Bill Text: MS SB2756 | 2021 | Regular Session | Introduced
Bill Title: Rural Health Availability Act; allow all hospitals to enter into agreements.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2021-02-02 - Died In Committee [SB2756 Detail]
Download: Mississippi-2021-SB2756-Introduced.html
MISSISSIPPI LEGISLATURE
2021 Regular Session
To: Public Health and Welfare; Accountability, Efficiency, Transparency
By: Senator(s) Fillingane
Senate Bill 2756
AN ACT TO AMEND SECTIONS 41-9-303, 41-9-305, 41-9-307 AND 41-9-309, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT ALL HOSPITALS IN THE STATE MAY ENTER INTO AGREEMENTS UNDER THE RURAL HEALTH AVAILABILITY ACT; TO CREATE NEW SECTION 41-9-310, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT APPLICANTS MUST IDENTIFY PROPRIETARY DOCUMENTS TO THE BOARD, WITH SUCH DOCUMENTS BEING DESIGNATED AS TRADE SECRETS BY THE BOARD; TO CONFORM THE PROVISIONS OF THE ACT WITH CURRENT ANTITRUST LAW; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 41-9-303, Mississippi Code of 1972, is amended as follows:
41-9-303. The Legislature finds and declares the following:
(a) In rural areas, access to health care is limited and the quality of health care is adversely affected by inadequate reimbursement and collection rates and difficulty in recruiting and retaining skilled health professionals.
(b) There is limited, if any, overlap in the geographic service areas of Mississippi rural hospitals.
(c) Rural hospitals' financial stability is threatened by patient migration to general acute care and specialty hospitals in urban areas.
(d) The availability of quality health care in rural areas is essential to the economic and social viability of rural communities.
(e) Cooperative agreements among rural hospitals and, where desired, between rural hospitals and other hospitals would improve the availability and quality of health care for Mississippians in rural areas and enhance the likelihood that rural hospitals can remain open.
(f) There is also a recognized need for improved health care services for all Mississippians. A certificate of public advantage between and among hospitals in general can improve the quality of health care for Mississippians.
(g) Access to healthcare in rural areas of our state is also influenced, in many instances, by the financial health of hospitals in nonrural areas; therefore, the provisions of this act should be extended to all hospitals in our state and combinations, thereof.
(h) It is the policy of this state, in certain instances, to displace competition among hospitals with regulation to the extent set forth in this act and to actively supervise that regulation to the fullest extent required by law, in order to promote cooperation and coordination among hospitals in the provision of health services and to provide state action immunity from federal and state antitrust law to the fullest extent possible to those hospitals issued a certificate of public advantage under this act.
SECTION 2. Section 41-9-305, Mississippi Code of 1972, is amended as follows:
41-9-305. For the purposes of Sections 41-9-301 through 41-9-311, the following terms shall have the following meanings:
(a) "Act" means the Rural Health Availability Act.
(b) "Affected person," with respect to any application for a certificate of public advantage, means:
(i) The applicant(s);
(ii) Any person residing within the geographic service area of an applicant;
(iii) Health care purchasers who reimburse health care facilities located in the geographic service area of an applicant;
(iv) Any other person furnishing goods or services to, or in competition with, an applicant; or
(v) Any other person who has notified the department in writing of his interest in applications for certificates of public advantage and has a direct economic interest in the decision.
Notwithstanding the
foregoing, * * * a person who is a resident of or has its
principal place of business in another state who would otherwise be
considered an "affected * * * person" * * * is not included, unless that other
state provides for similar involvement of persons from Mississippi in a similar
process in that state.
(c) "Board" means the State Board of Health established under Section 41-3-1.
(d) "Certificate of public advantage" means the formal written approval, including any conditions or modifications of a cooperative agreement by the department.
(e) "Cooperative agreement" means a contract, business or financial arrangement, or any other activities or practices among two (2) or more rural hospitals, hospitals, or any combination thereof for the sharing, allocation, or referral of patients; the sharing or allocation of personnel, instructional programs, support services and facilities, medical, diagnostic or laboratory facilities, procedures, equipment or other health care services; the acquisition or merger of assets among or by two (2) or more rural hospitals, hospitals, or any combination thereof, including agreements to negotiate jointly with respect to price or other competitive terms with suppliers. The term "cooperative agreement" includes any amendments thereto with respect to which a certificate of public advantage has been issued or applied for or with respect to which a certificate of public advantage is not required, unless the context clearly requires otherwise.
(f) "Department" means the State Department of Health created under Section 41-3-15.
(g) "Hospital" has the meaning set forth in Section 41-9-3.
(h) "Person" means an individual, a trust or estate, partnership, corporation, the state or a political subdivision or instrumentality of the state.
( * * *i) "Rural area" means an
area with a population density of less than one hundred (100) individuals per
square mile; a municipality or county with a population of less than seven
thousand five hundred (7,500) individuals; or an area defined by the most recent
United States Census as rural.
( * * *j) "Rural hospital" means a
private or community hospital having at least one (1) but no more than seventy-five
(75) licensed acute-care beds that is located in a rural area.
( * * *k) "State" means the State
of Mississippi.
( * * *l) "State Health Officer"
means the State Health Officer elected by the State Board of Health under
Section 41-3-5.
The use of a singular term in this section includes the plural of that term, and the use of a plural term in this section includes the singular of that term, unless the context clearly requires another connotation.
SECTION 3. Section 41-9-307, Mississippi Code of 1972, is amended as follows:
41-9-307. (1) A * * * hospital and any corporation,
partnership, joint venture or any other entity, all of whose principals are
rural hospitals, hospitals, or any combination thereof may negotiate and
enter into cooperative agreements with other such persons in the state, subject
to receipt of a certificate of public advantage governing the agreement as
provided in this act. If the parties to a cooperative agreement file an
application for a certificate of public advantage governing the agreement with
the department, the conduct of the parties in negotiating and entering into a
cooperative agreement is lawful conduct.
(2) Parties to a
cooperative agreement may apply to the department for a certificate of public
advantage governing that cooperative agreement. The application must include
an executed written copy of the cooperative agreement and describe the nature
and scope of the cooperation in the agreement and any consideration passing to
any party under the agreement. Within thirty (30) days of receipt of the
application, the department may request additional information as may be
necessary to complete the application. The applicant has thirty (30) days from
the date of the request to submit the additional information. If the applicant
fails to submit the requested information within the thirty-day period, or any
extension of time granted by the department, the application is deemed
withdrawn. The department may require * * * a reasonable application fee, set
by regulation, from the submitting parties sufficient to cover the cost of
processing the application.
(3) The department shall review the application in accordance with the standards set forth in subsection (4) of this section. The department shall give notice of the application to members of the public who reside in the service areas of the applicant hospitals, which may be provided through newspapers of general circulation or public information channels. If requested by an affected person within thirty (30) days of the giving of the public notice, the department may hold a public hearing in accordance with the rules adopted by the board. The department shall grant or deny the application within sixty (60) days after receipt of a completed application or from the date of the public hearing, if one is held, and that decision, along with any conditions of approval, must be in writing and must set forth the basis for the decision. The department may establish conditions for approval that are reasonably necessary to ensure that the cooperative agreement and the activities engaged under it are consistent with the intent of this act and to ensure that the activity is appropriately and actively supervised and regulated by the state. The department shall furnish a copy of the decision to the applicants and any affected persons who have asked in writing to be notified. If the department denies an application for a certificate of public advantage for an executed cooperative agreement, the cooperative agreement is void upon the decision of the department not to issue the certificate of public advantage. The parties to a void cooperative agreement may submit a new application for a certificate of public advantage based upon a cooperative agreement different from the original application.
(4) The department shall approve
a proposed cooperative agreement and shall issue a certificate of public
advantage for a cooperative agreement if it determines that * * * the benefits likely to result from the
proposed cooperative agreement outweigh the disadvantages likely to result from
a reduction in competition from the proposed cooperative agreement.
(5) In evaluating the potential benefits of a cooperative agreement, the department shall consider whether one or more of the following benefits may result from the cooperative agreement:
(a) Each of the parties to the cooperative agreement is a rural hospital, hospital, or is a corporation, partnership, joint venture or other entity all of whose principals are rural hospitals; and
* * *
( * * *b) The cooperative agreement * * * may result in one or more
of the following benefits:
(i) Enhancement of the quality of hospital and hospital-related care provided to Mississippi citizens;
(ii) Preservation of hospital facilities and health care in rural areas;
(iii) Gains in the cost-efficiency of services provided by the hospitals involved;
(iv) Encouragement of cost-sharing among the hospitals involved;
(v) Improvements
in the utilization of hospital resources and equipment; * * *
(vi) Avoidance or
reduction of duplication of hospital resources or expenses, including
administrative expenses * * *.;
(vii) Demonstration of population health improvement in the region served according to criteria set forth in the cooperative agreement and approved by the department;
(viii) The extent to which medically underserved populations have access to and are projected to utilize the proposed services; or
(ix) Any other benefits that may be identified.
( * * *6) A cooperative agreement for
which a certificate of public advantage has been issued is a lawful agreement.
The department shall actively supervise, monitor and regulate agreements
approved under this act and may request information whenever necessary to
ensure that the agreements remain in compliance with the conditions of
approval. The department may charge an annual fee, set by regulation,
to cover the cost of monitoring and regulating these agreements. During the
time the certificate is in effect, a report on the activities under the
cooperative agreement must be filed with the department every two (2) years.
The department shall review the report in order to determine that the
cooperative agreement continues to comply with the terms of the certificate of
public advantage.
( * * *7) If the department has reason to
believe that compliance with a cooperative agreement no longer meets the
requirements of this chapter, the department shall initiate a proceeding to
determine whether compliance with the cooperative agreement no longer meets the
requirements of this chapter. In the course of such proceeding, the department
is authorized to seek reasonable modifications to a cooperative agreement, with
the consent of the parties to the agreement, in order to ensure that it
continues to meet the requirements of this chapter. The department shall
revoke a certificate of public advantage by giving written notice to each party
to a cooperative agreement with respect to which the certificate is being
revoked, if it finds that:
(a) The cooperative agreement or activities undertaken by it are not in substantial compliance with the terms of the application or the conditions of approval;
(b) The likely benefits resulting from the cooperative agreement no longer exist; or
(c) The department's approval was obtained as a result of intentional material misrepresentation to the department or as the result of coercion, threats or intimidation toward any party to the cooperative agreement.
(8) The certificate of public advantage shall remain in full force and effect until such time as the certificate of public advantage holder has submitted, the department has approved, and the certificate holder has completed a plan of separation. The department's active supervision shall continue until such time as the department issues an official determination that the plan of separation has been completed.
( * * *9) The department shall maintain on
file all cooperative agreements for which certificates of public advantage
remain in effect. A party to a cooperative agreement who terminates or
withdraws from the agreement shall notify the department within fifteen (15)
days of the termination or withdrawal. If all parties terminate their
participation in the cooperative agreement, the department shall revoke the
certificate of public advantage for the agreement.
( * * *10) The parties to a cooperative
agreement with respect to which a certificate of advantage is in effect must
notify the department of any proposed amendment to the cooperative agreement,
including an amendment to add an additional party but excluding an amendment to
remove or to reflect the withdrawal of a party, before the amendment takes
effect. The parties must apply to the department for a certificate of public
advantage governing the amendment and the department shall consider and rule on
the application in accordance with the procedures applicable to cooperative
agreements generally.
( * * *11) The department * * * shall promulgate rules and
regulations in accordance with the Administrative Procedures Law as in effect
from time to time to implement the provisions of this act, including any fees
and application costs associated with the monitoring, supervision and
oversight of cooperative agreements approved under this act within ninety
(90) days following the effective date of this act.
( * * *12) A dispute among the parties to a
cooperative agreement concerning its meaning or terms is governed by the
principles of contract law or any other applicable law.
SECTION 4. Section 41-9-309, Mississippi Code of 1972, is amended as follows:
41-9-309. Any applicant or holder of a certificate of public advantage aggrieved by a decision of the department under this act shall be entitled to judicial review thereof in the Circuit Court of Hinds County, First Judicial District. In the review, the decision of the department shall be affirmed unless it is arbitrary, capricious, or it is not in compliance with this act.
SECTION 5. The following shall be codified as Section 41-9-310, Mississippi Code of 1972:
41-9-310. If any applicant for or holder of a Certificate of Public Advantage believes materials required to be submitted to the department contains proprietary information, such information must be clearly identified. Any materials required to be submitted to the department that are clearly identified as containing proprietary information shall be deemed trade secrets or confidential commercial or financial information and shall not be subject to disclosure, inspection, examination, copying or reproduction pursuant to the Mississippi Public Records Act of 1983, Sections 25-61-1 through 25-61-19. The applicants or certificate holders shall submit duplicate copies of any materials containing proprietary information, one (1) with full information for the department's use and one (1) redacted copy available for release to the public.
SECTION 6. This act shall take effect and be in force from and after July 1, 2021.