SB 2749 — Community health workers; establish licensure program by Department of Health and certain provisions of law related to.
Last action — Died On Calendar
No card. One bill, free forever — alerts when it moves.
-
✓Introduced
-
2In Committee
-
3Passed Senate
-
4Passed House
-
5To Executive
-
6Enacted
This bill died with 2025 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.
Bill Text
What changed in the latest version
1562 added · 1600 removedPlain-language change summary
The amended version of Bill SB 2749 inserts definitions and specific requirements for a new licensure program for community health workers in Mississippi. It now mandates the State Department of Health to implement this program by January 2026 and work with Medicaid to seek funding options. These changes clarify the structure and importance of community health workers in the healthcare system, aiming to enhance healthcare access and address workforce shortages in the state. By establishing a formal licensure, the bill highlights the crucial role these workers play in improving community health outcomes.
Public Health and Welfare COMMITTEE SUBSTITUTE FOR SENATE BILL NO.
WHEREAS,BE communityIT healthENACTED workersBY areTHE frontlineLEGISLATURE healthOF workersTHE withSTATE aOF uniquelyMISSISSIPPI: close relationship to and understanding of the communities they serve;
SECTION 1.
As used in this act, the following terms shall be defined as provided in this section:
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ G3/5 25/SS26/R54925/SS36/R549CS PAGE 1 (baf\tb)(a) WHEREAS,"Licensed community health workersworker" servemeans asan liaisonsindividual betweenwho patients,has healthbeen carelicensed providers,as sociala servicecommunity providers,health andworker by the community;department in accordance with this act;
WHEREAS, community health workers facilitate improved communication between patients and their health care providers, help patients learn to effectively comply with medical care instructions, improve the quality and cultural competency of service delivery and educate patients to improve health behaviors;
WHEREAS, the Association of State and Territorial Health Officials has recognized the effectiveness of community health workers in improving health outcomes, reducing health care costs and closing the health disparities gap across multiple settings and health issues;
WHEREAS, community health worker licensure may offer a path to college credit for health care workers interested in pursuing a college degree in the health care field and is thereby a necessary step toward addressing Mississippi's ongoing and well-documented health care worker shortage;
WHEREAS, the Division of Medicaid is currently considering coverage and reimbursement options for community health worker services to improve the health status of those it serves in a manner that is cost-effective, directed to underserved areas and populations and ensures program integrity;
and S.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 2(baf\tb) WHEREAS, Medicaid managed care organizations and some providers may employ community health workers to coordinate care, reduce costs and meet quality indicators;
and WHEREAS, providers strive to provide quality services using evidence-based practices to improve the health outcomes of Mississippians and play a role in increasing the number and aptitude of the community health worker workforce to meet the needs of the communities they serve;
NOW, THEREFORE, BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1.
As used in this act, the following terms shall be defined as provided in this section:
(a) "Licensed community health worker" means an individual who has been licensed as a community health worker by the department in accordance with this act;
and (b) Collaborate with the Division of Medicaid to seek approval from the Centers for Medicare and Medicaid Services for a state plan amendment, waiver or alternative payment model, S.including public-private partnerships, for services provided by licensed community health workers.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 3(baf\tb) including public-private partnerships, for services provided by licensed community health workers.
(b)S. Health promotion education to prevent illness or diseases, including the promotion of health behaviors to increase awareness and prevent the development of illness or disease;
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 2 (b) Health promotion education to prevent illness or diseases, including the promotion of health behaviors to increase awareness and prevent the development of illness or disease;
S.(4) The Division of Medicaid shall promulgate rules necessary to carry out the provisions of this section and obtain all necessary approvals from the federal Centers for Medicare and Medicaid Services.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 4(baf\tb) (4) The Division of Medicaid shall promulgate rules necessary to carry out the provisions of this section and obtain all necessary approvals from the federal Centers for Medicare and Medicaid Services.
(3)S. Community health workers must apply for license renewal on a regular basis as designated by the department.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 3 (3) Community health workers must apply for license renewal on a regular basis as designated by the department.
and S.(v) The scope of practice for licensed community health workers;
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 5(baf\tb) (v) The scope of practice for licensed community health workers;
(A) Medicaid as authorized by this article shall include payment of part or all of the costs, at the discretion of the division, with approval of the Governor and the Centers for Medicare and Medicaid Services, of the following types of care and servicesS. 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:
B.
Show all 367 changed lines (327 more)
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 4 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:
S.(2) Outpatient hospital services.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 6(baf\tb) (2) Outpatient hospital services.
In addition, the Medicare thirty-five-mile rule will apply to thoseS. hospital clinics not located inside the hospital that are constructed after July 1, 2009.
Where the same services are reimbursed as clinic services, the division may revise the rate or methodology of outpatient reimbursement to maintain consistency, efficiency, economy and quality of care.
(c) The division is authorized to implement an Ambulatory Payment Classification (APC) methodology for outpatient hospital services.
The division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 7(baf\tb)5 outpatientthose hospital services.clinics not located inside the hospital that are constructed after July 1, 2009.
Where the same services are reimbursed as clinic services, the division may revise the rate or methodology of outpatient reimbursement to maintain consistency, efficiency, economy and quality of care.
(c) The division is authorized to implement an Ambulatory Payment Classification (APC) methodology for outpatient hospital services.
The division 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.
(a) The division shall make full payment to nursing facilities for each day, not exceeding forty-two (42) days perS. year, that a patient is absent from the facility on home leave.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 6 per year, that a patient is absent from the facility on home leave.
The division 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 S.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.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 8(baf\tb) 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.
The division shall develop and implement a payment add-on to reimburseS. nursing facilities for ventilator-dependent resident services.
(e) The division 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 division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 9(baf\tb)7 reimburse nursing facilities to convert or construct beds for residentsventilator-dependent withresident Alzheimer'sservices. or other related dementia.
(e) The division 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 division 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.
(5) Periodic screening and diagnostic services for individuals under age twenty-one (21) years as are needed to identifyS. 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 division 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 division, 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 10(baf\tb)8 schoolidentify districtsphysical usingand statemental fundsdefects thatand areto providedprovide fromhealth thecare appropriationtreatment and other measures designed to correct or ameliorate defects and physical and mental illness and conditions discovered by the Departmentscreening ofservices, Educationregardless toof obtainwhether federalthese matchingservices fundsare throughincluded in the division.state plan.
The division 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 division, 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 division.
(6)S. Physician services.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 9 (6) Physician services.
The division shall reimburse obstetricians and gynecologists for certain primary care S.services as defined by the division at one hundred percent (100%) of the rate established under Medicare.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 11(baf\tb) services as defined by the division at one hundred percent (100%) of the rate established under Medicare.
(b)S. [Repealed] (8) Emergency medical transportation services as determined by the division.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 10 (b) [Repealed] (8) Emergency medical transportation services as determined by the division.
In addition, if allowed by federal law or S.regulation, the division 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.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 12(baf\tb) regulation, the division 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.
DrugsS. prescribed for a resident of a psychiatric residential treatment facility must be provided in true unit doses when available.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 11 Drugs prescribed for a resident of a psychiatric residential treatment facility must be provided in true unit doses when available.
The division shall develop a methodology for reimbursing for restocked drugs, which shall include a restock fee as S.determined by the division not exceeding Seven Dollars and Eighty-two Cents ($7.82).
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 13(baf\tb) determined by the division not exceeding Seven Dollars and Eighty-two Cents ($7.82).
All claims for drugs for dually eligible Medicare/Medicaid beneficiaries that are paid for by Medicare must be submitted to MedicareS. for payment before they may be processed by the division's online payment system.
The division 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 division shall develop and implement a method or methods by which the division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 14(baf\tb)12 drugsMedicare andfor innovatorpayment multiple-sourcebefore drugsthey andmay thebe costsprocessed toby the Medicaiddivision's programonline ofpayment thosesystem. alternative drugs.
The division 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 division shall develop and implement a method or methods by which the division 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.
The division 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 division 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 division.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 15(baf\tb)13 ItThe isdivision theshall intentnot ofreimburse thefor Legislaturesingle-source thator theinnovator divisionmultiple-source anddrugs anyif managedthere careare entityequally describedeffective ingeneric subsectionequivalents (H)available ofand thisif section encourage the usegeneric ofequivalents Alpha-Hydroxyprogesteroneare Caproatethe (17P)least toexpensive. prevent recurrent preterm birth.
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 division 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 division.
It is the intent of the Legislature that the division 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.
The division shall increase the amount of the reimbursement rate for restorative dental services for each of the fiscal years 2023, 2024S. 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, assisted by the Division of Medicaid, 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 16(baf\tb)14 2024 and 2025 by five percent (5%) above the goalsamount of thisthe legislativereimbursement intent.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, assisted by the Division of Medicaid, 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.
(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 division, or (b) one (1) pair every five (5) years and in accordance with policies establishedS. by the division.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 15 established by the division.
S.(b) All state-owned intermediate care facilities for individuals with intellectual disabilities shall be reimbursed on a full reasonable cost basis.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 17(baf\tb) (b) All state-owned intermediate care facilities for individuals with intellectual disabilities shall be reimbursed on a full reasonable cost basis.
Preventive, diagnostic, therapeutic, rehabilitative or palliative services that are furnished by a facility that is not part of a hospital but is organizedS. and operated to provide medical care to outpatients.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 16 organized and operated to provide medical care to outpatients.
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 division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 18(baf\tb)17 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 division 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.
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, S.provider-sponsored health plan, or other organization paid for services on a capitated basis by the division under any managed care program or coordinated care program implemented by the division 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 division shall make additional reimbursement to hospitals that S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 19(baf\tb)18 provider-sponsoredserve healtha plan,disproportionate orshare otherof organizationlow-income paidpatients forand servicesthat onmeet athe capitatedfederal basisrequirements byfor thethose divisionpayments underas anyprovided managedin careSection program1923 orof coordinatedthe carefederal programSocial implementedSecurity byAct theand divisionany underapplicable thisregulations. 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 division 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.
The division may establish a Medicare Upper Payment Limits Program, as defined in Section 1902(a)(30) of S.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.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 20(baf\tb) 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.
(ii)S. The division 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).
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 19 (ii) The division 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).
In addition to the hospital assessment provided in Section 43-13-145(4)(a), hospitals S.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 division, 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 division shall make additional reimbursement to hospitals, nursing facilities, and emergency S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 21(baf\tb)20 withambulance physicianstransportation participatingproviders infor the Medicare Upper Payment Limits Program or other program(s) authorized under this subsection (A)(18)(b)(A)(18)(b), shalland, beif requiredthe toprogram participateis inestablished anfor intergovernmentalphysicians, transfershall ormake assessment,additional asreimbursement determinedfor byphysicians, theas division,defined forin theSection purpose1902(a)(30) of financing the statefederal portionSocial ofSecurity theAct physicianand UPLany paymentsapplicable orfederal otherregulations, payment(s)provided authorizedthe underassessment in this subsection (A)(18)(b).(A)(18)(b) is in effect.
(iii) Subject to approval by the Centers for Medicare and Medicaid Services (CMS) and the provisions of this subsection (A)(18)(b), the division 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.
However, the division is authorized to develop and implement an alternative fee-for-service Upper Payment S.Limits model in accordance with federal laws and regulations if necessary to preserve supplemental funding.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 22(baf\tb) Limits model in accordance with federal laws and regulations if necessary to preserve supplemental funding.
supplementalS. payments based upon Medicaid utilization, quality, service lines and/or costs of providing such services to Medicaid beneficiaries and to uninsured patients.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 21 supplemental payments based upon Medicaid utilization, quality, service lines and/or costs of providing such services to Medicaid beneficiaries and to uninsured patients.
Effective July 1, 2018, and until such time as any payment S.model(s) as described above become effective, the division, 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.
S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 23(baf\tb)22 model(s)(v) as1. described above become effective, the division, 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.
S.3.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 24(baf\tb) 3.
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.S.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 23 gap.
(c) (i) Not later than December l, 2015, the division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 25(baf\tb)24 (c) (i) Not later than December l, 2015, the division 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.
(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 S.in effect hereafter, the division 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 division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 26(baf\tb)25 inassessment effectwill hereafter,remain thein divisioneffect shallas tolong theas 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 othersupplemental payment programs for inpatient and/or outpatient payments whichare mayin beeffect. developed under the authority of this paragraph.
(iv) The division 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.
The State S.Department of Health shall be reimbursed on a full reasonable cost basis for services provided under this subparagraph (a).
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 27(baf\tb) Department of Health shall be reimbursed on a full reasonable cost basis for services provided under this subparagraph (a).
Those funds then shall be used to provide expanded targeted case management servicesS. 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 Division of Medicaid.
(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 division and the department, provided that funds for these services are S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 28(baf\tb)26 specificallyservices appropriatedfor toMedicaid eligible children with special needs who are eligible for the Departmentstate's ofearly Rehabilitationintervention Services.system.
Qualifications for persons providing service coordination shall be determined by the State Department of Health and the Division of Medicaid.
(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 division and the department, provided that funds for these services are specifically appropriated to the Department of Rehabilitation Services.
The division may provideS. 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 division.
(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 division.
Federally qualified health centers shall be reimbursed by the Medicaid prospective payment system as approved by the Centers for Medicare S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 29(baf\tb)27 andprovide Medicaidfor Services.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 division.
(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 division.
Federally qualified health centers shall be reimbursed by the Medicaid prospective payment system as approved by the Centers for Medicare and Medicaid Services.
(a) Inpatient psychiatric services to be determined by the division for recipients under age twenty-one (21) that are provided under the direction of a physician in an inpatientS. 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 division 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 division.
From and after July 1, 2009, all state-owned and state-operated facilities that provide inpatient psychiatric services to persons S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 30(baf\tb)28 underinpatient program in a licensed acute care psychiatric facility or in a licensed psychiatric residential treatment facility, before the recipient reaches age twenty-one (21) whoor, areif eligiblethe forrecipient Medicaidwas reimbursementreceiving shallthe beservices reimbursedimmediately forbefore thosehe or she reached age twenty-one (21), before the earlier of the date he or she no longer requires the services onor athe fulldate reasonablehe costor basis.she reaches age twenty-two (22), as provided by federal regulations.
From and after January 1, 2015, the division 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 division.
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.
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 careS. that treats the terminally ill patient and family as a unit, employing a medically directed interdisciplinary team.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 29 care that treats the terminally ill patient and family as a unit, employing a medically directed interdisciplinary team.
(28) Other health insurance premiums that are cost-effective as defined by the United States Secretary of Health S.and Human Services.
Medicare eligible must have Medicare Part B before other insurance premiums can be paid.
(29) The Division of Medicaid 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 division and the department, provided that funds for these services are specifically appropriated to the S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 31(baf\tb)30 andDepartment Humanof Services.Mental Health and/or transferred to the department by a political subdivision or instrumentality of the state.
Medicare eligible must have Medicare Part B before other insurance premiums can be paid.
(29) The Division of Medicaid 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 division 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.
(32) Care and services provided in Christian Science Sanatoria listed and certified by the Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc., S.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.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 32(baf\tb) 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.
(35) Services and activities authorized in Sections 43-27-101 and 43-27-103, using state funds that are provided from theS. appropriation to the Mississippi Department of Human Services and used to match federal funds under a cooperative agreement between the division and the department.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 31 the appropriation to the Mississippi Department of Human Services and used to match federal funds under a cooperative agreement between the division and the department.
S.(37) [Deleted] (38) Chiropractic services.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 33(baf\tb) (37) [Deleted] (38) Chiropractic services.
The division shall pay the Medicare deductible and coinsurance amountsS. for services available under Medicare, as determined by the division.
From and after July 1, 2009, the division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 34(baf\tb)32 establishedamounts underfor Sectionservices 37-33-261available and used to match federal funds under aMedicare, cooperativeas agreementdetermined betweenby the divisiondivision. and the department.
From and after July 1, 2009, the division 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 division and the department.
(a)S. Severe disabilities include, but are not limited to, spinal cord injuries, closed-head injuries and ventilator-dependent patients.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 33 (a) Severe disabilities include, but are not limited to, spinal cord injuries, closed-head injuries and ventilator-dependent patients.
The division may provide for a reimbursement rate for physician assistant services S.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 division.
(46) The division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 35(baf\tb)34 of up to one hundred percent (100%) or the reimbursementDepartment rate for comparable services rendered by a physician for physician assistant services that are provided after the normal working hours of theMental physicianHealth. assistant, as determined in accordance with regulations of the division.
(46) The division 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.
S.(48) Pediatric long-term acute care hospital services.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 36(baf\tb) (48) Pediatric long-term acute care hospital services.
(49)S. The division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 37(baf\tb)35 home)(49) toThe aiddivision utilizationmay ofestablish diseasecopayments managementand/or tools.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.
(52) Notwithstanding any provisions of this article, the division may pay enhanced reimbursement fees related to trauma care, as determined by the division in conjunction with the State DepartmentS. 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 division and the State Department of Health.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 36 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 division and the State Department of Health.
The plan of care for therapy services may be developed to cover a period of treatment for up to S.six (6) months, but in no event shall the plan of care exceed a six-month period of treatment.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 38(baf\tb) six (6) months, but in no event shall the plan of care exceed a six-month period of treatment.
(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 division.
(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.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 39(baf\tb)37 (58)(56) TreatmentPrescribed pediatric extended care centers services for personsmedically dependent or technologically dependent children with opioidcomplex dependencymedical orconditions otherthat highlyrequire addictivecontinual substancecare useas disorders.prescribed by the child's attending physician, as determined by the division.
(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 division and the State Department ofS. Health shall coordinate and notify OB-GYN providers that the Vaccines for Children program is available to providers free of charge.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 38 of Health shall coordinate and notify OB-GYN providers that the Vaccines for Children program is available to providers free of charge.
(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 division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 40(baf\tb)39 (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 division 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.
S.(61) Services described in Section 2 of this act that are provided by licensed community health workers employed and supervised by a Medicaid provider.
Reimbursement for these services shall be provided only if the division has received approval from the Centers for Medicare and Medicaid Services for a state plan amendment, waiver or alternative payment model for services delivered by licensed community health workers.
(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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 41(baf\tb)40 (61)management Servicesservices describedat inthe Sectionmaximum 2rate ofapproved this act that are provided by licensedthe communityCenters healthfor workersMedicare employed and supervised by a Medicaid provider.Services (CMS).
Reimbursement for these services shall be provided only if the division has received approval from the Centers for Medicare and Medicaid Services for a state plan amendment, waiver or alternative payment model for services delivered by licensed community health workers.
(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).
(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.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 42(baf\tb)41 (a)(2) "Committees"Whenever means the Division of Medicaid Committeesproposes ofa rate change, the Housedivision ofshall Representativesgive andnotice to the Senate,chairmen andof "committee"the meanscommittees eitherat oneleast ofthirty those(30) committees.calendar days before the proposed rate change is scheduled to take effect.
(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 Division of Medicaid proposes a rate change, the division 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 chairman or chairmen may make written S.recommendations to the division 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 division of their intention in writing within seven (7) calendar days after receipt of the notice from the division, and shall set the date and time for the meeting in their notice to the division, which shall not be later than S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 43(baf\tb)42 recommendationsfourteen to(14) thecalendar divisiondays forafter changesreceipt toof bethe madenotice tofrom athe proposeddivision. 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 division of their intention in writing within seven (7) calendar days after receipt of the notice from the division, and shall set the date and time for the meeting in their notice to the division, which shall not be later than fourteen (14) calendar days after receipt of the notice from the division.
S.(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 division 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 division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 44(baf\tb)43 (6)the (a)original Ifdate thereas arescheduled anyby objections to a proposed rate change or any part thereof from either or both of the chairmendivision or theon committees,such theother divisiondate mayas withdrawspecified theby proposed rate change, make any of the recommendeddivision. changes to the proposed rate change, or not make any changes to the proposed rate change.
(b) If the division 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 division or on such other date as specified by the division.
(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 division may authorize S.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 Governor 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 division are reasonably anticipated to exceed the amount of funds appropriated to the division for any fiscal year, the Governor, S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 45(baf\tb)44 thoseafter changesconsultation withoutwith enablingthe legislationexecutive whendirector, theshall additiontake ofall recipientsappropriate ormeasures servicesto isreduce orderedcosts, bywhich amay courtinclude, ofbut properare authority.not limited to:
(F) The executive director shall keep the Governor 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 division are reasonably anticipated to exceed the amount of funds appropriated to the division for any fiscal year, the Governor, after consultation with the executive director, shall take all appropriate measures to reduce costs, which may include, but are not limited to:
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 S.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 division 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 and S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 46(baf\tb)45 paymentsreport its findings to organizationsthe describedLegislative inBudget paragraphOffice (1)not oflater subsectionthan (H).January 7 in any year.
Beginning in fiscal year 2010 and in fiscal years thereafter, when Medicaid expenditures are projected to exceed funds available for the fiscal year, the division 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 and report its findings to the Legislative Budget Office not later than January 7 in any year.
As a condition for the approval of any program under this subsection (H)(1), the division shall require that no managed care program, coordinated care program, coordinated care organization program, S.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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 47(baf\tb)46 health1395dd. 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.
(d) Implement a prior authorization and utilization review program for medical services, transportation S.services and prescription drugs that is more stringent than the prior authorization processes used by the division 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, S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 48(baf\tb)47 transportation services and prescription drugs that is morerequired stringentto thanbe theimplemented priorunder authorizationthis processessubparagraph used(d); by the division 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);
Each health maintenance organization, coordinated care organization, provider-sponsored health plan, or other organization paid for services on a capitated basis by the division under any managed care program or coordinated care program implemented by the division 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, S.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 division 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.
S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 49(baf\tb)48 including(2) Notwithstanding any provision of this section, the priorrecipients authorizationeligible process,for concurrentenrollment reviews,into retrospectivea reviewsMedicaid 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 payments,the thatCMS-approved areSection consistent1115 withdemonstration widelywaivers acceptedin professionaloperation standardsas of care.January 1, 2021.
Organizations participating in a managed care program or coordinated care program implemented by the division 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.
Additionally, each contractor shall disclose to the Chairmen of the Senate and House S.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 division 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, S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 50(baf\tb)49 Medicaid Committees the administrativePEER expensesCommittee, costs for the priorDepartment calendar year, and the number of full-equivalentInsurance employeesand/or locatedindependent inthird theparties. State of Mississippi dedicated to the Medicaid and CHIP lines of business as of June 30 of the current year.
(b) The division 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.
(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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 51(baf\tb)50 (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.
(5) No health maintenance organization, coordinated care organization, provider-sponsored health plan, or other organization paid for services on a capitated basis by the division under any managed care program or coordinated care program implemented by the division under this section shall S.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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 52(baf\tb)51 requirewho itsmeets providersthe orcriteria beneficiariesfor credentialing will be credentialed with all of those contractors and no such provider will have to usebe anyseparately pharmacycredentialed thatby ships,any mailsindividual orcontractor deliversin prescriptionorder drugsto orreceive legendreimbursement drugsfrom orthe devices.contractor.
(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.
Under the division'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 S.credentialing of the providers by the division's credentialing process.
(c) The division 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 division, 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 53(baf\tb)52 credentialinginformation necessary for credentialing, then the contractor or division, upon receipt of a written request from the providersapplicant byand within five (5) business days of its receipt, shall issue a temporary provider credential/enrollment to the division'sapplicant credentialingif process.the applicant has a valid Mississippi professional or occupational license to provide the health care services to which the credential/enrollment would apply.
(c) The division 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 division, 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 division, 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.
S.The contractor or division 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 division 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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 54(baf\tb)53 Theall contractor or division shall render a final decision regarding credentialing/enrollment of the providercontractors withinand sixtyeligible (60)to daysreceive reimbursement from the datecontractors. that the temporary provider credential/enrollment is issued to the applicant.
(d) If the contractor or division 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.
(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 S.the division.
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 division shall conduct a state fair hearing and/or agency appeal on the matter of S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 55(baf\tb)54 the division.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.
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 division 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.
(10) It is the intent of the Legislature that any contractor receiving capitated payments under a managed care S.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 S.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS PAGE 56(baf\tb)55 December 1, 2021, any contractors receiving capitated payments under a managed care delivery system established inunder this sectionsubsection (H) shall implementprovide innovativeto programsthe toChairmen improveof the healthHouse and well-beingSenate Medicaid Committees and House and Senate Public Health Committees a report of membersLARC diagnosedutilization withfor prediabetesState Fiscal Years 2018 through 2020 as well as any programs, initiatives, or efforts made by the contractors and diabetes.providers to increase LARC utilization.
(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.
The extended contracts S.shall be revised to incorporate any provisions of this subsection (H).
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 57(baf\tb) shall be revised to incorporate any provisions of this subsection (H).
reduced hospital admissions, audits or payments underS. the APR-DRG or APC models, or a managed care program or similar model described in subsection (H) of this section.
B.
No.
2749 *SS36/R549CS* ~ OFFICIAL ~ 25/SS36/R549CS PAGE 56 under the APR-DRG or APC models, or a managed care program or similar model described in subsection (H) of this section.
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, S.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.
B.
No.
2749 *SS26/R549* ~ OFFICIAL ~ 25/SS26/R549 PAGE 58(baf\tb) 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.
2749 *SS26/R549**SS36/R549CS* ~ OFFICIAL ~ 25/SS26/R54925/SS36/R549CS ST:
establish PAGE 59(baf\tb)57 licensure program by Department of Health and certain provisions of law related to.
Show all 367 changed rows (327 more)
View plain text versions (2)
- Current version View text Current pdf
- Introduced As Introduced pdf
Action History
-
Died On Calendar
-
Title Suff Do Pass Comm Sub
-
Referred To Public Health and Welfare
Sponsors
- Nicole Boyd · Primary
Sponsorship breakdown
Export CSV (upgrade) →1 sponsors · 0 co-sponsors · 174 not signed on
Sponsors (1)
- Nicole Boyd Republican
Co-sponsors (0)
None.
Not signed on (174)
174 members have not signed on to this bill.
Show all 174 →"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.
Subjects
Frequently asked questions
- Who sponsors SB 2749?
- SB 2749 is sponsored by Nicole Boyd (Republican).
- What is the current status of SB 2749?
- This bill died with 2025 Regular Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
- Where can I track SB 2749?
- Track SB 2749 free on One Click Politics — get push/email alerts when it moves.
Make your voice heard on SB 2749
Find the representatives who decide this bill and tell them where you stand — for yourself, or mobilize your whole list in one click with One Click Politics advocacy software.
Stay ahead of SB 2749
Last checked for changes 3 months ago · updated continuously
One Click Politics tracks every bill in Congress and all 50 states.
Track this bill →