Mississippi 2022 Regular Session Status: Passed House 1 R cosponsors

HB 658 — Medicaid; delete freeze on provider reimbursement rates and establish procedure for review of proposed rate changes.

Last action — Died In Conference

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2022 Regular Session. It reached “Passed House” 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This bill is no longer active — its legislative session has ended, so there is no live prognosis.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

1314 added · 1287 removed

Plain-language change summary

The recent amendments to Bill HB 658 remove the previous provision that froze Medicaid provider reimbursement rates based on 2021 levels. This change is important as it allows for a more flexible review process where legislative committees can assess proposed changes to these rates, although they cannot veto them. Furthermore, it prevents the Division of Medicaid from contracting with any entity that has a history of fraud or abuse in relation to the state's Medicaid program, enhancing accountability within the system. Lastly, the amendment introduces the option for a Mississippi nonprofit organization to provide Medicaid services, potentially increasing service diversity and competition.

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Medicaid COMMITTEE SUBSTITUTE FOR HOUSE BILL NO.
Medicaid HOUSE BILL NO.
658 AN ACT TO AMEND SECTION 43-13-117, MISSISSIPPI CODE OF 1972, TO DELETE THE PROVISION IN THE MEDICAID SERVICES SECTION THAT FREEZES MEDICAID PROVIDER RATES OF REIMBURSEMENT AT THE LEVELS IN EFFECT ON JULY 1, 2021;
658 (As Passed the House) AN ACT TO AMEND SECTION 43-13-117, MISSISSIPPI CODE OF 1972, TO DELETE THE PROVISION IN THE MEDICAID SERVICES SECTION THAT FREEZES MEDICAID PROVIDER RATES OF REIMBURSEMENT AT THE LEVELS IN EFFECT ON JULY 1, 2021;
TO PROHIBIT THE DIVISION OF MEDICAID FROM EXECUTING A CONTRACT OR MAKING CAPITATED PAYMENTS FOR SERVICES WITH ANY ENTITY THAT HAS EXECUTED A SETTLEMENT AGREEMENT WITH THE STATE OF MISSISSIPPI OR ANY OTHER STATE RELATED TO ALLEGATIONS OF FRAUD, WASTE, ABUSE OR OVERPAYMENTS IN THE STATE'S MEDICAID PROGRAM;
TO DIRECT THE DIVISION OF MEDICAID TO SELECT A MISSISSIPPI NONPROFIT CORPORATION IN ADDITION TO THE MANAGED CARE ENTITIES WITH WHICH THE DIVISION HAS CONTRACTED AS OF JANUARY 1, 2022, TO PROVIDE MEDICAID SERVICES ON A CAPITATED BASIS UNDER A MANAGED CARE PROGRAM OR COORDINATED CARE PROGRAM IMPLEMENTED BY THE DIVISION;
(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 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:
(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 H.
(1) Inpatient hospital services.
H.
658 *HR31/R856CS* ~ OFFICIAL ~ G1/2 22/HR31/R856CS PAGE 1 (RF\JAB) (a) The division is authorized to implement an All Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement methodology for inpatient hospital services.
658 *HR31/R856PH* ~ OFFICIAL ~ G1/2 22/HR31/R856PH PAGE 1 (RF\JAB) Medicare and Medicaid Services, of the following types of care and services rendered to eligible applicants who have been determined to be eligible for that care and services, within the limits of state appropriations and federal matching funds:
(1) Inpatient hospital services.
(a) The division is authorized to implement an All Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement methodology for inpatient hospital services.
In addition, the Medicare thirty-five-mile rule will apply to those hospital clinics not located inside the hospital that are constructed after July 1, 2009.
H.
Where the same services are reimbursed as clinic services, the division may revise the rate or H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 2(RF\JAB) methodology of outpatient reimbursement to maintain consistency, efficiency, economy and quality of care.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 2(RF\JAB) In addition, the Medicare thirty-five-mile rule will apply to those hospital clinics not located inside the hospital that are constructed after July 1, 2009.
Where the same services are reimbursed as clinic services, the division may revise the rate or methodology of outpatient reimbursement to maintain consistency, efficiency, economy and quality of care.
(a) The division shall make full payment to nursing facilities for each day, not exceeding forty-two (42) days per year, that a patient is absent from the facility on home leave.
H.
Payment may be made for the following home leave days in addition to the forty-two-day limitation:
Christmas, the day H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 3(RF\JAB) before Christmas, the day after Christmas, Thanksgiving, the day before Thanksgiving and the day after Thanksgiving.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 3(RF\JAB) (a) The division shall make full payment to nursing facilities for each day, not exceeding forty-two (42) days per year, that a patient is absent from the facility on home leave.
Payment may be made for the following home leave days in addition to the forty-two-day limitation:
Christmas, the day before Christmas, the day after Christmas, Thanksgiving, the day before Thanksgiving and the day after Thanksgiving.
The division shall develop and implement a payment add-on to reimburse nursing facilities for ventilator-dependent resident services.
H.
(e) The division shall develop and implement, not later than January 1, 2001, a case-mix payment add-on determined H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 4(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 4(RF\JAB) The division shall develop and implement a payment add-on to reimburse 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.
(5) Periodic screening and diagnostic services for individuals under age twenty-one (21) years as are needed to identify physical and mental defects and to provide health care treatment and other measures designed to correct or ameliorate defects and physical and mental illness and conditions discovered by the screening services, regardless of whether these services H.
H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 5(RF\JAB) are included in the state plan.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 5(RF\JAB) (5) Periodic screening and diagnostic services for individuals under age twenty-one (21) years as are needed to identify physical and mental defects and to provide health care treatment and other measures designed to correct or ameliorate defects and physical and mental illness and conditions discovered by the screening services, regardless of whether these services are included in the state plan.
The division, in obtaining medical and mental health assessments, treatment, care and services for children who are in, or at risk of being put in, the custody of the Mississippi Department of Human Services may enter into a cooperative agreement with the Mississippi Department of Human Services for the provision of those services using state funds that are provided from the appropriation to the Department of Human Services to obtain federal matching funds through the division.
The division, in obtaining medical and mental health assessments, treatment, care and services for children who are in, or at risk of being put in, the custody of the Mississippi Department of Human Services may enter into a cooperative agreement with the Mississippi Department of Human Services for the provision of those services using state funds that are provided from the appropriation to the Department H.
(6) Physician services.
Fees for physician's services that are covered only by Medicaid shall be reimbursed at ninety percent (90%) of the rate established on January 1, 2018, and as may be adjusted each July thereafter, under Medicare.
The division may provide for a reimbursement rate for physician's H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 6(RF\JAB) services of up to one hundred percent (100%) of the rate established under Medicare for physician's services that are provided after the normal working hours of the physician, as determined in accordance with regulations of the division.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 6(RF\JAB) of Human Services to obtain federal matching funds through the division.
(6) Physician services.
Fees for physician's services that are covered only by Medicaid shall be reimbursed at ninety percent (90%) of the rate established on January 1, 2018, and as may be adjusted each July thereafter, under Medicare.
The division may provide for a reimbursement rate for physician's services of up to one hundred percent (100%) of the rate established under Medicare for physician's services that are provided after the normal working hours of the physician, as determined in accordance with regulations of the division.
In addition to physicians, certified registered nurse practitioners, physician assistants and clinical nurse specialists are authorized to prescribe or order home health services and plans of care, sign home health plans of care, certify and recertify eligibility for home health services and conduct the required initial face-to-face visit with the recipient of the services.
In addition to physicians, certified registered nurse practitioners, physician assistants and clinical nurse specialists are authorized to prescribe or order home health services and plans of care, sign home health plans of care, certify and recertify eligibility for home health services and H.
(b) [Repealed] (8) Emergency medical transportation services as determined by the division.
(9) Prescription drugs and other covered drugs and services as determined by the division.
H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 7(RF\JAB) The division shall establish a mandatory preferred drug list.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 7(RF\JAB) conduct the required initial face-to-face visit with the recipient of the services.
(b) [Repealed] (8) Emergency medical transportation services as determined by the division.
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(9) Prescription drugs and other covered drugs and services as determined by the division.
The division shall establish a mandatory preferred drug list.
The executive director may approve specific maintenance drugs for beneficiaries with certain medical conditions, which may be prescribed and dispensed in three-month supply increments.
H.
Drugs prescribed for a resident of a psychiatric residential treatment facility must be provided in true unit doses when available.
The division may require that drugs not covered by Medicare Part D for a resident of a long-term care facility be provided in true unit doses when available.
Those drugs that were originally billed to the division but are not used by a resident H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 8(RF\JAB) in any of those facilities shall be returned to the billing pharmacy for credit to the division, in accordance with the guidelines of the State Board of Pharmacy and any requirements of federal law and regulation.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 8(RF\JAB) The executive director may approve specific maintenance drugs for beneficiaries with certain medical conditions, which may be prescribed and dispensed in three-month supply increments.
Drugs prescribed for a resident of a psychiatric residential treatment facility must be provided in true unit doses when available.
The division may require that drugs not covered by Medicare Part D for a resident of a long-term care facility be provided in true unit doses when available.
Those drugs that were originally billed to the division but are not used by a resident in any of those facilities shall be returned to the billing pharmacy for credit to the division, in accordance with the guidelines of the State Board of Pharmacy and any requirements of federal law and regulation.
All claims for drugs for dually eligible Medicare/Medicaid beneficiaries that are paid for by Medicare must be submitted to Medicare for payment before they may be processed by the 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.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 9(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 9(RF\JAB) All claims for drugs for dually eligible Medicare/Medicaid beneficiaries that are paid for by Medicare must be submitted to Medicare for payment before they may be processed by the 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 drugs and innovator multiple-source drugs and the costs to the Medicaid program of those alternative drugs.
The dispensing fee for each new or refill prescription, including nonlegend or over-the-counter drugs covered by the division, shall be not less than Three Dollars and Ninety-one Cents ($3.91), as determined by the division.
The dispensing fee for each new or refill prescription, including nonlegend or over-the-counter drugs covered by the H.
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.
H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 10(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 10(RF\JAB) division, shall be not less than Three Dollars and Ninety-one Cents ($3.91), as determined by the division.
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.
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.
H.
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, H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 11(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 11(RF\JAB) 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.
In either instance, the eyeglasses must be prescribed by a physician skilled in diseases of the eye or an optometrist, whichever the beneficiary may select.
In either instance, the eyeglasses H.
B.
No.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 12(RF\JAB) must be prescribed by a physician skilled in diseases of the eye or an optometrist, whichever the beneficiary may select.
Christmas, the day before H.
Christmas, the day before Christmas, the day after Christmas, Thanksgiving, the day before Thanksgiving and the day after Thanksgiving.
B.
No.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 12(RF\JAB) Christmas, the day after Christmas, Thanksgiving, the day before Thanksgiving and the day after Thanksgiving.
(a) Services provided by ambulatory surgical centers (ACSs) as defined in Section 41-75-1(a);
and (b) Dialysis center services.
(15) Home- and community-based services for the elderly and disabled, as provided under Title XIX of the federal Social Security Act, as amended, under waivers, subject to the availability of funds specifically appropriated for that purpose by the Legislature.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 13(RF\JAB) (16) Mental health services.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 13(RF\JAB) (a) Services provided by ambulatory surgical centers (ACSs) as defined in Section 41-75-1(a);
and (b) Dialysis center services.
(15) Home- and community-based services for the elderly and disabled, as provided under Title XIX of the federal Social Security Act, as amended, under waivers, subject to the availability of funds specifically appropriated for that purpose by the Legislature.
(16) Mental health services.
Any such services provided by a facility described in subparagraph (b) must have the prior approval of the division to be reimbursable under this section.
Any such services provided by a H.
B.
No.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 14(RF\JAB) facility described in subparagraph (b) must have the prior approval of the division to be reimbursable under this section.
H.
(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.
B.
No.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 14(RF\JAB) (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.
(b) (i) The division may establish a Medicare Upper Payment Limits Program, as defined in Section 1902(a)(30) of the federal Social Security Act and any applicable federal regulations, or an allowable delivery system or provider payment initiative authorized under 42 CFR 438.6(c), for hospitals, nursing facilities, physicians employed or contracted by hospitals, and emergency ambulance transportation providers.
(b) (i) The division may establish a Medicare Upper Payment Limits Program, as defined in Section 1902(a)(30) of H.
(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 H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 15(RF\JAB) Medicare Upper Payment Limits Program or other program(s) authorized under this subsection (A)(18)(b).
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 15(RF\JAB) 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, physicians employed or contracted by hospitals, and emergency ambulance transportation providers.
(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 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).
In addition to the hospital assessment provided in Section 43-13-145(4)(a), hospitals with physicians participating in the Medicare Upper Payment Limits Program or other program(s) authorized under this subsection (A)(18)(b) shall be required to participate in an intergovernmental transfer or assessment, as determined by the division, for the purpose of financing the state portion of the H.
(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 H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 16(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 16(RF\JAB) 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 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.
Further, the division, in consultation with the hospital industry shall develop alternative models for distribution of medical claims and supplemental payments for inpatient and outpatient hospital services, and such models may include, but shall not be limited to the following:
Further, the division, in consultation with the hospital industry shall develop alternative models for distribution of medical claims and supplemental payments for inpatient and outpatient hospital H.
B.
No.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 17(RF\JAB) services, and such models may include, but shall not be limited to the following:
The goals of such H.
The goals of such payment models shall be to ensure access to inpatient and outpatient care and to maximize any federal funds that are available to reimburse hospitals for services provided.
B.
No.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 17(RF\JAB) payment models shall be to ensure access to inpatient and outpatient care and to maximize any federal funds that are available to reimburse hospitals for services provided.
Effective July 1, 2018, and until such time as any payment 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.
Effective July 1, 2018, and until such time as any payment 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 H.
(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 H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 18(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 18(RF\JAB) 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.
(ii) Subject to approval by the Centers for Medicare and Medicaid Services (CMS), the MHAP shall provide increased inpatient capitation (PMPM) payments to managed care entities contracting with the division pursuant to subsection (H) of this section to support availability of hospital services or such other payments permissible under federal law necessary to accomplish the intent of this subsection.
(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 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 H.
(ii) Subject to approval by the Centers for Medicare and Medicaid Services (CMS), the MHAP shall provide increased inpatient capitation (PMPM) payments to managed care entities contracting with the division pursuant to subsection (H) H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 19(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 19(RF\JAB) of this section to support availability of hospital services or such other payments permissible under federal law necessary to accomplish the intent of this subsection.
(iii) The intent of this subparagraph (c) is that effective for all inpatient hospital Medicaid services during state fiscal year 2016, and so long as this provision shall remain in effect hereafter, the 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.
Services to be performed include case management, nutrition assessment/counseling, psychosocial assessment/counseling and health education.
Services to be performed H.
B.
No.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 20(RF\JAB) include case management, nutrition assessment/counseling, psychosocial assessment/counseling and health education.
The division shall cooperate with the State Department of Health, H.
The division shall cooperate with the State Department of Health, acting as lead agency, in the development and implementation of a statewide system of delivery of early intervention services, under Part C of the Individuals with Disabilities Education Act (IDEA).
B.
No.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 20(RF\JAB) acting as lead agency, in the development and implementation of a statewide system of delivery of early intervention services, under Part C of the Individuals with Disabilities Education Act (IDEA).
(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.
(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 H.
(21) Nurse practitioner services.
Services furnished by a registered nurse who is licensed and certified by the H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 21(RF\JAB) Mississippi Board of Nursing as a nurse practitioner, including, but not limited to, nurse anesthetists, nurse midwives, family nurse practitioners, family planning nurse practitioners, pediatric nurse practitioners, obstetrics-gynecology nurse practitioners and neonatal nurse practitioners, under regulations adopted by the division.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 21(RF\JAB) 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.
(21) Nurse practitioner services.
Services furnished by a registered nurse who is licensed and certified by the Mississippi Board of Nursing as a nurse practitioner, including, but not limited to, nurse anesthetists, nurse midwives, family nurse practitioners, family planning nurse practitioners, pediatric nurse practitioners, obstetrics-gynecology nurse practitioners and neonatal nurse practitioners, under regulations adopted by the 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.
(22) Ambulatory services delivered in federally qualified health centers, rural health centers and clinics of the H.
Federally qualified health centers shall be reimbursed by the Medicaid prospective payment system as approved by the Centers for Medicare and Medicaid Services.
The division shall recognize federally qualified health centers (FQHCs), rural health clinics (RHCs)) and community mental health centers (CMHCs) as both an originating and distant site provider for the purposes of telehealth H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 22(RF\JAB) reimbursement.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 22(RF\JAB) 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.
The division shall recognize federally qualified health centers (FQHCs), rural health clinics (RHCs)) and community mental health centers (CMHCs) as both an originating and distant site provider for the purposes of telehealth reimbursement.
From and after January 1, 2015, the division shall update the fair rental reimbursement system for psychiatric residential treatment facilities.
From and after January 1, 2015, the division shall update the fair rental H.
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.
H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 23(RF\JAB) (b) The division may reimburse for services provided by a licensed freestanding psychiatric hospital to Medicaid recipients over the age of twenty-one (21) in a method and manner consistent with the provisions of Section 43-13-117.5.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 23(RF\JAB) 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.
(b) The division may reimburse for services provided by a licensed freestanding psychiatric hospital to Medicaid recipients over the age of twenty-one (21) in a method and manner consistent with the provisions of Section 43-13-117.5.
(27) Group health plan premiums and cost-sharing if it is cost-effective as defined by the United States Secretary of Health and Human Services.
(28) Other health insurance premiums that are cost-effective as defined by the United States Secretary of Health and Human Services.
Medicare eligible must have Medicare Part B before other insurance premiums can be paid.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 24(RF\JAB) (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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 24(RF\JAB) (27) Group health plan premiums and cost-sharing if it is cost-effective as defined by the United States Secretary of Health and Human Services.
(28) Other health insurance premiums that are cost-effective as defined by the United States Secretary of Health and Human Services.
Medicare eligible must have Medicare Part B before other insurance premiums can be paid.
(29) The 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.
(31) Targeted case management services for children with special needs, under waivers from the United States Department of Health and Human Services, using state funds that are provided from the appropriation to the Mississippi Department of Human Services and used to match federal funds under a cooperative agreement between the division and the department.
(31) Targeted case management services for children with special needs, under waivers from the United States Department of Health and Human Services, using state funds that are provided from the appropriation to the Mississippi Department H.
(32) Care and services provided in Christian Science Sanatoria listed and certified by the Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc., rendered in connection with treatment by prayer or spiritual means H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 25(RF\JAB) to the extent that those services are subject to reimbursement under Section 1903 of the federal Social Security Act.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 25(RF\JAB) of Human Services and used to match federal funds under a cooperative agreement between the division and the department.
(32) Care and services provided in Christian Science Sanatoria listed and certified by the Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc., rendered in connection with treatment by prayer or spiritual means to the extent that those services are subject to reimbursement under Section 1903 of the federal Social Security Act.
The PEER Committee shall conduct a performance evaluation of the nonemergency transportation program to evaluate the administration of the program and the providers of transportation services to determine the most cost-effective ways of providing nonemergency transportation services to the patients served under the program.
The PEER Committee shall conduct a performance evaluation of the nonemergency transportation program to evaluate the administration of the program and the providers of transportation services to determine the most cost-effective ways of providing nonemergency H.
The performance evaluation shall be completed and provided to the members of the Senate Medicaid Committee and the House Medicaid Committee not later than January 1, 2019, and every two (2) years thereafter.
(37) [Deleted] H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 26(RF\JAB) (38) Chiropractic services.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 26(RF\JAB) transportation services to the patients served under the program.
The performance evaluation shall be completed and provided to the members of the Senate Medicaid Committee and the House Medicaid Committee not later than January 1, 2019, and every two (2) years thereafter.
(37) [Deleted] (38) Chiropractic services.
(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 H.
(40) [Deleted] (41) Services provided by the State Department of Rehabilitation Services for the care and rehabilitation of persons H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 27(RF\JAB) funds under a cooperative agreement between the division and the department.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 27(RF\JAB) 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.
Services furnished by a physician assistant who is licensed by the State Board of Medical Licensure and is practicing with physician supervision under regulations adopted by the board, under regulations adopted by the division.
Services furnished by a physician assistant who is licensed by the State Board of Medical Licensure and is practicing with physician supervision H.
Reimbursement for those services shall not exceed ninety percent (90%) of the reimbursement rate for comparable services rendered by a physician.
The division may provide for a reimbursement rate for physician assistant services of up to one hundred percent (100%) or the reimbursement rate for H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 28(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 28(RF\JAB) under regulations adopted by the board, under regulations adopted by the division.
Reimbursement for those services shall not exceed ninety percent (90%) of the reimbursement rate for comparable services rendered by a physician.
The division may provide for a reimbursement rate for physician assistant services of up to one hundred percent (100%) or the reimbursement rate for comparable services rendered by a physician for physician assistant services that are provided after the normal working hours of the physician assistant, as determined in accordance with regulations of the division.
(b) Participation in any disease management program implemented under this paragraph (47) is optional with the individual.
An individual must affirmatively elect to participate in the disease management program in order to participate, and may elect to discontinue participation in the program at any time.
(48) Pediatric long-term acute care hospital services.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 29(RF\JAB) (a) Pediatric long-term acute care hospital services means services provided to eligible persons under twenty-one (21) years of age by a freestanding Medicare-certified hospital that has an average length of inpatient stay greater than twenty-five (25) days and that is primarily engaged in providing chronic or long-term medical care to persons under twenty-one (21) years of age.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 29(RF\JAB) (b) Participation in any disease management program implemented under this paragraph (47) is optional with the individual.
An individual must affirmatively elect to participate in the disease management program in order to participate, and may elect to discontinue participation in the program at any time.
(48) Pediatric long-term acute care hospital services.
(a) Pediatric long-term acute care hospital services means services provided to eligible persons under twenty-one (21) years of age by a freestanding Medicare-certified hospital that has an average length of inpatient stay greater than twenty-five (25) days and that is primarily engaged in providing chronic or long-term medical care to persons under twenty-one (21) years of age.
(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.
H.
This H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 30(RF\JAB) physical examination and utilization of these disease management tools shall be consistent with current United States Preventive Services Task Force or other recognized authority recommendations.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 30(RF\JAB) (51) Upon determination of Medicaid eligibility and in association with annual redetermination of Medicaid eligibility, beneficiaries shall be encouraged to undertake a physical examination that will establish a base-line level of health and identification of a usual and customary source of care (a medical home) to aid utilization of disease management tools.
This physical examination and utilization of these disease management tools shall be consistent with current United States Preventive Services Task Force or other recognized authority recommendations.
(53) Targeted case management services for high-cost beneficiaries may be developed by the division for all services under this section.
H.
(54) [Deleted] (55) Therapy services.
The plan of care for therapy services may be developed to cover a period of treatment for up to six (6) months, but in no event shall the plan of care exceed a H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 31(RF\JAB) six-month period of treatment.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 31(RF\JAB) (53) Targeted case management services for high-cost beneficiaries may be developed by the division for all services under this section.
(54) [Deleted] (55) Therapy services.
The plan of care for therapy services may be developed to cover a period of treatment for up to six (6) months, but in no event shall the plan of care exceed a six-month period of treatment.
(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.
(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 H.
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.
H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 32(RF\JAB) (58) Treatment services for persons with opioid dependency or other highly addictive substance use disorders.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 32(RF\JAB) 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.
Federally qualified health centers may participate in the emergency room redirection program, and the division may pay those centers a percentage of any savings to the Medicaid program achieved by the centers' accepting patient referrals through the program, as provided in this subsection (C).
Federally qualified H.
H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 33(RF\JAB) (D) (1) * * * As used in this subsection, the following terms shall be defined as provided in this paragraph, except as otherwise provided in this subsection:
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 33(RF\JAB) health centers may participate in the emergency room redirection program, and the division may pay those centers a percentage of any savings to the Medicaid program achieved by the centers' accepting patient referrals through the program, as provided in this subsection (C).
(D) (1) * * * As used in this subsection, the following terms shall be defined as provided in this paragraph, except as otherwise provided in this subsection:
The division also shall provide a copy and summary of each proposed rate change to any other member of the Legislature upon request.
The division also shall provide a copy and summary of each H.
(3) (a) The committees may hold meetings to review a proposed rate change.
If the committees decide to hold meetings, they shall notify the division of their intention in writing H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 34(RF\JAB) within seven (7) calendar days after receipt of the notice from the division under paragraph (2) of this subsection, and shall set the dates and times for the meetings in the notice to the division, which shall not be later than fourteen (14) calendar days after receipt of the notice from the division.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 34(RF\JAB) proposed rate change to any other member of the Legislature upon request.
(3) (a) The committees may hold meetings to review a proposed rate change.
If the committees decide to hold meetings, they shall notify the division of their intention in writing within seven (7) calendar days after receipt of the notice from the division under paragraph (2) of this subsection, and shall set the dates and times for the meetings in the notice to the division, which shall not be later than fourteen (14) calendar days after receipt of the notice from the division.
(4) (a) If there are any objections to a proposed rate change or any part thereof from the committees, the division may withdraw the proposed rate change, make any of the suggested changes to the proposed rate change that are recommended by the committees, or not make any changes to the proposed rate change.
(4) (a) If there are any objections to a proposed rate change or any part thereof from the committees, the division may H.
(b) If the division does not make any changes to the proposed rate change, it shall notify the members of the H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 35(RF\JAB) committees 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 later date as specified by the division.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 35(RF\JAB) withdraw the proposed rate change, make any of the suggested changes to the proposed rate change that are recommended by the committees, 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 members of the committees 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 later date as specified by the division.
(F) The executive director shall keep the Governor advised on a timely basis of the funds available for expenditure and the projected expenditures.
H.
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, H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 36(RF\JAB) after consultation with the executive director, shall take all appropriate measures to reduce costs, which may include, but are not limited to:
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 36(RF\JAB) (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:
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.
H.
PEER shall review the computations of the division and H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 37(RF\JAB) report its findings to the Legislative Budget Office not later than January 7 in any year.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 37(RF\JAB) 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.
(a) Pay providers at a rate that is less than the Medicaid All Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement rate;
H.
(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 H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 38(RF\JAB) 1395dd.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 38(RF\JAB) (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 services and prescription drugs that is more stringent than the prior authorization processes used by the division in its administration of the Medicaid program.
(d) Implement a prior authorization and utilization review program for medical services, transportation services and prescription drugs that is more stringent than the prior authorization processes used by the division in its H.
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, H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 39(RF\JAB) transportation services and prescription drugs that is required to be implemented under this subparagraph (d);
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 39(RF\JAB) 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, including the prior authorization process, concurrent reviews, retrospective reviews and payments, that are consistent with widely accepted professional standards of care.
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, including the prior authorization process, concurrent reviews, retrospective reviews and payments, that are consistent with H.
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.
H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 40(RF\JAB) (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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 40(RF\JAB) 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.
(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 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.
Additionally, each contractor shall disclose to the Chairmen of the Senate and House Medicaid Committees the administrative expenses costs for the prior calendar year, and the number of full-equivalent employees H.
(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, H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 41(RF\JAB) the PEER Committee, the Department of Insurance and/or independent third parties.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 41(RF\JAB) 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, 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 H.
(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, H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 42(RF\JAB) (xi) The most common claim denial codes to determine the reasons for the denials.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 42(RF\JAB) (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 require its providers or beneficiaries to use any pharmacy that ships, mails or delivers prescription drugs or legend drugs or devices.
(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 require its providers or beneficiaries to use any pharmacy that H.
(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 H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 43(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 43(RF\JAB) ships, mails or delivers prescription drugs or legend drugs or devices.
(6) (a) Not later than December 1, 2021, the contractors who are receiving capitated payments under a managed care delivery system established under this subsection (H) shall develop and implement a uniform credentialing process for providers.
Under that uniform credentialing process, a provider who meets the criteria for credentialing will be credentialed with all of those contractors and no such provider will have to be separately credentialed by any individual contractor in order to receive reimbursement from the contractor.
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 credentialing of the providers by the division's credentialing process.
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 H.
(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 H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 44(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 44(RF\JAB) 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 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.
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.
H.
(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 H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 45(RF\JAB) all of the contractors and eligible to receive reimbursement from the contractors.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 45(RF\JAB) 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 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 the division.
(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 H.
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 H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 46(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 46(RF\JAB) 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 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 delivery system established in this section shall implement innovative programs to improve the health and well-being of members diagnosed with prediabetes and diabetes.
(10) It is the intent of the Legislature that any contractor receiving capitated payments under a managed care H.
(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 H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 47(RF\JAB) 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.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 47(RF\JAB) delivery system established in this section shall implement innovative programs to improve the health and well-being of members diagnosed with prediabetes and diabetes.
(11) It is the intent of the Legislature that any contractors receiving capitated payments under a managed care delivery system established under this subsection (H) shall work with providers of Medicaid services to improve the utilization of long-acting reversible contraceptives (LARCs).
Not later than December 1, 2021, any contractors receiving capitated payments under a managed care delivery system established under this subsection (H) shall provide to the Chairmen of the House and Senate Medicaid Committees and House and Senate Public Health Committees a report of LARC utilization for State Fiscal Years 2018 through 2020 as well as any programs, initiatives, or efforts made by the contractors and providers to increase LARC utilization.
The extended contracts shall be revised to incorporate any provisions of this subsection (H).
The extended contracts H.
B.
No.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 48(RF\JAB) shall be revised to incorporate any provisions of this subsection (H).
(13) Notwithstanding any other provision of law to the contrary, the Division of Medicaid shall not execute a contract or make capitated payments for services provided under this subsection (H) with any entity which has executed a settlement agreement with the State of Mississippi or any other state to repay over Fifty Million Dollars ($50,000,000.00) related to allegations of fraud, waste, abuse or overpayments in the state's Medicaid program.
(14) In addition to the managed care entities with which the division has contracted as of January 1, 2022, to provide Medicaid services on a capitated basis under a managed care program or coordinated care program implemented by the division under this subsection (H), the division shall select a Mississippi nonprofit corporation to provide Medicaid services on a capitated basis under this subsection (H).
reduced hospital admissions, audits or payments H.
reduced hospital admissions, audits or payments under the APR-DRG or APC models, or a managed care program or similar model described in subsection (H) of this section.
H.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS PAGE 48(RF\JAB) under the APR-DRG or APC models, or a managed care program or similar model described in subsection (H) of this section.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 49(RF\JAB) (K) In the negotiation and execution of such contracts involving services performed by actuarial firms, the Executive Director of the Division of Medicaid may negotiate a limitation on liability to the state of prospective contractors.
(K) In the negotiation and execution of such contracts involving services performed by actuarial firms, the Executive Director of the Division of Medicaid may negotiate a limitation on liability to the state of prospective contractors.
658 *HR31/R856CS* ~ OFFICIAL ~ 22/HR31/R856CS ST:
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH ST:
delete freeze on provider PAGE 49(RF\JAB) reimbursement rates and establish procedure for review of proposed rate changes.
delete freeze on provider PAGE 50(RF\JAB) reimbursement rates and establish procedure for review of proposed rate changes.
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Amendments

3 amendments

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Action History

  1. Died In Conference

  2. Conferees Named Blackwell,Fillingane,Wiggins

  3. Conferees Named Hood,White,Deweese

  4. Decline to Concur/Invite Conf

  5. Returned For Concurrence

  6. Passed As Amended

  7. Amended

  8. Title Suff Do Pass As Amended

  9. Referred To Medicaid

  10. Transmitted To Senate

  11. Motion to Reconsider W/Drawn

  12. Motion to Reconsider Entered (Hood, Deweese)

  13. Passed As Amended

  14. Amended

  15. Committee Substitute Adopted

  16. Read the Third Time

  17. Title Suff Do Pass Comm Sub

  18. Referred To Medicaid

Sponsors

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 174 not signed on · 2 voted No

Sponsors (1)

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.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Passage as Amended

Passed 46 Yea · 1 Nay · 5 Other
Party YeaNayPresentNot Voting
Unaffiliated 17000
Republican 20105
Democrat 9000
Total 46105
% of votes cast 88%2%0%10%
How each member voted (52)
Member Party Vote
Parker — Yea
Polk — Yea
Sojourner — Yea
Thompson — Yea
Turner-Ford — Yea
Barnett — Yea
Blackmon — Yea
Boyd — Yea
Branning — Yea
Butler A. (36th) — Yea
Butler K. (38th) — Yea
Caughman — Yea
Horhn — Yea
Johnson — Yea
Jordan — Yea
McDaniel — Yea
Moran — Yea
David Blount Democrat Yea
Derrick T. Simmons Democrat Yea
Hillman Terome Frazier Democrat Yea
Hob Bryan Democrat Yea
Joseph Thomas Democrat Yea
Reginald Jackson Democrat Yea
Rod Hickman Democrat Yea
Sarita Simmons Democrat Yea
Sollie B. Norwood Democrat Yea
Angela Burks Hill Republican Not Voting
Bart Williams Republican Yea
Benjamin Suber Republican Not Voting
Brice Wiggins Republican Yea
Briggs Hopson Republican Not Voting
Chad McMahan Republican Yea
Chuck Younger Republican Yea
Daniel H. Sparks Republican Yea
Dean Kirby Republican Yea
Dennis DeBar, Jr. Republican Yea
J. Walter Michel Republican Yea
Jason Barrett Republican Not Voting
Jeff Tate Republican Not Voting
Jeremy England Republican Yea
Joel R. Carter, Jr. Republican Yea
Joey Fillingane Republican Yea
Joseph M. Seymour Republican Yea
Josh Harkins Republican Yea
Kathy L. Chism Republican Nay
Kevin Blackwell Republican Yea
Lydia Graves Chassaniol Republican Yea
Michael McLendon Republican Yea
Neil S. Whaley Republican Yea
Rita Potts Parks Republican Yea
Scott DeLano Republican Yea
Tyler McCaughn Republican Yea

Official roll call →

Passage as Amended

Passed 113 Yea · 4 Nay · 5 Other
Party YeaNayPresentNot Voting
Republican 55002
Democrat 28101
Unaffiliated 29301
Independent 1001
Total 113405
% of votes cast 93%3%0%4%
How each member voted (122)
Member Party Vote
Barnett — Yea
Beckett — Yea
Blackmon — Yea
Boyd — Yea
Busby — Yea
Clarke — Yea
Darnell — Yea
Gibbs (72nd) — Yea
Goodin — Yea
Huddleston — Yea
Jackson — Yea
Johnson — Yea
Lancaster — Yea
McLeod — Yea
Miles — Yea
Paden — Yea
Patterson — Yea
Reynolds — Yea
Robinson — Yea
Stamps — Yea
Straughter — Yea
Thompson — Yea
Walker — Yea
Weathersby — Yea
Williams-Barnes — Yea
Williamson — Yea
Wright — Yea
Young — Yea
Mr. Speaker — Yea
Bomgar — Nay
Criswell — Nay
Hopkins — Nay
Bain — Not Voting
Bo Brown Democrat Yea
Bo Brown Democrat Nay
Bob Evans Democrat Yea
Bob Evans Democrat Yea
Bryant W. Clark Democrat Yea
Carl Mickens Democrat Yea
Cedric Burnett Democrat Yea
Cheikh Taylor Democrat Yea
Christopher M. Bell Democrat Yea
Daryl Porter Democrat Yea
Earle S. Banks Democrat Yea
Gregory Holloway, Sr. Democrat Yea
Hester Jackson McCray Democrat Yea
Jeffery Harness Democrat Yea
Jeramey Anderson Democrat Yea
John G. Faulkner Democrat Yea
John W. Hines, Sr. Democrat Yea
Kabir Karriem Democrat Yea
Karl Gibbs Democrat Yea
Omeria Scott Democrat Yea
Oscar Denton Democrat Yea
Otis Anthony Democrat Yea
Percy W. Watson Democrat Yea
Robert L. Sanders Democrat Yea
Ronnie C. Crudup Democrat Yea
Solomon C. Osborne Democrat Yea
Stephanie Foster Democrat Yea
Tracey T. Rosebud Democrat Yea
Willie Bailey Democrat Yea
Zakiya Summers Democrat Not Voting
Angela Cockerham Independent Not Voting
Shanda Yates Independent Yea
Becky Currie Republican Yea
Bill Kinkade Republican Yea
Bill Pigott Republican Yea
Billy Adam Calvert Republican Yea
Brent Anderson Republican Yea
Brent Powell Republican Yea
C. Scott Bounds Republican Yea
Carolyn Crawford Republican Yea
Casey Eure Republican Yea
Clay Deweese Republican Yea
Dan Eubanks Republican Yea
Dana McLean Republican Yea
Donnie Bell Republican Yea
Donnie Scoggin Republican Yea
Fred Shanks Republican Yea
Gene Newman Republican Yea
Greg Haney Republican Yea
Henry Zuber III Republican Yea
Jansen Owen Republican Yea
Jason White Republican Yea
Jay McKnight Republican Yea
Jeff Hale Republican Yea
Jeffrey S. Guice Republican Yea
Jerry R. Turner Republican Yea
Jill Ford Republican Yea
Jody Steverson Republican Yea
Joey Hood Republican Yea
John Read Republican Not Voting
John Thomas "Trey" Lamar, III Republican Yea
Joseph Tubb Republican Yea
Karl Oliver Republican Yea
Ken Morgan Republican Yea
Kent McCarty Republican Yea
Kevin Felsher Republican Yea
Kevin Ford Republican Yea
Kevin Horan Republican Yea
Larry Byrd Republican Yea
Lee Yancey Republican Yea
Lester Carpenter Republican Yea
Manly Barton Republican Yea
Mark Tullos Republican Yea
Missy McGee Republican Yea
Noah Sanford Republican Yea
Price Wallace Republican Yea
Randy Rushing Republican Yea
Richard Bennett Republican Yea
Rob Roberson Republican Yea
Sam C. Mims, V Republican Not Voting
Sam Creekmore IV Republican Yea
Shane Aguirre Republican Yea
Stacey Hobgood-Wilkes Republican Yea
Stephen A. Horne Republican Yea
Steve Massengill Republican Yea
Timmy Ladner Republican Yea
Troy Smith Republican Yea
Vince Mangold Republican Yea
William Tracy Arnold Republican Yea

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

Who sponsors HB 658?
HB 658 is sponsored by Joey Hood (Republican).
What is the current status of HB 658?
This bill died with 2022 Regular Session. It reached “Passed House” 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 HB 658?
Track HB 658 free on One Click Politics — get push/email alerts when it moves.

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