Bill Text: MS SB2439 | 2019 | Regular Session | Engrossed
Bill Title: Division of Medicaid; clarify authority to apply for waivers, etc.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Failed) 2019-03-05 - Died In Committee [SB2439 Detail]
Download: Mississippi-2019-SB2439-Engrossed.html
MISSISSIPPI LEGISLATURE
2019 Regular Session
To: Medicaid; Appropriations
By: Senator(s) Blackwell, Wiggins
Senate Bill 2439
(As Passed the Senate)
AN ACT TO AMEND SECTIONS 43-13-113, 43-13-117.1 AND 43-13-122, MISSISSIPPI CODE OF 1972, TO REQUIRE MEDICAID PROVIDERS TO SUBMIT CLAIMS NO LATER THAN 12 MONTHS FROM DATE OF SERVICE, TO AUTHORIZE THE DIVISION OF MEDICAID TO IMPLEMENT AN ALTERNATIVE METHOD OF REIMBURSEMENT OF MEDICARE CROSSOVER CLAIMS AND MAKE NECESSARY CHANGES, TO AUTHORIZE THE DIVISION TO EXPEND FUNDS AS NECESSARY TO PROVIDE HOME- AND COMMUNITY-BASED SERVICES THROUGH WAIVERS NOT TO EXCEED THE COST OF NURSING FACILITY REIMBURSEMENT AND TO CLARIFY THE AUTHORITY OF THE DIVISION TO APPLY FOR WAIVERS TO IMPROVE ACCESS OR REDUCE COSTS AS DETERMINED BY THE DIVISION; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. 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 Governor's Office-Division of Medicaid, which funds shall be expended by the division 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 division 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 division by the State Auditor, upon requisition of the director. It is the purpose of this section to provide that the State Auditor shall transfer, in lump sums, amounts to the division for disbursement under the regulations which shall be made by the director with the approval of the Governor; however, the division, or its fiscal agent in behalf of the division, 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 division 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 division may pledge as security for such interim financing future funds that will be received by the division. Any such loans shall be repaid from the first available funds received by the division in the manner of and subject to the same terms provided in this section.
In the event the State Treasurer makes a determination that special source funds are not sufficient to cover a line of credit for the Division of Medicaid, the division 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 division 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 division may pledge as security for such interim financing future funds that will be received by the division. Any such loans shall be repaid from the first available funds received by the division 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) * * * The Division of Medicaid shall require providers to
submit all claims no later than twelve (12) months from the date of service.
(b) The Division of Medicaid's fiscal agent must pay ninety percent (90%) of all clean claims within thirty (30) days of the date of receipt.
(c) The Division of Medicaid's fiscal agent must pay ninety-nine percent (99%) of all clean claims within ninety (90) days of the date of receipt.
(d) The Division of Medicaid'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 Division of Medicaid'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 Division of Medicaid 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.
(7) Repealed.
(8) If sufficient funds are appropriated therefor by the Legislature, the Division of Medicaid may contract with the Mississippi Dental Association, or an approved designee, to develop and operate a Donated Dental Services (DDS) program through which volunteer dentists will treat needy disabled, aged and medically compromised individuals who are non-Medicaid eligible recipients.
(9) From and after January 1, 2020, the Division of Medicaid may implement an alternative method of reimbursing crossover claims for inpatient hospital services and crossover claims covered under Medicare Part B.
SECTION 2. Section 43-13-117.1, Mississippi Code of 1972, is amended as follows:
43-13-117.1. It is the
intent of the Legislature to expand access to Medicaid-funded home- and
community-based services for eligible nursing facility residents who choose
those services. The Executive Director of the Division of Medicaid is
authorized to transfer funds allocated for nursing facility services for
eligible residents to cover the cost of services available through the
Independent Living Waiver, the Traumatic Brain Injury/Spinal Cord Injury
Waiver, the Elderly and Disabled Waiver, and the Assisted Living Waiver
programs when eligible residents choose those community services. The amount
of funding transferred by the division shall be sufficient to cover the cost of
home- and community-based waiver services for each eligible nursing facility * * * resident who * * * chooses those services. The
number of nursing facility residents who return to the community and home- and
community-based waiver services shall not count against the total number of
waiver slots for which the Legislature appropriates funding each year. Any
funds remaining in the program when a former nursing facility resident ceases
to participate in a home- and community-based waiver program under this
provision shall be returned to nursing facility funding.
Notwithstanding any other provision of this article, the division is authorized to expend funds appropriated out of the State General Fund as necessary to provide home- and community-based services offered through any CMS-approved state plan or waiver to individuals who qualify for those services to avoid institutionalization or to transition an individual from an institution to a noninstitutional setting. Under no circumstance shall the cost of providing home- and community-based services exceed the cost of nursing facility services, as determined by the division.
SECTION 3. Section 43-13-122, Mississippi Code of 1972, is amended as follows:
43-13-122. (1) The
division is authorized to apply to the Center for Medicare and Medicaid
Services of the United States Department of Health and Human Services for any
waivers * * *,
research grants and demonstration grants necessary to improve access
to care, improve quality of care, improve health outcomes, or reduce health
care costs, as determined by the division.
(2) The division is further
authorized to accept and expend any grants, donations or contributions from any
public or private organization together with any additional federal matching
funds that may accrue and, including, but not limited to, one hundred percent
(100%) federal grant funds or funds from any governmental entity or
instrumentality thereof in furthering the purposes and objectives of the
Mississippi Medicaid program, provided that such receipts and expenditures are
reported and otherwise handled in accordance with * * * state
law. The Department of Finance and Administration is authorized to
transfer monies to the division from special funds in the State Treasury in
amounts not exceeding the amounts authorized in the appropriation to the
division.
SECTION 4. This act shall take effect and be in force from and after its passage.
