Amendment vs bill Committee Amendment No 1 (Adopted) (Voice Vote) vs Current version

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MISSISSIPPI LEGISLATURE REGULAR SESSION 2022 By:
Adopted COMMITTEE AMENDMENT NO 1 PROPOSED TO House Bill No.
Representative Hood To:
658 BY:
Medicaid HOUSE BILL NO.
Committee Amend by striking all after the enacting clause and inserting in lieu thereof the following:
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 ESTABLISH A PROCEDURE FOR THE MEDICAID AND APPROPRIATIONS COMMITTEES OF THE HOUSE AND SENATE TO REVIEW PROPOSED CHANGES IN PROVIDER RATES OF REIMBURSEMENT BY THE DIVISION OF MEDICAID BEFORE THE CHANGES WILL TAKE EFFECT;
TO PROVIDE THAT THE COMMITTEES HAVE NO AUTHORITY TO VETO OR REVISE ANY PROPOSED RATE CHANGE, BUT ARE LIMITED TO REVIEWING, MAKING OBJECTIONS TO AND MAKING RECOMMENDATIONS FOR SUGGESTED CHANGES TO RATE CHANGES PROPOSED BY THE DIVISION;
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;
AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
(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.
(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:
B.
No.
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:
(a) The division is authorized to implement an All Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement methodology for inpatient hospital services.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 1 (a) The division is authorized to implement an All Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement methodology for inpatient hospital services.
H.
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.
B.
Where the same services are reimbursed as clinic services, the division may revise the rate or 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 2 methodology of outpatient reimbursement to maintain consistency, efficiency, economy and quality of care.
No.
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.
H.
(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.
B.
No.
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.
Christmas, the day before Christmas, the day after Christmas, Thanksgiving, the day before Thanksgiving and the day after Thanksgiving.
Christmas, the day 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 3 before Christmas, the day after Christmas, Thanksgiving, the day before Thanksgiving and the day after Thanksgiving.
H.
The division shall develop and implement a payment add-on to reimburse nursing facilities for ventilator-dependent resident services.
B.
(e) The division shall develop and implement, not later than January 1, 2001, a case-mix payment add-on determined 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 4 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.
No.
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.
H.
(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 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 5 are included in the state plan.
B.
No.
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 H.
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.
B.
No.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 6(RF\JAB) of Human Services to obtain federal matching funds through the division.
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.
The division may provide for a reimbursement rate for physician's 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 6 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 H.
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.
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B.
No.
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.
The division shall establish a mandatory preferred drug list.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 7 The division shall establish a mandatory preferred drug list.
H.
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.
B.
No.
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.
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.
Those drugs that were originally billed to the division but are not used by a resident 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 8 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.
H.
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.
B.
No.
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 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.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 9 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 H.
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.
B.
No.
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 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.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 10 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.
H.
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.
B.
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, 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 11 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.
No.
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 H.
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.
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 Christmas, the day after Christmas, Thanksgiving, the day before Thanksgiving and the day after Thanksgiving.
Christmas, the day before 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 12 Christmas, the day after Christmas, Thanksgiving, the day before Thanksgiving and the day after Thanksgiving.
H.
(a) Services provided by ambulatory surgical centers (ACSs) as defined in Section 41-75-1(a);
B.
No.
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);
(16) Mental health services.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 13 (16) Mental health services.
Any such services provided by a H.
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.
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.
A maximum dollar amount of reimbursement for noninvasive 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 14 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, 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.
However, from and after January 1, 1999, public hospitals participating in the Medicaid disproportionate share program may be required to participate in an intergovernmental transfer program as provided in Section 1903 of the federal Social Security Act and any applicable regulations.
However, from and after January 1, 1999, public hospitals participating in the Medicaid disproportionate share program may be required to participate in an intergovernmental transfer program as provided 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 15 in Section 1903 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 H.
(b) (i) 1.
B.
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 * * * and physicians employed or contracted by hospitals * * *.
No.
2.
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.
The division shall establish a Medicaid Supplemental Payment Program, as permitted by the federal Social Security Act and a comparable allowable delivery system or provider payment initiative authorized under 42 CFR 438.6(c), for emergency ambulance transportation providers in accordance with this subsection (A)(18)(b).
The assessments will remain in effect as long as the state participates in the Medicare Upper Payment Limits Program or other program(s) authorized under this subsection (A)(18)(b).
The assessments 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 16 will remain in effect as long as the state participates in 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 H.
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).
B.
No.
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).
(iv) Notwithstanding any other provision of this article to the contrary, effective upon implementation of the Mississippi Hospital Access Program (MHAP) provided in subparagraph (c)(i) below, the hospital portion of the inpatient Upper Payment Limits Program shall transition into and be replaced by the MHAP program.
(iv) Notwithstanding any other provision of this article to the contrary, effective upon implementation of the Mississippi Hospital Access Program (MHAP) provided in 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 17 subparagraph (c)(i) below, the hospital portion of the inpatient Upper Payment Limits Program shall transition into and be replaced by the MHAP program.
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.
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:
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:
Any such documents required to achieve the goals described in this paragraph shall be submitted to the Centers for Medicare and Medicaid Services, with a proposed effective date of July 1, 2019, to the extent possible, but in no event shall the effective date of such payment models be later than July 1, 2020.
Any such documents required to achieve the goals described in this paragraph shall be submitted to the Centers for Medicare and Medicaid Services, with a proposed effective date of July 1, 2019, to the extent possible, but in no event shall the effective date 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 18 of such payment models be later than July 1, 2020.
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.
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.
B.
(v) 1.
No.
To preserve and improve access to ambulance transportation provider services, the division shall seek CMS approval to make ambulance service access payments as set forth in this subsection (A)(18)(b) for all covered emergency ambulance services rendered on or after July 1, 2022, and shall make such ambulance service access payments for all covered services rendered on or after the effective date of CMS approval.
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.
2.
The division shall calculate the ambulance service access payment amount as the balance of the portion of the Medical Care Fund related to ambulance 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 19 transportation service provider assessments plus any federal matching funds earned on the balance, up to, but not to exceed, the upper payment limit gap for all emergency ambulance service providers.
3.
a.
Except for ambulance services exempt from the assessment provided in this subparagraph, all ambulance transportation service providers shall be eligible for ambulance service access payments each state fiscal year as set forth in this subsection.
b.
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.
Subject to approval by the Centers for Medicare and Medicaid Services, ambulance service access payments shall be made no less than on a quarterly basis.
c.
As used in this section, "upper payment limit gap" means the difference between the total amount which the ambulance transportation service provider received from Medicaid and the average amount which would the ambulance transportation service provider would have received from commercial insurers for those services reimbursed by Medicaid.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 20 4.
An ambulance service access payment shall not be used to offset any other payment by the division for emergency or nonemergency services to Medicaid beneficiaries.
(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.
(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.
B.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 21 (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.
No.
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 H.
Services to be performed include case management, nutrition assessment/counseling, psychosocial assessment/counseling and health education.
B.
The division shall contract with the State Department of Health to 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 22 provide services within this paragraph (Perinatal High Risk Management/Infant Services System (PHRM/ISS)).
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 contract with the State Department of Health to provide services within this paragraph (Perinatal High Risk Management/Infant Services System (PHRM/ISS)).
(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.
(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 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 23 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.
B.
No.
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.
(22) Ambulatory services delivered in federally qualified health centers, rural health centers and clinics of the H.
(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.
B.
Federally 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 24 qualified health centers shall be reimbursed by the Medicaid prospective payment system as approved by the Centers for Medicare and Medicaid Services.
No.
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.
From and after January 1, 2015, the division shall update the fair rental H.
From and after January 1, 2015, the division shall update the fair rental reimbursement system for psychiatric residential treatment facilities.
B.
No.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH PAGE 23(RF\JAB) reimbursement system for psychiatric residential treatment facilities.
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.
From 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 25 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.
(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.
B.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 26 (28) Other health insurance premiums that are cost-effective as defined by the United States Secretary of Health and Human Services.
No.
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.
(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.
(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.
B.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 27 (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.
No.
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 H.
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.
B.
The performance evaluation shall be completed and provided to the 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 28 members of the Senate Medicaid Committee and the House Medicaid Committee not later than January 1, 2019, and every two (2) years thereafter.
No.
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.
(40) [Deleted] (41) Services provided by the State Department of Rehabilitation Services for the care and rehabilitation of persons H.
(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 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 29 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.
B.
No.
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 H.
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.
B.
Reimbursement for those services shall not 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 30 exceed ninety percent (90%) of the reimbursement rate for comparable services rendered by a physician.
No.
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.
H.
(b) Participation in any disease management program implemented under this paragraph (47) is optional with the 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 31 individual.
B.
No.
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.
H.
(51) Upon determination of Medicaid eligibility and in association with annual redetermination of Medicaid eligibility, 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 32 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.
B.
No.
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.
H.
(53) Targeted case management services for high-cost beneficiaries may be developed by the division for all services under this section.
B.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 33 (54) [Deleted] (55) Therapy services.
No.
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.
(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.
(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.
B.
As used in this paragraph (57), "terminal condition" means any aggressive 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 34 malignancy, chronic end-stage cardiovascular or cerebral vascular disease, or any other disease, illness or condition which a physician diagnoses as terminal.
No.
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.
(B) [Deleted] (C) The division may pay to those providers who participate in and accept patient referrals from the division's emergency room redirection program a percentage, as determined by the division, of savings achieved according to the performance measures and reduction of costs required of that program.
(60) Border city university-affiliated pediatric teaching hospital.
Federally qualified H.
(a) Subject to approval by the Centers for Medicare and Medicaid Services (CMS) and the provisions of this section, the division shall 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, an allowable delivery system or provider payment initiative authorized under 42 CFR 438.6(c), or other program(s) authorized 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 35 under this section, for a border city university-affiliated pediatric teaching hospital.
B.
Any program established under this subsection shall be subject to the availability of funds specifically appropriated for that purpose by the Legislature and effective for the state fiscal years 2023 and 2024.
No.
(b) As used in this subsection, 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).
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).
(c) The cost of providing services to Mississippi Medicaid beneficiaries under the age of twenty-one (21) who are treated by a border city university-affiliated pediatric teaching hospital shall not exceed the cost of providing the same services to individuals in hospitals in the state.
(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:
(d) This subsection shall stand repealed on July 1, 2024.
(a) "Committees" means the Medicaid Committees and the Appropriations Committees of the House of Representatives and the Senate.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 36 (B) [Deleted] (C) The division may pay to those providers who participate in and accept patient referrals from the division's emergency room redirection program a percentage, as determined by the division, of savings achieved according to the performance measures and reduction of costs required of that program.
As used in paragraphs (3) and (4) of this subsection, the term "committees" means one (1) of the committees or two (2) or more of the committees jointly.
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).
(b) "Rate change" means an increase, decrease or other change to the payments, payment methodologies or rates of reimbursement to any Medicaid providers that render any services authorized to be provided to Medicaid recipients under this article.
(D) * * * The division shall report to the Chairmen of the Senate and House of Representatives Medicaid Committees at least thirty (30) days before the division notifies providers that it is implementing a payment methodology that would result in a reduction in reimbursement to providers rendering care or services authorized under this section to recipients.
(2) * * * Whenever the Division of Medicaid proposes a rate change, the division shall give notice to the chairmen and other members of the committees at least thirty (30) calendar days before the proposed rate change is scheduled to take effect.
The division shall furnish each member of the committees with a copy and summary of each proposed rate change along with the notice.
The division also shall provide a copy and summary of each H.
B.
No.
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.
The committees may hold public hearings on any proposed rate change as part of their meetings.
(b) After the committees have held their meetings, the committees may object to the proposed rate change or any part thereof.
The committees shall notify the division of any objection and shall provide the division with the reasons for their objection in writing not later than seven (7) calendar days after the meeting.
The committees may make written recommendations to the division for suggested changes to be made to a proposed rate change.
(c) If the committees do not hold meetings to review a proposed rate change, the proposed rate change will take effect on the date as scheduled by the division.
(4) (a) If there are any objections to a proposed rate change or any part thereof from the committees, the division may H.
B.
No.
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.
(c) If the division makes any changes to the proposed rate change, the division shall notify the committees of its actions in writing, and the revised proposed rate change shall take effect on the date as specified by the division.
(5) Nothing in this subsection (D) shall be construed as giving the committees any authority to veto, nullify or revise any rate change proposed by the division.
The authority of the committees under this subsection shall be limited to reviewing, making objections to and making recommendations for suggested changes to rate changes proposed by the division.
H.
(F) The executive director shall keep the Governor advised on a timely basis of the funds available for expenditure and the 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 37 projected expenditures.
B.
No.
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.
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 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 38 shortfall information to the PEER Committee not later than December 1 of the year in which the shortfall is projected to occur.
B.
No.
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.
H.
(a) Pay providers at a rate that is less than the Medicaid All Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement rate;
B.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 39 (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.
No.
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 H.
(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.
B.
Not later than December 2, 2021, the contractors that are receiving capitated payments under a managed care delivery system established under this 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 40 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);
No.
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 H.
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.
B.
Organizations participating in a managed care program or coordinated care program implemented by the division may not use any additional 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 41 criteria that would result in denial of care that would be determined appropriate and, therefore, medically necessary under those levels of care guidelines.
No.
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.
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.
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.
B.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 42 (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.
No.
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, 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, (viii) Value-added benefits and the extent to which they are used, 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 43 (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.
B.
No.
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 H.
(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.
B.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 44 (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.
No.
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 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.
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.
B.
22/SS36/HB658A.J *SS36/HB658A.J* PAGE 45 (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).
No.
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).
H.
The contractor or division shall render a final decision regarding credentialing/enrollment of the provider within sixty (60) days 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 46 from the date that the temporary provider credential/enrollment is issued to the applicant.
B.
No.
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.
(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.
(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.
If a contractor does not issue a final ruling of denial within sixty (60) days as required by this subparagraph 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 47 (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.
No.
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.
(9) It is the intention of the Legislature that the division evaluate the feasibility of using a single vendor to administer dental benefits provided under a managed care delivery system established in this subsection (H).
(9) * * * The division shall evaluate the feasibility of using a single vendor to administer dental benefits provided under a managed care delivery system established in this subsection (H).
(10) It is the intent of the Legislature that any contractor receiving capitated payments under a managed care H.
(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 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 48 innovative programs to improve the health and well-being of members diagnosed with prediabetes and diabetes.
B.
No.
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.
The extended contracts H.
The extended contracts 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 49 shall be revised to incorporate any provisions of this subsection (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).
H.
(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.
B.
(L) The Division of Medicaid shall reimburse for services provided to eligible Medicaid beneficiaries by a licensed birthing center in a method and manner to be determined by the division in accordance with federal laws and federal regulations.
No.
The division shall seek any necessary waivers, make any required amendments to its State Plan or revise any contracts authorized under subsection (H) of this section as necessary to provide the services authorized under this subsection.
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.
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, 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 50 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.
(L) This section shall stand repealed on July 1, 2024.
( * * *M) This section shall stand repealed on July 1, 2024.
This act shall take effect and be in force from and after its passage.
Section 43-13-139, Mississippi Code of 1972, is amended as follows:
H.
43-13-139.
B.
Nothing contained in this article shall be construed to prevent the Governor, in his discretion, from discontinuing or limiting medical assistance to any individuals who are classified or deemed to be within any optional group or optional category of recipients as prescribed under Title XIX of the federal Social Security Act or the implementing federal regulations.
No.
If the Congress or the United States Department of Health and Human Services ceases to provide federal matching funds for any group or category of recipients or any type of care and services, the division shall cease state funding for such group or category or such type of care and services, notwithstanding any provision of this article.
658 *HR31/R856PH* ~ OFFICIAL ~ 22/HR31/R856PH ST:
If any state plan amendment submitted to comply with the provisions of Section 43-13-117 is disapproved by the United States Department of Health and Human Services, the division may operate under the state plan as previously approved by the United States Department of Health and Human Services in order to preserve federal matching funds.
Medicaid;
The division shall 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 51 provide notice of the disapproval to the Chairmen of the House and Senate Medicaid Committees.
delete freeze on provider PAGE 50(RF\JAB) reimbursement rates and establish procedure for review of proposed rate changes.
SECTION 3.
This act shall take effect and be in force from and after July 1, 2022, and shall stand repealed on June 30, 2022.
Further, amend by striking the title in its entirety and inserting in lieu thereof the following:
AN ACT TO AMEND SECTION 43-13-117, MISSISSIPPI CODE OF 1972, TO DELETE THE PROVISION THAT REQUIRED THE DIVISION OF MEDICAID'S RATES OF REIMBURSEMENT, SERVICES, CHARGES AND FEES TO NOT BE INCREASED, DECREASED OR OTHERWISE CHANGED UNLESS THEY ARE AUTHORIZED BY AN AMENDMENT BY THE LEGISLATURE;
TO REQUIRE THE DIVISION TO REPORT TO THE CHAIRMEN OF THE SENATE AND HOUSE OF REPRESENTATIVES MEDICAID COMMITTEES AT LEAST THIRTY (30) DAYS BEFORE THE DIVISION NOTIFIES PROVIDERS THAT IT IS DECREASING OR CHANGING PAYMENTS, PAYMENT METHODOLOGY OR RATES OR REIMBURSEMENT TO PROVIDERS RENDERING CARE OF SERVICES AUTHORIZED UNDER THIS SECTION TO RECIPIENTS;
TO SET REQUIREMENTS FOR THE REIMBURSEMENT OF DURABLE MEDICAL EQUIPMENT, INCLUDING NONINVASIVE VENTILATORS OR VENTILATION TREATMENTS PROPERLY ORDERED AND BEING USED IN AN APPROPRIATE CARE SETTING;
TO REQUIRE REIMBURSEMENT TO DURABLE MEDICAL EQUIPMENT SUPPLIERS FOR HOME USE OF NONINVASIVE AND INVASIVE VENTILATORS TO BE ON A CONTINUOUS MONTHLY PAYMENT BASIS FOR THE DURATION OF MEDICAL NEED THROUGHOUT A PATIENT'S VALID PRESCRIPTION PERIOD;
TO REQUIRE THE DIVISION OF MEDICAID TO ESTABLISH A MEDICARE UPPER PAYMENT LIMITS PROGRAM OR ANOTHER ALLOWABLE DELIVERY SYSTEM AUTHORIZED BY FEDERAL LAW FOR EMERGENCY AMBULANCE TRANSPORTATION PROVIDERS;
TO PROVIDE FOR THE FORMULA THAT THE DIVISION SHALL USE FOR CALCULATING AMBULANCE SERVICE ACCESS PAYMENT AMOUNTS;
TO REQUIRE THE DIVISION TO EVALUATE THE FEASIBILITY OF USING A SINGLE VENDOR TO ADMINISTER DENTAL BENEFITS PROVIDED UNDER A MANAGED CARE DELIVERY SYSTEM;
TO PROVIDE THAT THE DIVISION OF MEDICAID SHALL REIMBURSE FOR OUTPATIENT HOSPITAL SERVICES PROVIDED TO ELIGIBLE MEDICAID BENEFICIARIES UNDER THE AGE OF 21 BY BORDER CITY UNIVERSITY-AFFILIATED PEDIATRIC TEACHING HOSPITALS;
TO REQUIRE THE DIVISION OF MEDICAID TO REIMBURSE FOR SERVICES PROVIDED TO ELIGIBLE MEDICAID BENEFICIARIES BY A LICENSED BIRTHING CENTER IN A METHOD AND MANNER TO BE DETERMINED BY THE DIVISION IN ACCORDANCE WITH FEDERAL LAWS AND FEDERAL REGULATIONS;
TO REQUIRE THE DIVISION TO SEEK ANY NECESSARY WAIVERS, MAKE ANY REQUIRED AMENDMENTS TO ITS STATE PLAN OR REVISE ANY CONTRACTS AUTHORIZED UNDER THE SECTION AS NECESSARY TO PROVIDE THE SERVICES AUTHORIZED UNDER THE ACT;
TO AMEND SECTION 43-13-139, MISSISSIPPI 22/SS36/HB658A.J *SS36/HB658A.J* PAGE 52 CODE OF 1972, TO PROVIDE THAT IF ANY STATE PLAN AMENDMENT SUBMITTED TO COMPLY WITH THE PROVISIONS OF SECTION 43-13-117 IS DISAPPROVED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, THE DIVISION MAY OPERATE UNDER THE STATE PLAN AS PREVIOUSLY APPROVED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES IN ORDER TO PRESERVE FEDERAL MATCHING FUNDS;
TO REQUIRE THE DIVISION TO PROVIDE NOTICE OF THE DISAPPROVAL TO THE CHAIRMEN OF THE HOUSE AND SENATE MEDICAID COMMITTEES;
AND FOR RELATED PURPOSES.
PAGE 53/HB658A.J *SS36/HB658A.J*