operations by licensed Mississippi hospitals and physicians that participate in the Mississippi Medicaid program. Notwithstanding any other provision of law to the contrary, for the purpose of meeting this requirement, hospitals owned by the state and hospitals owned by local governmental entities are authorized to provide funds for the establishment and operation of provider-sponsored health plans provided the hospital governing body first determines that such participation is in the best interest of the hospital and the communities it serves.
(b) Establish and maintain capital or surplus, or any combination thereof, of Two Million Five Hundred Thousand Dollars ($2,500,000.00) or an amount equal to twenty-five percent (25%) of the provider-sponsored health plan's total actual or projected average monthly expenditures, whichever is greater. The provider-sponsored health plan shall maintain a minimum capital or surplus of Two Million Five Hundred Thousand Dollars ($2,500,000.00) and any capital or surplus requirement greater than the minimum will be calculated at the end of the fiscal year.
(c) Provide written approval from the Division of Medicaid that the plan has established a network of contracted physicians, hospitals and other health care providers that is sufficient to adequately serve the needs of the provider-sponsored health plan's enrolled or expected Medicaid population and obtain the Division of Medicaid's approval for the form of the provider contracts used for this purpose.
(d) Meet all contractual requirements for contracting with the Division of Medicaid to provide managed care or coordinated care services to Medicaid recipients pursuant to Section 43-13-117(H). Compliance with this requirement shall be determined and supervised by the Division of Medicaid. Nothing in this act shall be construed as giving the Insurance Department responsibility or authority for the operation of the State Medicaid Program.
(e) Notwithstanding any other provision of law to the contrary, a provider-sponsored health plan shall not be deemed an insurance company under state law and shall be exempt from payment of any premium taxes.
SECTION 5. This act shall be codified as a separate article within Chapter 41, Title 83, Mississippi Code of 1972.
SECTION 6. This act shall take effect and be in force from and after July 1, 2015, and stand repealed from and after June 30, 2015.
