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To: Medicaid;
Accountability, Efficiency,
Transparency
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026
By: Representative Johnson
HOUSE BILL NO. 130
AN ACT TO AMEND SECTION 43-13-107, MISSISSIPPI CODE OF 1972, 1
TO CREATE THE MISSISSIPPI MEDICAID COMMISSION TO ADMINISTER THE 2
MEDICAID PROGRAM; TO PROVIDE FOR THE MEMBERSHIP AND APPOINTMENT OF 3
THE COMMISSION; TO PROVIDE THAT THE EXECUTIVE DIRECTOR OF THE 4
COMMISSION SHALL BE APPOINTED BY THE COMMISSION; TO ABOLISH THE 5
DIVISION OF MEDICAID AND TRANSFER THE POWERS, DUTIES, PROPERTY AND 6
EMPLOYEES OF THE DIVISION TO THE MEDICAID COMMISSION; TO AMEND 7
SECTIONS 43-13-103, 43-13-105, 43-13-109, 43-13-113, 43-13-115, 8
43-13-116, 43-13-117, 43-13-120, 43-13-121, 43-13-123, 43-13-125, 9
43-13-139 AND 43-13-145, MISSISSIPPI CODE OF 1972, TO CONFORM TO 10
THE PRECEDING PROVISIONS; AND FOR RELATED PURPOSES. 11
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 12
SECTION 1. Section 43-13-107, Mississippi Code of 1972, is 13
amended as follows: 14
43-13-107. (1) (a) The * * * Mississippi Medicaid 15
Commission is created * * * to administer this article and perform 16
such other duties as are prescribed by law. The commission shall 17
consist of seven (7) members, with four (4) members appointed by 18
the Governor and three (3) members appointed by the Lieutenant 19
Governor. All initial and later appointments to the commission 20
shall be with the advice and consent of the Senate. 21
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(b) All members of the commission shall be persons who 22
have some knowledge or practical experience in matters under the 23
jurisdiction of the commission. No member of the commission shall 24
be a provider or representative of any provider of Medicaid 25
services or have any financial or other interest in any provider 26
of Medicaid services, and no member of the commission shall be an 27
elected official of the State of Mississippi or a political 28
subdivision of the state. 29
(c) The Governor shall appoint one (1) member from each 30
congressional district as constituted on January 1, 2026, and the 31
Lieutenant Governor shall appoint one (1) member from each Supreme 32
Court district as constituted on January 1, 2026. The initial 33
members shall be appointed for staggered terms, as follows: one 34
(1) member appointed by the Governor and one (1) member appointed 35
by the Lieutenant Governor shall be appointed for terms that end 36
on June 30, 2027; two (2) members appointed by the Governor and 37
one (1) member appointed by the Lieutenant Governor shall be 38
appointed for terms that end on June 30, 2029; and one (1) member 39
appointed by the Governor and one (1) member appointed by the 40
Lieutenant Governor shall be appointed for terms that end on June 41
30, 2031. All later appointments to the commission shall be made 42
by the respective appointing authorities for terms of five (5) 43
years from the expiration date of the previous term, and the 44
appointments shall be subject to the same qualifications and 45
geographical districts as the initial members. No person shall be 46
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appointed to the commission for more than two (2) consecutive 47
terms. 48
(d) Any vacancy on the commission before the expiration 49
of a term shall be filled by appointment of the original 50
appointing authority for that position, with the advice and 51
consent of the Senate. The person appointed to fill the vacancy 52
shall serve for the remainder of the unexpired term. 53
(e) The members of the commission shall select one (1) 54
member to serve as chairman of the commission. The commission 55
shall select a chairman once every two (2) years, and any person 56
who has previously served as chairman may be reelected as 57
chairman. 58
(f) Four (4) members of the commission shall constitute 59
a quorum for the transaction of any business of the commission. 60
The commission shall hold regular monthly meetings, and other 61
meetings as may be necessary for the purpose of conducting any 62
business as may be required. All meetings shall be called by the 63
chairman or by a majority of the members of the commission, except 64
the first meeting, which shall be called by the Governor. Any 65
member who does not attend three (3) consecutive regular meetings 66
of the commission, except for illness, shall be subject to removal 67
by a majority vote of the members of the commission. 68
(g) Members of the commission shall receive the per 69
diem authorized under Section 25-3-69 for each day spent actually 70
discharging their official duties, and shall receive reimbursement 71
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for mileage and necessary travel expenses incurred as provided in 72
Section 25-3-41. 73
(h) Each member of the commission, before entering upon 74
the discharge of the duties of the office, shall take and 75
subscribe to the oath of office prescribed by the Mississippi 76
Constitution and shall file the oath in the Office of the 77
Secretary of State, and shall execute a bond in some surety 78
company authorized to do business in the state in the penal sum of 79
One Hundred Thousand Dollars ($100,000.00), conditioned for the 80
faithful and impartial discharge of the duties of the office. The 81
bonds shall be filed in the Office of the Secretary of State, and 82
the premium on the bonds shall be paid as provided by law out of 83
funds appropriated to the commission. 84
(2) (a) The * * * commission shall appoint a full-time 85
executive director, * * * who shall be either (i) a physician with 86
administrative experience in a medical care or health program, or 87
(ii) a person holding a graduate degree in medical care 88
administration, public health, hospital administration, or the 89
equivalent, or (iii) a person holding a bachelor's degree with at 90
least three (3) years' experience in management-level 91
administration of, or policy development for, Medicaid programs, 92
and who shall serve at the will and pleasure of the commission. 93
* * * No one who has been a member of the Mississippi Legislature 94
during the previous three (3) years may be executive director. 95
The executive director shall be the official secretary and legal 96
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custodian of the records of the * * * commission; shall be the 97
agent of the * * * commission for the purpose of receiving all 98
service of process, summons and notices directed to the * * * 99
commission; shall perform such other duties as the * * * 100
commission may prescribe from time to time; and shall perform all 101
other duties that are now or may be imposed upon him or her by 102
law. 103
* * * 104
( * * *b) The executive director shall, before entering 105
upon the discharge of the duties of the office, take and subscribe 106
to the oath of office prescribed by the Mississippi Constitution 107
and shall file the same in the Office of the Secretary of State, 108
and shall execute a bond in some surety company authorized to do 109
business in the state in the penal sum of One Hundred Thousand 110
Dollars ($100,000.00), conditioned for the faithful and impartial 111
discharge of the duties of the office. The premium on the bond 112
shall be paid as provided by law out of funds appropriated to 113
the * * * commission. 114
( * * *c) The executive director, * * * with the 115
approval of the commission and subject to the rules and 116
regulations of the State Personnel Board, shall employ such 117
professional, administrative, stenographic, secretarial, clerical 118
and technical assistance as may be necessary to perform the duties 119
required in administering this article and fix the compensation 120
for those persons, all in accordance with a state merit system 121
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meeting federal requirements. When the salary of the executive 122
director is not set by law, that salary shall be set by the State 123
Personnel Board. * * * The provisions of Section 25-9-107(c)(xv) 124
shall apply to the executive director and other administrative 125
heads of the * * * commission. 126
(3) (a) There is established a Medical Care Advisory 127
Committee, which shall be the committee that is required by 128
federal regulation to advise the * * * commission about health and 129
medical care services. 130
(b) The advisory committee shall consist of not less 131
than eleven (11) members, as follows: 132
(i) The Governor shall appoint five (5) members, 133
one (1) from each congressional district and one (1) from the 134
state at large; 135
(ii) The Lieutenant Governor shall appoint three 136
(3) members, one (1) from each Supreme Court district; 137
(iii) The Speaker of the House of Representatives 138
shall appoint three (3) members, one (1) from each Supreme Court 139
district. 140
All members appointed under this paragraph shall either be 141
health care providers or consumers of health care services. One 142
(1) member appointed by each of the appointing authorities shall 143
be a board-certified physician. 144
(c) The respective Chairmen of the House Medicaid 145
Committee, the House Public Health and Human Services Committee, 146
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the House Appropriations Committee, the Senate Medicaid Committee, 147
the Senate Public Health and Welfare Committee and the Senate 148
Appropriations Committee, or their designees, one (1) member of 149
the State Senate appointed by the Lieutenant Governor and one (1) 150
member of the House of Representatives appointed by the Speaker of 151
the House, shall serve as ex officio nonvoting members of the 152
advisory committee. 153
(d) In addition to the committee members required by 154
paragraph (b), the advisory committee shall consist of such other 155
members as are necessary to meet the requirements of the federal 156
regulation applicable to the advisory committee, who shall be 157
appointed as provided in the federal regulation. 158
(e) The chairmanship of the advisory committee shall be 159
elected by the voting members of the committee annually and shall 160
not serve more than two (2) consecutive years as chairman. 161
(f) The members of the advisory committee specified in 162
paragraph (b) shall serve for terms that are concurrent with the 163
terms of members of the Legislature, and any member appointed 164
under paragraph (b) may be reappointed to the advisory committee. 165
The members of the advisory committee specified in paragraph (b) 166
shall serve without compensation, but shall receive reimbursement 167
to defray actual expenses incurred in the performance of committee 168
business as authorized by law. Legislators shall receive per diem 169
and expenses, which may be paid from the contingent expense funds 170
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of their respective houses in the same amounts as provided for 171
committee meetings when the Legislature is not in session. 172
(g) The advisory committee shall meet not less than 173
quarterly, and advisory committee members shall be furnished 174
written notice of the meetings at least ten (10) days before the 175
date of the meeting. 176
(h) The * * * commission shall submit to the advisory 177
committee all amendments, modifications and changes to the state 178
plan for the operation of the Medicaid program, for review by the 179
advisory committee before the amendments, modifications or changes 180
may be implemented by the * * * commission. 181
(i) The advisory committee, among its duties and 182
responsibilities, shall: 183
(i) Advise the * * * commission with respect to 184
amendments, modifications and changes to the state plan for the 185
operation of the Medicaid program; 186
(ii) Advise the * * * commission with respect to 187
issues concerning receipt and disbursement of funds and 188
eligibility for Medicaid; 189
(iii) Advise the * * * commission with respect to 190
determining the quantity, quality and extent of medical care 191
provided under this article; 192
(iv) Communicate the views of the medical care 193
professions to the * * * commission and communicate the views of 194
the * * * commission to the medical care professions; 195
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(v) Gather information on reasons that medical 196
care providers do not participate in the Medicaid program and 197
changes that could be made in the program to encourage more 198
providers to participate in the Medicaid program, and advise 199
the * * * commission with respect to encouraging physicians and 200
other medical care providers to participate in the Medicaid 201
program; 202
(vi) Provide a written report on or before 203
November 30 of each year to the Governor, Lieutenant Governor and 204
Speaker of the House of Representatives. 205
(4) (a) There is established a Drug Use Review Board, which 206
shall be the board that is required by federal law to: 207
(i) Review and initiate retrospective drug use, 208
review including ongoing periodic examination of claims data and 209
other records in order to identify patterns of fraud, abuse, gross 210
overuse, or inappropriate or medically unnecessary care, among 211
physicians, pharmacists and individuals receiving Medicaid 212
benefits or associated with specific drugs or groups of drugs. 213
(ii) Review and initiate ongoing interventions for 214
physicians and pharmacists, targeted toward therapy problems or 215
individuals identified in the course of retrospective drug use 216
reviews. 217
(iii) On an ongoing basis, assess data on drug use 218
against explicit predetermined standards using the compendia and 219
literature set forth in federal law and regulations. 220
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(b) The board shall consist of not less than twelve 221
(12) members appointed by the * * * commission. 222
(c) The board shall meet at least quarterly, and board 223
members shall be furnished written notice of the meetings at least 224
ten (10) days before the date of the meeting. 225
(d) The board meetings shall be open to the public, 226
members of the press, legislators and consumers. Additionally, 227
all documents provided to board members shall be available to 228
members of the Legislature in the same manner, and shall be made 229
available to others for a reasonable fee for copying. However, 230
patient confidentiality and provider confidentiality shall be 231
protected by blinding patient names and provider names with 232
numerical or other anonymous identifiers. The board meetings 233
shall be subject to the Open Meetings Act (Sections 25-41-1 234
through 25-41-17). Board meetings conducted in violation of this 235
section shall be deemed unlawful. 236
(5) (a) There is established a Pharmacy and Therapeutics 237
Committee, which shall be appointed by the * * * commission. 238
(b) The committee shall meet as often as needed to 239
fulfill its responsibilities and obligations as set forth in this 240
section, and committee members shall be furnished written notice 241
of the meetings at least ten (10) days before the date of the 242
meeting. 243
(c) The committee meetings shall be open to the public, 244
members of the press, legislators and consumers. Additionally, 245
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all documents provided to committee members shall be available to 246
members of the Legislature in the same manner, and shall be made 247
available to others for a reasonable fee for copying. However, 248
patient confidentiality and provider confidentiality shall be 249
protected by blinding patient names and provider names with 250
numerical or other anonymous identifiers. The committee meetings 251
shall be subject to the Open Meetings Act (Sections 25-41-1 252
through 25-41-17). Committee meetings conducted in violation of 253
this section shall be deemed unlawful. 254
(d) After a thirty-day public notice, * * * the 255
commission shall present its recommendation regarding prior 256
approval for a therapeutic class of drugs to the committee. 257
However, in circumstances where the * * * commission deems it 258
necessary for the health and safety of Medicaid beneficiaries, 259
the * * * commission may present to the committee its 260
recommendations regarding a particular drug without a thirty-day 261
public notice. In making that presentation, the * * * commission 262
shall state to the committee the circumstances that precipitate 263
the need for the committee to review the status of a particular 264
drug without a thirty-day public notice. The committee may 265
determine whether or not to review the particular drug under the 266
circumstances stated by the * * * commission without a thirty-day 267
public notice. If the committee determines to review the status 268
of the particular drug, it shall make its recommendations to 269
the * * * commission, after which the * * * commission shall file 270
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those recommendations for a thirty-day public comment under 271
Section 25-43-7(1). 272
(e) Upon reviewing the information and recommendations, 273
the committee shall forward a written recommendation approved by a 274
majority of the committee to the * * * commission. The decisions 275
of the committee regarding any limitations to be imposed on any 276
drug or its use for a specified indication shall be based on sound 277
clinical evidence found in labeling, drug compendia, and 278
peer-reviewed clinical literature pertaining to use of the drug in 279
the relevant population. 280
(f) Upon reviewing and considering all recommendations 281
including recommendations of the committee, comments, and data, 282
the * * * commission shall make a final determination whether to 283
require prior approval of a therapeutic class of drugs, or modify 284
existing prior approval requirements for a therapeutic class of 285
drugs. 286
(g) At least thirty (30) days before the * * * 287
commission implements new or amended prior authorization 288
decisions, written notice of the * * * commission's decision shall 289
be provided to all prescribing Medicaid providers, all Medicaid 290
enrolled pharmacies, and any other party who has requested the 291
notification. However, notice given under Section 25-43-7(1) will 292
substitute for and meet the requirement for notice under this 293
subsection. 294
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(h) Members of the committee shall dispose of matters 295
before the committee in an unbiased and professional manner. If a 296
matter being considered by the committee presents a real or 297
apparent conflict of interest for any member of the committee, 298
that member shall disclose the conflict in writing to the 299
committee chair and recuse himself or herself from any discussions 300
and/or actions on the matter. 301
SECTION 2. (1) The Division of Medicaid in the Office of 302
the Governor is abolished, and all powers, duties and functions of 303
the Division of Medicaid shall be transferred to the Mississippi 304
Medicaid Commission created in Section 1 of this act. All 305
records, property and contractual rights and obligations of, and 306
unexpended balances of appropriations or other allocations to, the 307
Division of Medicaid shall be transferred to the Mississippi 308
Medicaid Commission on July 1, 2026. All employees of the 309
Division of Medicaid on June 30, 2026, shall become employees of 310
the Mississippi Medicaid Commission on July 1, 2026. The Division 311
of Medicaid shall assist and cooperate with the Mississippi 312
Medicaid Commission in order to accomplish an orderly transition 313
under this act. 314
(2) Whenever the term "Governor's Office-Division of 315
Medicaid", "Division of Medicaid" or "division," when referring to 316
the Division of Medicaid in the Office of the Governor, is used in 317
any statute, rule, regulation or document, it shall mean the 318
Mississippi Medicaid Commission. 319
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SECTION 3. Section 43-13-103, Mississippi Code of 1972, is 320
amended as follows: 321
43-13-103. For the purpose of affording health care and 322
remedial and institutional services in accordance with the 323
requirements for federal grants and other assistance under Titles 324
XVIII, XIX and XXI of the Social Security Act, as amended, a 325
statewide system of medical assistance is established and shall be 326
in effect in all political subdivisions of the state, to be 327
financed by state appropriations and federal matching funds 328
therefor, and to be administered by the * * * Mississippi Medicaid 329
Commission as * * * provided in this article. 330
SECTION 4. Section 43-13-105, Mississippi Code of 1972, is 331
amended as follows: 332
43-13-105. When used in this article, the following 333
definitions shall apply, unless the context requires otherwise: 334
(a) "Administering agency" means the * * * Mississippi 335
Medicaid Commission as created by this article. 336
(b) "Commission" or "Medicaid Commission" means the 337
Mississippi Medicaid Commission. 338
(c) "Division", * * * "Division of Medicaid" or 339
Governor's Office-Division of Medicaid means the * * * Mississippi 340
Medicaid Commission. 341
( * * *d) "Medical assistance" means payment of part or 342
all of the costs of medical and remedial care provided under the 343
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terms of this article and in accordance with provisions of Titles 344
XIX and XXI of the Social Security Act, as amended. 345
( * * *e) "Applicant" means a person who applies for 346
assistance under Titles IV, XVI, XIX or XXI of the Social Security 347
Act, as amended, and under the terms of this article. 348
( * * *f) "Recipient" means a person who is eligible 349
for assistance under Title XIX or XXI of the Social Security Act, 350
as amended and under the terms of this article. 351
( * * *g) "State health agency" means any agency, 352
department, institution, board or commission of the State of 353
Mississippi, except the University of Mississippi Medical School, 354
which is supported in whole or in part by any public funds, 355
including funds directly appropriated from the State Treasury, 356
funds derived by taxes, fees levied or collected by statutory 357
authority, or any other funds used by "state health agencies" 358
derived from federal sources, when any funds available to such 359
agency are expended either directly or indirectly in connection 360
with, or in support of, any public health, hospital, 361
hospitalization or other public programs for the preventive 362
treatment or actual medical treatment of persons with a physical 363
disability, mental illness or an intellectual disability. 364
(h) "Executive director" or "director" means the 365
Executive Director of the Mississippi Medicaid Commission. 366
* * * 367
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SECTION 5. Section 43-13-109, Mississippi Code of 1972, is 368
amended as follows: 369
43-13-109. The * * * commission, under the rules and 370
regulations of the State Personnel Board, may adopt reasonable 371
rules and regulations to provide for an open, competitive or 372
qualifying examination for all employees of the * * * commission 373
other than the executive director, part-time consultants and 374
professional staff members. 375
SECTION 6. Section 43-13-113, Mississippi Code of 1972, is 376
amended as follows: 377
43-13-113. (1) The State Treasurer shall receive on behalf 378
of the state, and execute all instruments incidental thereto, 379
federal and other funds to be used for financing the medical 380
assistance plan or program adopted pursuant to this article, and 381
place all such funds in a special account to the credit of 382
the * * * Mississippi Medicaid Commission, which funds shall be 383
expended by the * * * commission for the purposes and under the 384
provisions of this article, and shall be paid out by the State 385
Treasurer as funds appropriated to carry out the provisions of 386
this article are paid out by him. 387
The * * * commission shall issue all checks or electronic 388
transfers for administrative expenses, and for medical assistance 389
under the provisions of this article. All such checks or 390
electronic transfers shall be drawn upon funds made available to 391
the * * * commission by the State * * * Fiscal Officer, upon 392
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requisition of the executive director. It is the purpose of this 393
section to provide that the State * * * Fiscal Officer shall 394
transfer, in lump sums, amounts to the * * * commission for 395
disbursement under the regulations which shall be made by 396
the * * * commission. However, the * * * commission, or its 397
fiscal agent in behalf of the * * * commission, shall be 398
authorized in maintaining separate accounts with a Mississippi 399
bank to handle claim payments, refund recoveries and related 400
Medicaid program financial transactions, to aggressively manage 401
the float in these accounts while awaiting clearance of checks or 402
electronic transfers and/or other disposition so as to accrue 403
maximum interest advantage of the funds in the account, and to 404
retain all earned interest on these funds to be applied to match 405
federal funds for Medicaid program operations. 406
(2) The * * * commission is authorized to obtain a line of 407
credit through the State Treasurer from the Working 408
Cash-Stabilization Fund or any other special source funds 409
maintained in the State Treasury in an amount not exceeding One 410
Hundred Fifty Million Dollars ($150,000,000.00) to fund shortfalls 411
which, from time to time, may occur due to decreases in state 412
matching fund cash flow. The length of indebtedness under this 413
provision shall not carry past the end of the quarter following 414
the loan origination. Loan proceeds shall be received by the 415
State Treasurer and shall be placed in a Medicaid designated 416
special fund account. Loan proceeds shall be expended only for 417
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health care services provided under the Medicaid program. 418
The * * * commission may pledge as security for such interim 419
financing future funds that will be received by the * * * 420
commission. Any such loans shall be repaid from the first 421
available funds received by the * * * commission in the manner of 422
and subject to the same terms provided in this section. 423
* * * If the State Treasurer makes a determination that 424
special source funds are not sufficient to cover a line of credit 425
for the * * * commission, the * * * commission is authorized to 426
obtain a line of credit, in an amount not exceeding One Hundred 427
Fifty Million Dollars ($150,000,000.00), from a commercial lender 428
or a consortium of lenders. The length of indebtedness under this 429
provision shall not carry past the end of the quarter following 430
the loan origination. The * * * commission shall obtain a minimum 431
of two (2) written quotes that shall be presented to the State 432
Fiscal Officer and State Treasurer, who shall jointly select a 433
lender. Loan proceeds shall be received by the State Treasurer 434
and shall be placed in a Medicaid designated special fund account. 435
Loan proceeds shall be expended only for health care services 436
provided under the Medicaid program. The * * * commission may 437
pledge as security for such interim financing future funds that 438
will be received by the * * * commission. Any such loans shall be 439
repaid from the first available funds received by the * * * 440
commission in the manner of and subject to the same terms provided 441
in this section. 442
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(3) Disbursement of funds to providers shall be made as 443
follows: 444
(a) All providers must submit all claims to the * * * 445
commission's fiscal agent no later than twelve (12) months from 446
the date of service. 447
(b) The * * * commission's fiscal agent must pay ninety 448
percent (90%) of all clean claims within thirty (30) days of the 449
date of receipt. 450
(c) The * * * commission's fiscal agent must pay 451
ninety-nine percent (99%) of all clean claims within ninety (90) 452
days of the date of receipt. 453
(d) The * * * commission's fiscal agent must pay all 454
other claims within twelve (12) months of the date of receipt. 455
(e) If a claim is neither paid nor denied for valid and 456
proper reasons by the end of the time periods as specified above, 457
the * * * commission's fiscal agent must pay the provider interest 458
on the claim at the rate of one and one-half percent (1-1/2%) per 459
month on the amount of such claim until it is finally settled or 460
adjudicated. 461
(4) The date of receipt is the date the fiscal agent 462
receives the claim as indicated by its date stamp on the claim or, 463
for those claims filed electronically, the date of receipt is the 464
date of transmission. 465
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(5) The date of payment is the date of the check or, for 466
those claims paid by electronic funds transfer, the date of the 467
transfer. 468
(6) The above specified time limitations do not apply in the 469
following circumstances: 470
(a) Retroactive adjustments paid to providers 471
reimbursed under a retrospective payment system; 472
(b) If a claim for payment under Medicare has been 473
filed in a timely manner, the fiscal agent may pay a Medicaid 474
claim relating to the same services within six (6) months after 475
it, or the provider, receives notice of the disposition of the 476
Medicare claim; 477
(c) Claims from providers under investigation for fraud 478
or abuse; and 479
(d) The * * * commission and/or its fiscal agent may 480
make payments at any time in accordance with a court order, to 481
carry out hearing decisions or corrective actions taken to resolve 482
a dispute, or to extend the benefits of a hearing decision, 483
corrective action, or court order to others in the same situation 484
as those directly affected by it. 485
* * * 486
SECTION 7. Section 43-13-115, Mississippi Code of 1972, is 487
amended as follows: 488
43-13-115. Recipients of Medicaid shall be the following 489
persons only: 490
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(1) Those who are qualified for public assistance 491
grants under provisions of Title IV-A and E of the federal Social 492
Security Act, as amended, including those statutorily deemed to be 493
IV-A and low income families and children under Section 1931 of 494
the federal Social Security Act. For the purposes of this 495
paragraph (1) and paragraphs (8), (17) and (18) of this section, 496
any reference to Title IV-A or to Part A of Title IV of the 497
federal Social Security Act, as amended, or the state plan under 498
Title IV-A or Part A of Title IV, shall be considered as a 499
reference to Title IV-A of the federal Social Security Act, as 500
amended, and the state plan under Title IV-A, including the income 501
and resource standards and methodologies under Title IV-A and the 502
state plan, as they existed on July 16, 1996. The Department of 503
Human Services shall determine Medicaid eligibility for children 504
receiving public assistance grants under Title IV-E. The * * * 505
commission shall determine eligibility for low income families 506
under Section 1931 of the federal Social Security Act and shall 507
redetermine eligibility for those continuing under Title IV-A 508
grants. 509
(2) Those qualified for Supplemental Security Income 510
(SSI) benefits under Title XVI of the federal Social Security Act, 511
as amended, and those who are deemed SSI eligible as contained in 512
federal statute. The eligibility of individuals covered in this 513
paragraph shall be determined by the Social Security 514
Administration and certified to the * * * commission. 515
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(3) Qualified pregnant women who would be eligible for 516
Medicaid as a low income family member under Section 1931 of the 517
federal Social Security Act if her child were born. The 518
eligibility of the individuals covered under this paragraph shall 519
be determined by the * * * commission. 520
(4) [Deleted] 521
(5) A child born on or after October 1, 1984, to a 522
woman eligible for and receiving Medicaid under the state plan on 523
the date of the child's birth shall be deemed to have applied for 524
Medicaid and to have been found eligible for Medicaid under the 525
plan on the date of that birth, and will remain eligible for 526
Medicaid for a period of one (1) year so long as the child is a 527
member of the woman's household and the woman remains eligible for 528
Medicaid or would be eligible for Medicaid if pregnant. The 529
eligibility of individuals covered in this paragraph shall be 530
determined by the * * * commission. 531
(6) Children certified by the State Department of Human 532
Services to the * * * commission of whom the state and county 533
departments of human services have custody and financial 534
responsibility, and children who are in adoptions subsidized in 535
full or part by the Department of Human Services, including 536
special needs children in non-Title IV-E adoption assistance, who 537
are approvable under Title XIX of the Medicaid program. The 538
eligibility of the children covered under this paragraph shall be 539
determined by the State Department of Human Services. 540
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(7) Persons certified by the * * * commission who are 541
patients in a medical facility (nursing home, hospital, 542
tuberculosis sanatorium or institution for treatment of mental 543
diseases), and who, except for the fact that they are patients in 544
that medical facility, would qualify for grants under Title IV, 545
Supplementary Security Income (SSI) benefits under Title XVI or 546
state supplements, and those aged, blind and disabled persons who 547
would not be eligible for Supplemental Security Income (SSI) 548
benefits under Title XVI or state supplements if they were not 549
institutionalized in a medical facility but whose income is below 550
the maximum standard set by the * * * commission, which standard 551
shall not exceed that prescribed by federal regulation. 552
(8) Children under eighteen (18) years of age and 553
pregnant women (including those in intact families) who meet the 554
financial standards of the state plan approved under Title IV-A of 555
the federal Social Security Act, as amended. The eligibility of 556
children covered under this paragraph shall be determined by 557
the * * * commission. 558
(9) Individuals who are: 559
(a) Children born after September 30, 1983, who 560
have not attained the age of nineteen (19), with family income 561
that does not exceed one hundred percent (100%) of the nonfarm 562
official poverty level; 563
(b) Pregnant women, infants and children who have 564
not attained the age of six (6), with family income that does not 565
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exceed one hundred thirty-three percent (133%) of the federal 566
poverty level; and 567
(c) Pregnant women and infants who have not 568
attained the age of one (1), with family income that does not 569
exceed one hundred eighty-five percent (185%) of the federal 570
poverty level. 571
The eligibility of individuals covered in (a), (b) and (c) of 572
this paragraph shall be determined by the * * * commission. 573
(10) Certain disabled children age eighteen (18) or 574
under who are living at home, who would be eligible, if in a 575
medical institution, for SSI or a state supplemental payment under 576
Title XVI of the federal Social Security Act, as amended, and 577
therefore for Medicaid under the plan, and for whom the state has 578
made a determination as required under Section 1902(e)(3)(b) of 579
the federal Social Security Act, as amended. The eligibility of 580
individuals under this paragraph shall be determined by the * * * 581
commission. 582
(11) Until the end of the day on December 31, 2005, 583
individuals who are sixty-five (65) years of age or older or are 584
disabled as determined under Section 1614(a)(3) of the federal 585
Social Security Act, as amended, and whose income does not exceed 586
one hundred thirty-five percent (135%) of the nonfarm official 587
poverty level as defined by the Office of Management and Budget 588
and revised annually, and whose resources do not exceed those 589
established by the * * * commission. The eligibility of 590
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individuals covered under this paragraph shall be determined by 591
the * * * commission. After December 31, 2005, only those 592
individuals covered under the 1115(c) Healthier Mississippi waiver 593
will be covered under this category. 594
Any individual who applied for Medicaid during the period 595
from July 1, 2004, through March 31, 2005, who otherwise would 596
have been eligible for coverage under this paragraph (11) if it 597
had been in effect at the time the individual submitted his or her 598
application and is still eligible for coverage under this 599
paragraph (11) on March 31, 2005, shall be eligible for Medicaid 600
coverage under this paragraph (11) from March 31, 2005, through 601
December 31, 2005. The * * * commission shall give priority in 602
processing the applications for those individuals to determine 603
their eligibility under this paragraph (11). 604
(12) Individuals who are qualified Medicare 605
beneficiaries (QMB) entitled to Part A Medicare as defined under 606
Section 301, Public Law 100-360, known as the Medicare 607
Catastrophic Coverage Act of 1988, and whose income does not 608
exceed one hundred percent (100%) of the nonfarm official poverty 609
level as defined by the Office of Management and Budget and 610
revised annually. 611
The eligibility of individuals covered under this paragraph 612
shall be determined by the * * * commission, and those individuals 613
determined eligible shall receive Medicare cost-sharing expenses 614
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only as more fully defined by the Medicare Catastrophic Coverage 615
Act of 1988 and the Balanced Budget Act of 1997. 616
(13) (a) Individuals who are entitled to Medicare Part 617
A as defined in Section 4501 of the Omnibus Budget Reconciliation 618
Act of 1990, and whose income does not exceed one hundred twenty 619
percent (120%) of the nonfarm official poverty level as defined by 620
the Office of Management and Budget and revised annually. 621
Eligibility for Medicaid benefits is limited to full payment of 622
Medicare Part B premiums. 623
(b) Individuals entitled to Part A of Medicare, 624
with income above one hundred twenty percent (120%), but less than 625
one hundred thirty-five percent (135%) of the federal poverty 626
level, and not otherwise eligible for Medicaid. Eligibility for 627
Medicaid benefits is limited to full payment of Medicare Part B 628
premiums. The number of eligible individuals is limited by the 629
availability of the federal capped allocation at one hundred 630
percent (100%) of federal matching funds, as more fully defined in 631
the Balanced Budget Act of 1997. 632
The eligibility of individuals covered under this paragraph 633
shall be determined by the * * * commission. 634
(14) [Deleted] 635
(15) Disabled workers who are eligible to enroll in 636
Part A Medicare as required by Public Law 101-239, known as the 637
Omnibus Budget Reconciliation Act of 1989, and whose income does 638
not exceed two hundred percent (200%) of the federal poverty level 639
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as determined in accordance with the Supplemental Security Income 640
(SSI) program. The eligibility of individuals covered under this 641
paragraph shall be determined by the * * * commission and those 642
individuals shall be entitled to buy-in coverage of Medicare Part 643
A premiums only under the provisions of this paragraph (15). 644
(16) In accordance with the terms and conditions of 645
approved Title XIX waiver from the United States Department of 646
Health and Human Services, persons provided home- and 647
community-based services who are physically disabled and certified 648
by the * * * commission as eligible due to applying the income and 649
deeming requirements as if they were institutionalized. 650
(17) In accordance with the terms of the federal 651
Personal Responsibility and Work Opportunity Reconciliation Act of 652
1996 (Public Law 104-193), persons who become ineligible for 653
assistance under Title IV-A of the federal Social Security Act, as 654
amended, because of increased income from or hours of employment 655
of the caretaker relative or because of the expiration of the 656
applicable earned income disregards, who were eligible for 657
Medicaid for at least three (3) of the six (6) months preceding 658
the month in which the ineligibility begins, shall be eligible for 659
Medicaid for up to twelve (12) months. The eligibility of the 660
individuals covered under this paragraph shall be determined by 661
the * * * commission. 662
(18) Persons who become ineligible for assistance under 663
Title IV-A of the federal Social Security Act, as amended, as a 664
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result, in whole or in part, of the collection or increased 665
collection of child or spousal support under Title IV-D of the 666
federal Social Security Act, as amended, who were eligible for 667
Medicaid for at least three (3) of the six (6) months immediately 668
preceding the month in which the ineligibility begins, shall be 669
eligible for Medicaid for an additional four (4) months beginning 670
with the month in which the ineligibility begins. The eligibility 671
of the individuals covered under this paragraph shall be 672
determined by the * * * commission. 673
(19) Disabled workers, whose incomes are above the 674
Medicaid eligibility limits, but below two hundred fifty percent 675
(250%) of the federal poverty level, shall be allowed to purchase 676
Medicaid coverage on a sliding fee scale developed by the * * * 677
commission. 678
(20) Medicaid eligible children under age eighteen (18) 679
shall remain eligible for Medicaid benefits until the end of a 680
period of twelve (12) months following an eligibility 681
determination, or until such time that the individual exceeds age 682
eighteen (18). 683
(21) Women of childbearing age whose family income does 684
not exceed one hundred eighty-five percent (185%) of the federal 685
poverty level. The eligibility of individuals covered under this 686
paragraph (21) shall be determined by the * * * commission, and 687
those individuals determined eligible shall only receive family 688
planning services covered under Section 43-13-117(13) and not any 689
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other services covered under Medicaid. However, any individual 690
eligible under this paragraph (21) who is also eligible under any 691
other provision of this section shall receive the benefits to 692
which he or she is entitled under that other provision, in 693
addition to family planning services covered under Section 694
43-13-117(13). 695
The * * * commission shall apply to the United States 696
Secretary of Health and Human Services for a federal waiver of the 697
applicable provisions of Title XIX of the federal Social Security 698
Act, as amended, and any other applicable provisions of federal 699
law as necessary to allow for the implementation of this paragraph 700
(21). The provisions of this paragraph (21) shall be implemented 701
from and after the date that the * * * commission receives the 702
federal waiver. 703
(22) Persons who are workers with a potentially severe 704
disability, as determined by the * * * commission, shall be 705
allowed to purchase Medicaid coverage. The term "worker with a 706
potentially severe disability" means a person who is at least 707
sixteen (16) years of age but under sixty-five (65) years of age, 708
who has a physical or mental impairment that is reasonably 709
expected to cause the person to become blind or disabled as 710
defined under Section 1614(a) of the federal Social Security Act, 711
as amended, if the person does not receive items and services 712
provided under Medicaid. 713
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The eligibility of persons under this paragraph (22) shall be 714
conducted as a demonstration project that is consistent with 715
Section 204 of the Ticket to Work and Work Incentives Improvement 716
Act of 1999, Public Law 106-170, for a certain number of persons 717
as specified by the * * * commission. The eligibility of 718
individuals covered under this paragraph (22) shall be determined 719
by the * * * commission. 720
(23) Children certified by the Mississippi Department 721
of Human Services for whom the state and county departments of 722
human services have custody and financial responsibility who are 723
in foster care on their eighteenth birthday as reported by the 724
Mississippi Department of Human Services shall be certified 725
Medicaid eligible by the * * * commission until their twenty-first 726
birthday. 727
(24) Individuals who have not attained age sixty-five 728
(65), are not otherwise covered by creditable coverage as defined 729
in the Public Health Services Act, and have been screened for 730
breast and cervical cancer under the Centers for Disease Control 731
and Prevention Breast and Cervical Cancer Early Detection Program 732
established under Title XV of the Public Health Service Act in 733
accordance with the requirements of that act and who need 734
treatment for breast or cervical cancer. Eligibility of 735
individuals under this paragraph (24) shall be determined by 736
the * * * commission. 737
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(25) The * * * commission shall apply to the Centers 738
for Medicare and Medicaid Services (CMS) for any necessary waivers 739
to provide services to individuals who are sixty-five (65) years 740
of age or older or are disabled as determined under Section 741
1614(a)(3) of the federal Social Security Act, as amended, and 742
whose income does not exceed one hundred thirty-five percent 743
(135%) of the nonfarm official poverty level as defined by the 744
Office of Management and Budget and revised annually, and whose 745
resources do not exceed those established by the * * * commission, 746
and who are not otherwise covered by Medicare. Nothing contained 747
in this paragraph (25) shall entitle an individual to benefits. 748
The eligibility of individuals covered under this paragraph shall 749
be determined by the * * * commission. 750
(26) The * * * commission shall apply to the Centers 751
for Medicare and Medicaid Services (CMS) for any necessary waivers 752
to provide services to individuals who are sixty-five (65) years 753
of age or older or are disabled as determined under Section 754
1614(a)(3) of the federal Social Security Act, as amended, who are 755
end stage renal disease patients on dialysis, cancer patients on 756
chemotherapy or organ transplant recipients on antirejection 757
drugs, whose income does not exceed one hundred thirty-five 758
percent (135%) of the nonfarm official poverty level as defined by 759
the Office of Management and Budget and revised annually, and 760
whose resources do not exceed those established by the * * * 761
commission. Nothing contained in this paragraph (26) shall 762
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entitle an individual to benefits. The eligibility of individuals 763
covered under this paragraph shall be determined by the * * * 764
commission. 765
(27) Individuals who are entitled to Medicare Part D 766
and whose income does not exceed one hundred fifty percent (150%) 767
of the nonfarm official poverty level as defined by the Office of 768
Management and Budget and revised annually. Eligibility for 769
payment of the Medicare Part D subsidy under this paragraph shall 770
be determined by the * * * commission. 771
(28) The * * * commission is authorized and directed to 772
provide up to twelve (12) months of continuous coverage postpartum 773
for any individual who qualifies for Medicaid coverage under this 774
section as a pregnant woman, to the extent allowable under federal 775
law and as determined by the * * * commission. 776
The * * * commission shall redetermine eligibility for all 777
categories of recipients described in each paragraph of this 778
section not less frequently than required by federal law. 779
SECTION 8. Section 43-13-116, Mississippi Code of 1972, is 780
amended as follows: 781
43-13-116. (1) It shall be the duty of the * * * commission 782
to fully implement and carry out the administrative functions of 783
determining the eligibility of those persons who qualify for 784
medical assistance under Section 43-13-115. 785
(2) In determining Medicaid eligibility, the * * * 786
commission is authorized to enter into an agreement with the 787
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Secretary of the Department of Health and Human Services for the 788
purpose of securing the transfer of eligibility information from 789
the Social Security Administration on those individuals receiving 790
supplemental security income benefits under the federal Social 791
Security Act and any other information necessary in determining 792
Medicaid eligibility. The * * * commission is further empowered 793
to enter into contractual arrangements with its fiscal agent or 794
with the State Department of Human Services in securing electronic 795
data processing support as may be necessary. 796
(3) Administrative hearings shall be available to any 797
applicant who requests it because his or her claim of eligibility 798
for services is denied or is not acted upon with reasonable 799
promptness or by any recipient who requests it because he or she 800
believes the agency has erroneously taken action to deny, reduce, 801
or terminate benefits. The agency need not grant a hearing if the 802
sole issue is a federal or state law requiring an automatic change 803
adversely affecting some or all recipients. Eligibility 804
determinations that are made by other agencies and certified to 805
the * * * commission pursuant to Section 43-13-115 are not subject 806
to the administrative hearing procedures of the * * * commission 807
but are subject to the administrative hearing procedures of the 808
agency that determined eligibility. 809
(a) A request may be made either for a local regional 810
office hearing or a state office hearing when the local regional 811
office has made the initial decision that the claimant seeks to 812
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appeal or when the regional office has not acted with reasonable 813
promptness in making a decision on a claim for eligibility or 814
services. The only exception to requesting a local hearing is 815
when the issue under appeal involves either (i) a disability or 816
blindness denial, or termination, or (ii) a level of care denial 817
or termination for a disabled child living at home. An appeal 818
involving disability, blindness or level of care must be handled 819
as a state level hearing. The decision from the local hearing may 820
be appealed to the state office for a state hearing. A decision 821
to deny, reduce or terminate benefits that is initially made at 822
the state office may be appealed by requesting a state hearing. 823
(b) A request for a hearing, either state or local, 824
must be made in writing by the claimant or claimant's legal 825
representative. "Legal representative" includes the claimant's 826
authorized representative, an attorney retained by the claimant or 827
claimant's family to represent the claimant, a paralegal 828
representative with a legal aid services, a parent of a minor 829
child if the claimant is a child, a legal guardian or conservator 830
or an individual with power of attorney for the claimant. The 831
claimant may also be represented by anyone that he or she so 832
designates but must give the designation to the Medicaid regional 833
office or state office in writing, if the person is not the legal 834
representative, legal guardian, or authorized representative. 835
(c) The claimant may make a request for a hearing in 836
person at the regional office but an oral request must be put into 837
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written form. Regional office staff will determine from the 838
claimant if a local or state hearing is requested and assist the 839
claimant in completing and signing the appropriate form. Regional 840
office staff may forward a state hearing request to the 841
appropriate division in the state office or the claimant may mail 842
the form to the address listed on the form. The claimant may make 843
a written request for a hearing by letter. A simple statement 844
requesting a hearing that is signed by the claimant or legal 845
representative is sufficient; however, if possible, the claimant 846
should state the reason for the request. The letter may be mailed 847
to the regional office or it may be mailed to the state office. If 848
the letter does not specify the type of hearing desired, local or 849
state, Medicaid staff will attempt to contact the claimant to 850
determine the level of hearing desired. If contact cannot be made 851
within three (3) days of receipt of the request, the request will 852
be assumed to be for a local hearing and scheduled accordingly. A 853
hearing will not be scheduled until either a letter or the 854
appropriate form is received by the regional or state office. 855
(d) When both members of a couple wish to appeal an 856
action or inaction by the agency that affects both applications or 857
cases similarly and arose from the same issue, one or both may 858
file the request for hearing, both may present evidence at the 859
hearing, and the agency's decision will be applicable to both. If 860
both file a request for hearing, two (2) hearings will be 861
registered but they will be conducted on the same day and in the 862
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same place, either consecutively or jointly, as the couple wishes. 863
If they so desire, only one of the couple need attend the hearing. 864
(e) The procedure for administrative hearings shall be 865
as follows: 866
(i) The claimant has thirty (30) days from the 867
date the agency mails the appropriate notice to the claimant of 868
its decision regarding eligibility, services, or benefits to 869
request either a state or local hearing. This time period may be 870
extended if the claimant can show good cause for not filing within 871
thirty (30) days. Good cause includes, but may not be limited to, 872
illness, failure to receive the notice, being out of state, or 873
some other reasonable explanation. If good cause can be shown, a 874
late request may be accepted provided the facts in the case remain 875
the same. If a claimant's circumstances have changed or if good 876
cause for filing a request beyond thirty (30) days is not shown, a 877
hearing request will not be accepted. If the claimant wishes to 878
have eligibility reconsidered, he or she may reapply. 879
(ii) If a claimant or representative requests a 880
hearing in writing during the advance notice period before 881
benefits are reduced or terminated, benefits must be continued or 882
reinstated to the benefit level in effect before the effective 883
date of the adverse action. Benefits will continue at the 884
original level until the final hearing decision is rendered. Any 885
hearing requested after the advance notice period will not be 886
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accepted as a timely request in order for continuation of benefits 887
to apply. 888
(iii) Upon receipt of a written request for a 889
hearing, the request will be acknowledged in writing within twenty 890
(20) days and a hearing scheduled. The claimant or representative 891
will be given at least five (5) days' advance notice of the 892
hearing date. The local and/or state level hearings will be held 893
by telephone unless, at the hearing officer's discretion, it is 894
determined that an in-person hearing is necessary. If a local 895
hearing is requested, the regional office will notify the claimant 896
or representative in writing of the time of the local hearing. If 897
a state hearing is requested, the state office will notify the 898
claimant or representative in writing of the time of the state 899
hearing. If an in-person hearing is necessary, local hearings 900
will be held at the regional office and state hearings will be 901
held at the state office unless other arrangements are 902
necessitated by the claimant's inability to travel. 903
(iv) All persons attending a hearing will attend 904
for the purpose of giving information on behalf of the claimant or 905
rendering the claimant assistance in some other way, or for the 906
purpose of representing the * * * commission. 907
(v) A state or local hearing request may be 908
withdrawn at any time before the scheduled hearing, or after the 909
hearing is held but before a decision is rendered. The withdrawal 910
must be in writing and signed by the claimant or representative. 911
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A hearing request will be considered abandoned if the claimant or 912
representative fails to appear at a scheduled hearing without good 913
cause. If no one appears for a hearing, the appropriate office 914
will notify the claimant in writing that the hearing is dismissed 915
unless good cause is shown for not attending. The proposed agency 916
action will be taken on the case following failure to appear for a 917
hearing if the action has not already been effected. 918
(vi) The claimant or his representative has the 919
following rights in connection with a local or state hearing: 920
(A) The right to examine at a reasonable time 921
before the date of the hearing and during the hearing the content 922
of the claimant's case record; 923
(B) The right to have legal representation at 924
the hearing and to bring witnesses; 925
(C) The right to produce documentary evidence 926
and establish all facts and circumstances concerning eligibility, 927
services, or benefits; 928
(D) The right to present an argument without 929
undue interference; 930
(E) The right to question or refute any 931
testimony or evidence including an opportunity to confront and 932
cross-examine adverse witnesses. 933
(vii) When a request for a local hearing is 934
received by the regional office or if the regional office is 935
notified by the state office that a local hearing has been 936
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requested, the Medicaid specialist supervisor in the regional 937
office will review the case record, reexamine the action taken on 938
the case, and determine if policy and procedures have been 939
followed. If any adjustments or corrections should be made, the 940
Medicaid specialist supervisor will ensure that corrective action 941
is taken. If the request for hearing was timely made such that 942
continuation of benefits applies, the Medicaid specialist 943
supervisor will ensure that benefits continue at the level before 944
the proposed adverse action that is the subject of the appeal. 945
The Medicaid specialist supervisor will also ensure that all 946
needed information, verification, and evidence is in the case 947
record for the hearing. 948
(viii) When a state hearing is requested that 949
appeals the action or inaction of a regional office, the regional 950
office will prepare copies of the case record and forward it to 951
the appropriate division in the state office no later than five 952
(5) days after receipt of the request for a state hearing. The 953
original case record will remain in the regional office. Either 954
the original case record in the regional office or the copy 955
forwarded to the state office will be available for inspection by 956
the claimant or claimant's representative a reasonable time before 957
the date of the hearing. 958
(ix) The Medicaid specialist supervisor will serve 959
as the hearing officer for a local hearing unless the Medicaid 960
specialist supervisor actually participated in the eligibility, 961
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benefits, or services decision under appeal, in which case the 962
Medicaid specialist supervisor must appoint a Medicaid specialist 963
in the regional office who did not actually participate in the 964
decision under appeal to serve as hearing officer. The local 965
hearing will be an informal proceeding in which the claimant or 966
representative may present new or additional information, may 967
question the action taken on the client's case, and will hear an 968
explanation from agency staff as to the regulations and 969
requirements that were applied to claimant's case in making the 970
decision. 971
(x) After the hearing, the hearing officer will 972
prepare a written summary of the hearing procedure and file it 973
with the case record. The hearing officer will consider the facts 974
presented at the local hearing in reaching a decision. The 975
claimant will be notified of the local hearing decision on the 976
appropriate form that will state clearly the reason for the 977
decision, the policy that governs the decision, the claimant's 978
right to appeal the decision to the state office, and, if the 979
original adverse action is upheld, the new effective date of the 980
reduction or termination of benefits or services if continuation 981
of benefits applied during the hearing process. The new effective 982
date of the reduction or termination of benefits or services must 983
be at the end of the fifteen-day advance notice period from the 984
mailing date of the notice of hearing decision. The notice to 985
claimant will be made part of the case record. 986
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(xi) The claimant has the right to appeal a local 987
hearing decision by requesting a state hearing in writing within 988
fifteen (15) days of the mailing date of the notice of local 989
hearing decision. The state hearing request should be made to the 990
regional office. If benefits have been continued pending the 991
local hearing process, then benefits will continue throughout the 992
fifteen-day advance notice period for an adverse local hearing 993
decision. If a state hearing is timely requested within the 994
fifteen-day period, then benefits will continue pending the state 995
hearing process. State hearings requested after the fifteen-day 996
local hearing advance notice period will not be accepted unless 997
the initial thirty-day period for filing a hearing request has not 998
expired because the local hearing was held early, in which case a 999
state hearing request will be accepted as timely within the number 1000
of days remaining of the unexpired initial thirty-day period in 1001
addition to the fifteen-day time period. Continuation of benefits 1002
during the state hearing process, however, will only apply if the 1003
state hearing request is received within the fifteen-day advance 1004
notice period. 1005
(xii) When a request for a state hearing is 1006
received in the regional office, the request will be made part of 1007
the case record and the regional office will prepare the case 1008
record and forward it to the appropriate division in the state 1009
office within five (5) days of receipt of the state hearing 1010
request. A request for a state hearing received in the state 1011
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office will be forwarded to the regional office for inclusion in 1012
the case record and the regional office will prepare the case 1013
record and forward it to the appropriate division in the state 1014
office within five (5) days of receipt of the state hearing 1015
request. 1016
(xiii) Upon receipt of the hearing record, an 1017
impartial hearing officer will be assigned to hear the case * * * 1018
by the commission. Hearing officers will be individuals with 1019
appropriate expertise employed by the * * * commission and who 1020
have not been involved in any way with the action or decision on 1021
appeal in the case. The hearing officer will review the case 1022
record and if the review shows that an error was made in the 1023
action of the agency or in the interpretation of policy, or that a 1024
change of policy has been made, the hearing officer will discuss 1025
these matters with the appropriate agency personnel and request 1026
that an appropriate adjustment be made. Appropriate agency 1027
personnel will discuss the matter with the claimant and if the 1028
claimant is agreeable to the adjustment of the claim, then agency 1029
personnel will request in writing dismissal of the hearing and the 1030
reason therefor, to be placed in the case record. If the hearing 1031
is to go forward, it shall be scheduled by the hearing officer in 1032
the manner set forth in subparagraph (iii) of this paragraph (e). 1033
(xiv) In conducting the hearing, the state hearing 1034
officer will inform those present of the following: 1035
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(A) That the hearing will be recorded on tape 1036
and that a transcript of the proceedings will be typed for the 1037
record; 1038
(B) The action taken by the agency which 1039
prompted the appeal; 1040
(C) An explanation of the claimant's rights 1041
during the hearing as outlined in subparagraph (vi) of this 1042
paragraph (e); 1043
(D) That the purpose of the hearing is for 1044
the claimant to express dissatisfaction and present additional 1045
information or evidence; 1046
(E) That the case record is available for 1047
review by the claimant or representative during the hearing; 1048
(F) That the final hearing decision will be 1049
rendered by the * * * commission * * * on the basis of facts 1050
presented at the hearing and the case record and that the claimant 1051
will be notified by letter of the final decision. 1052
(xv) During the hearing, the claimant and/or 1053
representative will be allowed an opportunity to make a full 1054
statement concerning the appeal and will be assisted, if 1055
necessary, in disclosing all information on which the claim is 1056
based. All persons representing the claimant and those 1057
representing the * * * commission will have the opportunity to 1058
state all facts pertinent to the appeal. The hearing officer may 1059
recess or continue the hearing for a reasonable time should 1060
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additional information or facts be required or if some change in 1061
the claimant's circumstances occurs during the hearing process 1062
which impacts the appeal. When all information has been 1063
presented, the hearing officer will close the hearing and stop the 1064
recorder. 1065
(xvi) Immediately following the hearing the 1066
hearing tape will be transcribed and a copy of the transcription 1067
forwarded to the regional office for filing in the case record. 1068
As soon as possible, the hearing officer shall review the evidence 1069
and record of the proceedings, testimony, exhibits, and other 1070
supporting documents, prepare a written summary of the facts as 1071
the hearing officer finds them, and prepare a written 1072
recommendation of action to be taken by the agency, citing 1073
appropriate policy and regulations that govern the recommendation. 1074
The decision cannot be based on any material, oral or written, not 1075
available to the claimant before or during the hearing. The 1076
hearing officer's recommendation will become part of the case 1077
record which will be submitted to the * * * commission * * * for 1078
further review and decision. 1079
(xvii) The * * * commission * * *, upon review of 1080
the recommendation, proceedings and the record, may sustain the 1081
recommendation of the hearing officer, reject the same, or remand 1082
the matter to the hearing officer to take additional testimony and 1083
evidence, in which case, the hearing officer thereafter shall 1084
submit to the * * * commission a new recommendation. The * * * 1085
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commission shall prepare a written decision summarizing the facts 1086
and identifying policies and regulations that support the 1087
decision, which shall be mailed to the claimant and the 1088
representative, with a copy to the regional office if appropriate, 1089
as soon as possible after submission of a recommendation by the 1090
hearing officer. The decision notice will specify any action to 1091
be taken by the agency, specify any revised eligibility dates or, 1092
if continuation of benefits applies, will notify the claimant of 1093
the new effective date of reduction or termination of benefits or 1094
services, which will be fifteen (15) days from the mailing date of 1095
the notice of decision. The decision rendered by the * * * 1096
commission * * * is final and binding. The claimant is entitled 1097
to seek judicial review in a court of proper jurisdiction. 1098
(xviii) The * * * commission must take final 1099
administrative action on a hearing, whether state or local, within 1100
ninety (90) days from the date of the initial request for a 1101
hearing. 1102
(xix) A group hearing may be held for a number of 1103
claimants under the following circumstances: 1104
(A) The * * * commission may consolidate the 1105
cases and conduct a single group hearing when the only issue 1106
involved is one (1) of a single law or agency policy; 1107
(B) The claimants may request a group hearing 1108
when there is one (1) issue of agency policy common to all of 1109
them. 1110
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In all group hearings, whether initiated by the * * * 1111
commission or by the claimants, the policies governing fair 1112
hearings must be followed. Each claimant in a group hearing must 1113
be permitted to present his or her own case and be represented by 1114
his or her own representative, or to withdraw from the group 1115
hearing and have his or her appeal heard individually. As in 1116
individual hearings, the hearing will be conducted only on the 1117
issue being appealed, and each claimant will be expected to keep 1118
individual testimony within a reasonable time frame as a matter of 1119
consideration to the other claimants involved. 1120
(xx) Any specific matter necessitating an 1121
administrative hearing not otherwise provided under this article 1122
or agency policy shall be afforded under the hearing procedures as 1123
outlined above. If the specific time frames of such a unique 1124
matter relating to requesting, granting, and concluding of the 1125
hearing is contrary to the time frames as set out in the hearing 1126
procedures above, the specific time frames will govern over the 1127
time frames as set out within these procedures. 1128
(4) The executive director * * * with the approval of the 1129
commission and subject to the rules and regulations of the State 1130
Personnel Board, shall be authorized to employ eligibility, 1131
technical, clerical and supportive staff as may be required in 1132
carrying out and fully implementing the determination of Medicaid 1133
eligibility, including conducting quality control reviews and the 1134
investigation of the improper receipt of medical assistance. 1135
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Staffing needs will be set forth in the annual appropriation act 1136
for the * * * commission. Additional office space as needed in 1137
performing eligibility, quality control and investigative 1138
functions shall be obtained by the * * * commission. 1139
SECTION 9. Section 43-13-117, Mississippi Code of 1972, is 1140
amended as follows: 1141
43-13-117. (A) Medicaid as authorized by this article shall 1142
include payment of part or all of the costs, at the discretion of 1143
the * * * commission, with approval of * * * the Centers for 1144
Medicare and Medicaid Services, of the following types of care and 1145
services rendered to eligible applicants who have been determined 1146
to be eligible for that care and services, within the limits of 1147
state appropriations and federal matching funds: 1148
(1) Inpatient hospital services. 1149
(a) The * * * commission is authorized to 1150
implement an All Patient Refined Diagnosis Related Groups 1151
(APR-DRG) reimbursement methodology for inpatient hospital 1152
services. 1153
(b) No service benefits or reimbursement 1154
limitations in this subsection (A)(1) shall apply to payments 1155
under an APR-DRG or Ambulatory Payment Classification (APC) model 1156
or a managed care program or similar model described in subsection 1157
(H) of this section unless specifically authorized by the * * * 1158
commission. 1159
(2) Outpatient hospital services. 1160
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(a) Emergency services. 1161
(b) Other outpatient hospital services. The * * * 1162
commission shall allow benefits for other medically necessary 1163
outpatient hospital services (such as chemotherapy, radiation, 1164
surgery and therapy), including outpatient services in a clinic or 1165
other facility that is not located inside the hospital, but that 1166
has been designated as an outpatient facility by the hospital, and 1167
that was in operation or under construction on July 1, 2009, 1168
provided that the costs and charges associated with the operation 1169
of the hospital clinic are included in the hospital's cost report. 1170
In addition, the Medicare thirty-five-mile rule will apply to 1171
those hospital clinics not located inside the hospital that are 1172
constructed after July 1, 2009. Where the same services are 1173
reimbursed as clinic services, the * * * commission may revise the 1174
rate or methodology of outpatient reimbursement to maintain 1175
consistency, efficiency, economy and quality of care. 1176
(c) The * * * commission is authorized to 1177
implement an Ambulatory Payment Classification (APC) methodology 1178
for outpatient hospital services. The * * * commission shall give 1179
rural hospitals that have fifty (50) or fewer licensed beds the 1180
option to not be reimbursed for outpatient hospital services using 1181
the APC methodology, but reimbursement for outpatient hospital 1182
services provided by those hospitals shall be based on one hundred 1183
one percent (101%) of the rate established under Medicare for 1184
outpatient hospital services. Those hospitals choosing to not be 1185
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reimbursed under the APC methodology shall remain under cost-based 1186
reimbursement for a two-year period. 1187
(d) No service benefits or reimbursement 1188
limitations in this subsection (A)(2) shall apply to payments 1189
under an APR-DRG or APC model or a managed care program or similar 1190
model described in subsection (H) of this section unless 1191
specifically authorized by the * * * commission. 1192
(3) Laboratory and x-ray services. 1193
(4) Nursing facility services. 1194
(a) The * * * commission shall make full payment 1195
to nursing facilities for each day, not exceeding forty-two (42) 1196
days per year, that a patient is absent from the facility on home 1197
leave. Payment may be made for the following home leave days in 1198
addition to the forty-two-day limitation: Christmas, the day 1199
before Christmas, the day after Christmas, Thanksgiving, the day 1200
before Thanksgiving and the day after Thanksgiving. 1201
(b) From and after July 1, 1997, the * * * 1202
commission shall implement the integrated case-mix payment and 1203
quality monitoring system, which includes the fair rental system 1204
for property costs and in which recapture of depreciation is 1205
eliminated. The * * * commission may reduce the payment for 1206
hospital leave and therapeutic home leave days to the lower of the 1207
case-mix category as computed for the resident on leave using the 1208
assessment being utilized for payment at that point in time, or a 1209
case-mix score of 1.000 for nursing facilities, and shall compute 1210
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case-mix scores of residents so that only services provided at the 1211
nursing facility are considered in calculating a facility's per 1212
diem. 1213
(c) From and after July 1, 1997, all state-owned 1214
nursing facilities shall be reimbursed on a full reasonable cost 1215
basis. 1216
(d) On or after January 1, 2015, the * * * 1217
commission shall update the case-mix payment system resource 1218
utilization grouper and classifications and fair rental 1219
reimbursement system. The * * * commission shall develop and 1220
implement a payment add-on to reimburse nursing facilities for 1221
ventilator-dependent resident services. 1222
(e) The * * * commission shall develop and 1223
implement, not later than January 1, 2001, a case-mix payment 1224
add-on determined by time studies and other valid statistical data 1225
that will reimburse a nursing facility for the additional cost of 1226
caring for a resident who has a diagnosis of Alzheimer's or other 1227
related dementia and exhibits symptoms that require special care. 1228
Any such case-mix add-on payment shall be supported by a 1229
determination of additional cost. The * * * commission shall also 1230
develop and implement as part of the fair rental reimbursement 1231
system for nursing facility beds, an Alzheimer's resident bed 1232
depreciation enhanced reimbursement system that will provide an 1233
incentive to encourage nursing facilities to convert or construct 1234
beds for residents with Alzheimer's or other related dementia. 1235
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(f) The * * * commission shall develop and 1236
implement an assessment process for long-term care services. 1237
The * * * commission may provide the assessment and related 1238
functions directly or through contract with the area agencies on 1239
aging. 1240
The * * * commission shall apply for necessary federal 1241
waivers to assure that additional services providing alternatives 1242
to nursing facility care are made available to applicants for 1243
nursing facility care. 1244
(5) Periodic screening and diagnostic services for 1245
individuals under age twenty-one (21) years as are needed to 1246
identify physical and mental defects and to provide health care 1247
treatment and other measures designed to correct or ameliorate 1248
defects and physical and mental illness and conditions discovered 1249
by the screening services, regardless of whether these services 1250
are included in the state plan. The * * * commission may include 1251
in its periodic screening and diagnostic program those 1252
discretionary services authorized under the federal regulations 1253
adopted to implement Title XIX of the federal Social Security Act, 1254
as amended. The * * * commission, in obtaining physical therapy 1255
services, occupational therapy services, and services for 1256
individuals with speech, hearing and language disorders, may enter 1257
into a cooperative agreement with the State Department of 1258
Education for the provision of those services to handicapped 1259
students by public school districts using state funds that are 1260
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provided from the appropriation to the Department of Education to 1261
obtain federal matching funds through the * * * commission. 1262
The * * * commission, in obtaining medical and mental health 1263
assessments, treatment, care and services for children who are in, 1264
or at risk of being put in, the custody of the Mississippi 1265
Department of Human Services may enter into a cooperative 1266
agreement with the Mississippi Department of Human Services for 1267
the provision of those services using state funds that are 1268
provided from the appropriation to the Department of Human 1269
Services to obtain federal matching funds through the * * * 1270
commission. 1271
(6) Physician services. Fees for physician's services 1272
that are covered only by Medicaid shall be reimbursed at ninety 1273
percent (90%) of the rate established on January 1, 2018, and as 1274
may be adjusted each July thereafter, under Medicare. The * * * 1275
commission may provide for a reimbursement rate for physician's 1276
services of up to one hundred percent (100%) of the rate 1277
established under Medicare for physician's services that are 1278
provided after the normal working hours of the physician, as 1279
determined in accordance with regulations of the * * * commission. 1280
The * * * commission may reimburse eligible providers, as 1281
determined by the * * * commission, for certain primary care 1282
services at one hundred percent (100%) of the rate established 1283
under Medicare. The * * * commission shall reimburse 1284
obstetricians and gynecologists for certain primary care services 1285
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as defined by the * * * commission at one hundred percent (100%) 1286
of the rate established under Medicare. 1287
(7) (a) Home health services for eligible persons, not 1288
to exceed in cost the prevailing cost of nursing facility 1289
services. All home health visits must be precertified as required 1290
by the * * * commission. In addition to physicians, certified 1291
registered nurse practitioners, physician assistants and clinical 1292
nurse specialists are authorized to prescribe or order home health 1293
services and plans of care, sign home health plans of care, 1294
certify and recertify eligibility for home health services and 1295
conduct the required initial face-to-face visit with the recipient 1296
of the services. 1297
(b) [Repealed] 1298
(8) Emergency medical transportation services as 1299
determined by the * * * commission. 1300
(9) Prescription drugs and other covered drugs and 1301
services as determined by the * * * commission. 1302
The * * * commission shall establish a mandatory preferred 1303
drug list. Drugs not on the mandatory preferred drug list shall 1304
be made available by utilizing prior authorization procedures 1305
established by the * * * commission. 1306
The * * * commission may seek to establish relationships with 1307
other states in order to lower acquisition costs of prescription 1308
drugs to include single-source and innovator multiple-source drugs 1309
or generic drugs. In addition, if allowed by federal law or 1310
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regulation, the * * * commission may seek to establish 1311
relationships with and negotiate with other countries to 1312
facilitate the acquisition of prescription drugs to include 1313
single-source and innovator multiple-source drugs or generic 1314
drugs, if that will lower the acquisition costs of those 1315
prescription drugs. 1316
The * * * commission may allow for a combination of 1317
prescriptions for single-source and innovator multiple-source 1318
drugs and generic drugs to meet the needs of the beneficiaries. 1319
The executive director may approve specific maintenance drugs 1320
for beneficiaries with certain medical conditions, which may be 1321
prescribed and dispensed in three-month supply increments. 1322
Drugs prescribed for a resident of a psychiatric residential 1323
treatment facility must be provided in true unit doses when 1324
available. The * * * commission may require that drugs not 1325
covered by Medicare Part D for a resident of a long-term care 1326
facility be provided in true unit doses when available. Those 1327
drugs that were originally billed to the * * * commission but are 1328
not used by a resident in any of those facilities shall be 1329
returned to the billing pharmacy for credit to the * * * 1330
commission, in accordance with the guidelines of the State Board 1331
of Pharmacy and any requirements of federal law and regulation. 1332
Drugs shall be dispensed to a recipient and only one (1) 1333
dispensing fee per month may be charged. The * * *commission 1334
shall develop a methodology for reimbursing for restocked drugs, 1335
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which shall include a restock fee as determined by the * * * 1336
commission not exceeding Seven Dollars and Eighty-two Cents 1337
($7.82). 1338
Except for those specific maintenance drugs approved by the 1339
executive director, the * * * commission shall not reimburse for 1340
any portion of a prescription that exceeds a thirty-one-day supply 1341
of the drug based on the daily dosage. 1342
The * * * commission is authorized to develop and implement a 1343
program of payment for additional pharmacist services as 1344
determined by the * * * commission. 1345
All claims for drugs for dually eligible Medicare/Medicaid 1346
beneficiaries that are paid for by Medicare must be submitted to 1347
Medicare for payment before they may be processed by the * * * 1348
commission's online payment system. 1349
The * * * commission shall develop a pharmacy policy in which 1350
drugs in tamper-resistant packaging that are prescribed for a 1351
resident of a nursing facility but are not dispensed to the 1352
resident shall be returned to the pharmacy and not billed to 1353
Medicaid, in accordance with guidelines of the State Board of 1354
Pharmacy. 1355
The * * * commission shall develop and implement a method or 1356
methods by which the * * * commission will provide on a regular 1357
basis to Medicaid providers who are authorized to prescribe drugs, 1358
information about the costs to the Medicaid program of 1359
single-source drugs and innovator multiple-source drugs, and 1360
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information about other drugs that may be prescribed as 1361
alternatives to those single-source drugs and innovator 1362
multiple-source drugs and the costs to the Medicaid program of 1363
those alternative drugs. 1364
Notwithstanding any law or regulation, information obtained 1365
or maintained by the * * * commission regarding the prescription 1366
drug program, including trade secrets and manufacturer or labeler 1367
pricing, is confidential and not subject to disclosure except to 1368
other state agencies. 1369
The dispensing fee for each new or refill prescription, 1370
including nonlegend or over-the-counter drugs covered by the * * * 1371
commission, shall be not less than Three Dollars and Ninety-one 1372
Cents ($3.91), as determined by the * * * commission. 1373
The * * * commission shall not reimburse for single-source or 1374
innovator multiple-source drugs if there are equally effective 1375
generic equivalents available and if the generic equivalents are 1376
the least expensive. 1377
It is the intent of the Legislature that the pharmacists 1378
providers be reimbursed for the reasonable costs of filling and 1379
dispensing prescriptions for Medicaid beneficiaries. 1380
The * * * commission shall allow certain drugs, including 1381
physician-administered drugs, and implantable drug system devices, 1382
and medical supplies, with limited distribution or limited access 1383
for beneficiaries and administered in an appropriate clinical 1384
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setting, to be reimbursed as either a medical claim or pharmacy 1385
claim, as determined by the * * * commission. 1386
It is the intent of the Legislature that the * * * commission 1387
and any managed care entity described in subsection (H) of this 1388
section encourage the use of Alpha-Hydroxyprogesterone Caproate 1389
(17P) to prevent recurrent preterm birth. 1390
(10) Dental and orthodontic services to be determined 1391
by the * * * commission. 1392
The * * * commission shall increase the amount of the 1393
reimbursement rate for diagnostic and preventative dental services 1394
for each of the fiscal years 2022, 2023 and 2024 by five percent 1395
(5%) above the amount of the reimbursement rate for the previous 1396
fiscal year. The * * * commission shall increase the amount of 1397
the reimbursement rate for restorative dental services for each of 1398
the fiscal years 2023, 2024 and 2025 by five percent (5%) above 1399
the amount of the reimbursement rate for the previous fiscal year. 1400
It is the intent of the Legislature that the reimbursement rate 1401
revision for preventative dental services will be an incentive to 1402
increase the number of dentists who actively provide Medicaid 1403
services. This dental services reimbursement rate revision shall 1404
be known as the "James Russell Dumas Medicaid Dental Services 1405
Incentive Program." 1406
The Medical Care Advisory Committee, assisted by the * * * 1407
commission, shall annually determine the effect of this incentive 1408
by evaluating the number of dentists who are Medicaid providers, 1409
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the number who and the degree to which they are actively billing 1410
Medicaid, the geographic trends of where dentists are offering 1411
what types of Medicaid services and other statistics pertinent to 1412
the goals of this legislative intent. This data shall annually be 1413
presented to the Chair of the Senate Medicaid Committee and the 1414
Chair of the House Medicaid Committee. 1415
The * * * commission shall include dental services as a 1416
necessary component of overall health services provided to 1417
children who are eligible for services. 1418
(11) Eyeglasses for all Medicaid beneficiaries who have 1419
(a) had surgery on the eyeball or ocular muscle that results in a 1420
vision change for which eyeglasses or a change in eyeglasses is 1421
medically indicated within six (6) months of the surgery and is in 1422
accordance with policies established by the * * * commission, or 1423
(b) one (1) pair every five (5) years and in accordance with 1424
policies established by the * * * commission. In either instance, 1425
the eyeglasses must be prescribed by a physician skilled in 1426
diseases of the eye or an optometrist, whichever the beneficiary 1427
may select. 1428
(12) Intermediate care facility services. 1429
(a) The * * * commission shall make full payment 1430
to all intermediate care facilities for individuals with 1431
intellectual disabilities for each day, not exceeding sixty-three 1432
(63) days per year, that a patient is absent from the facility on 1433
home leave. Payment may be made for the following home leave days 1434
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in addition to the sixty-three-day limitation: Christmas, the day 1435
before Christmas, the day after Christmas, Thanksgiving, the day 1436
before Thanksgiving and the day after Thanksgiving. 1437
(b) All state-owned intermediate care facilities 1438
for individuals with intellectual disabilities shall be reimbursed 1439
on a full reasonable cost basis. 1440
(c) Effective January 1, 2015, the * * * 1441
commission shall update the fair rental reimbursement system for 1442
intermediate care facilities for individuals with intellectual 1443
disabilities. 1444
(13) Family planning services, including drugs, 1445
supplies and devices, when those services are under the 1446
supervision of a physician or nurse practitioner. 1447
(14) Clinic services. Preventive, diagnostic, 1448
therapeutic, rehabilitative or palliative services that are 1449
furnished by a facility that is not part of a hospital but is 1450
organized and operated to provide medical care to outpatients. 1451
Clinic services include, but are not limited to: 1452
(a) Services provided by ambulatory surgical 1453
centers (ASCs) as defined in Section 41-75-1(a); and 1454
(b) Dialysis center services. 1455
(15) Home- and community-based services for the elderly 1456
and disabled, as provided under Title XIX of the federal Social 1457
Security Act, as amended, under waivers, subject to the 1458
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availability of funds specifically appropriated for that purpose 1459
by the Legislature. 1460
(16) Mental health services. Certain services provided 1461
by a psychiatrist shall be reimbursed at up to one hundred percent 1462
(100%) of the Medicare rate. Approved therapeutic and case 1463
management services (a) provided by an approved regional mental 1464
health/intellectual disability center established under Sections 1465
41-19-31 through 41-19-39, or by another community mental health 1466
service provider meeting the requirements of the Department of 1467
Mental Health to be an approved mental health/intellectual 1468
disability center if determined necessary by the Department of 1469
Mental Health, using state funds that are provided in the 1470
appropriation to the * * * commission to match federal funds, or 1471
(b) provided by a facility that is certified by the State 1472
Department of Mental Health to provide therapeutic and case 1473
management services, to be reimbursed on a fee for service basis, 1474
or (c) provided in the community by a facility or program operated 1475
by the Department of Mental Health. Any such services provided by 1476
a facility described in subparagraph (b) must have the prior 1477
approval of the * * * commission to be reimbursable under this 1478
section. 1479
(17) Durable medical equipment services and medical 1480
supplies. Precertification of durable medical equipment and 1481
medical supplies must be obtained as required by the * * * 1482
commission. The * * * commission may require durable medical 1483
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equipment providers to obtain a surety bond in the amount and to 1484
the specifications as established by the Balanced Budget Act of 1485
1997. A maximum dollar amount of reimbursement for noninvasive 1486
ventilators or ventilation treatments properly ordered and being 1487
used in an appropriate care setting shall not be set by any health 1488
maintenance organization, coordinated care organization, 1489
provider-sponsored health plan, or other organization paid for 1490
services on a capitated basis by the * * * commission under any 1491
managed care program or coordinated care program implemented by 1492
the * * * commission under this section. Reimbursement by these 1493
organizations to durable medical equipment suppliers for home use 1494
of noninvasive and invasive ventilators shall be on a continuous 1495
monthly payment basis for the duration of medical need throughout 1496
a patient's valid prescription period. 1497
(18) (a) Notwithstanding any other provision of this 1498
section to the contrary, as provided in the Medicaid state plan 1499
amendment or amendments as defined in Section 43-13-145(10), 1500
the * * * commission shall make additional reimbursement to 1501
hospitals that serve a disproportionate share of low-income 1502
patients and that meet the federal requirements for those payments 1503
as provided in Section 1923 of the federal Social Security Act and 1504
any applicable regulations. It is the intent of the Legislature 1505
that the * * * commission shall draw down all available federal 1506
funds allotted to the state for disproportionate share hospitals. 1507
However, from and after January 1, 1999, public hospitals 1508
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participating in the Medicaid disproportionate share program may 1509
be required to participate in an intergovernmental transfer 1510
program as provided in Section 1903 of the federal Social Security 1511
Act and any applicable regulations. 1512
(b) (i) 1. The * * * commission may establish a 1513
Medicare Upper Payment Limits Program, as defined in Section 1514
1902(a)(30) of the federal Social Security Act and any applicable 1515
federal regulations, or an allowable delivery system or provider 1516
payment initiative authorized under 42 CFR 438.6(c), for 1517
hospitals, nursing facilities and physicians employed or 1518
contracted by hospitals. 1519
2. The * * * commission shall establish 1520
a Medicaid Supplemental Payment Program, as permitted by the 1521
federal Social Security Act and a comparable allowable delivery 1522
system or provider payment initiative authorized under 42 CFR 1523
438.6(c), for emergency ambulance transportation providers in 1524
accordance with this subsection (A)(18)(b). 1525
(ii) The * * * commission shall assess each 1526
hospital, nursing facility, and emergency ambulance transportation 1527
provider for the sole purpose of financing the state portion of 1528
the Medicare Upper Payment Limits Program or other program(s) 1529
authorized under this subsection (A)(18)(b). The hospital 1530
assessment shall be as provided in Section 43-13-145(4)(a), and 1531
the nursing facility and the emergency ambulance transportation 1532
assessments, if established, shall be based on Medicaid 1533
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utilization or other appropriate method, as determined by 1534
the * * * commission, consistent with federal regulations. The 1535
assessments will remain in effect as long as the state 1536
participates in the Medicare Upper Payment Limits Program or other 1537
program(s) authorized under this subsection (A)(18)(b). In 1538
addition to the hospital assessment provided in Section 1539
43-13-145(4)(a), hospitals with physicians participating in the 1540
Medicare Upper Payment Limits Program or other program(s) 1541
authorized under this subsection (A)(18)(b) shall be required to 1542
participate in an intergovernmental transfer or assessment, as 1543
determined by the * * * commission, for the purpose of financing 1544
the state portion of the physician UPL payments or other 1545
payment(s) authorized under this subsection (A)(18)(b). 1546
(iii) Subject to approval by the Centers for 1547
Medicare and Medicaid Services (CMS) and the provisions of this 1548
subsection (A)(18)(b), the * * * commission shall make additional 1549
reimbursement to hospitals, nursing facilities, and emergency 1550
ambulance transportation providers for the Medicare Upper Payment 1551
Limits Program or other program(s) authorized under this 1552
subsection (A)(18)(b), and, if the program is established for 1553
physicians, shall make additional reimbursement for physicians, as 1554
defined in Section 1902(a)(30) of the federal Social Security Act 1555
and any applicable federal regulations, provided the assessment in 1556
this subsection (A)(18)(b) is in effect. 1557
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(iv) Notwithstanding any other provision of 1558
this article to the contrary, effective upon implementation of the 1559
Mississippi Hospital Access Program (MHAP) provided in 1560
subparagraph (c)(i) below, the hospital portion of the inpatient 1561
Upper Payment Limits Program shall transition into and be replaced 1562
by the MHAP program. However, the * * * commission is authorized 1563
to develop and implement an alternative fee-for-service Upper 1564
Payment Limits model in accordance with federal laws and 1565
regulations if necessary to preserve supplemental funding. 1566
Further, the * * * commission, in consultation with the hospital 1567
industry shall develop alternative models for distribution of 1568
medical claims and supplemental payments for inpatient and 1569
outpatient hospital services, and such models may include, but 1570
shall not be limited to the following: increasing rates for 1571
inpatient and outpatient services; creating a low-income 1572
utilization pool of funds to reimburse hospitals for the costs of 1573
uncompensated care, charity care and bad debts as permitted and 1574
approved pursuant to federal regulations and the Centers for 1575
Medicare and Medicaid Services; supplemental payments based upon 1576
Medicaid utilization, quality, service lines and/or costs of 1577
providing such services to Medicaid beneficiaries and to uninsured 1578
patients. The goals of such payment models shall be to ensure 1579
access to inpatient and outpatient care and to maximize any 1580
federal funds that are available to reimburse hospitals for 1581
services provided. Any such documents required to achieve the 1582
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goals described in this paragraph shall be submitted to the 1583
Centers for Medicare and Medicaid Services, with a proposed 1584
effective date of July 1, 2019, to the extent possible, but in no 1585
event shall the effective date of such payment models be later 1586
than July 1, 2020. The Chairmen of the Senate and House Medicaid 1587
Committees shall be provided a copy of the proposed payment 1588
model(s) prior to submission. Effective July 1, 2018, and until 1589
such time as any payment model(s) as described above become 1590
effective, the * * * commission, in consultation with the hospital 1591
industry, is authorized to implement a transitional program for 1592
inpatient and outpatient payments and/or supplemental payments 1593
(including, but not limited to, MHAP and directed payments), to 1594
redistribute available supplemental funds among hospital 1595
providers, provided that when compared to a hospital's prior year 1596
supplemental payments, supplemental payments made pursuant to any 1597
such transitional program shall not result in a decrease of more 1598
than five percent (5%) and shall not increase by more than the 1599
amount needed to maximize the distribution of the available funds. 1600
(v) 1. To preserve and improve access to 1601
ambulance transportation provider services, the * * * commission 1602
shall seek CMS approval to make ambulance service access payments 1603
as set forth in this subsection (A)(18)(b) for all covered 1604
emergency ambulance services rendered on or after July 1, 2022, 1605
and shall make such ambulance service access payments for all 1606
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covered services rendered on or after the effective date of CMS 1607
approval. 1608
2. The * * * commission shall calculate 1609
the ambulance service access payment amount as the balance of the 1610
portion of the Medical Care Fund related to ambulance 1611
transportation service provider assessments plus any federal 1612
matching funds earned on the balance, up to, but not to exceed, 1613
the upper payment limit gap for all emergency ambulance service 1614
providers. 1615
3. a. Except for ambulance services 1616
exempt from the assessment provided in this paragraph (18)(b), all 1617
ambulance transportation service providers shall be eligible for 1618
ambulance service access payments each state fiscal year as set 1619
forth in this paragraph (18)(b). 1620
b. In addition to any other funds 1621
paid to ambulance transportation service providers for emergency 1622
medical services provided to Medicaid beneficiaries, each eligible 1623
ambulance transportation service provider shall receive ambulance 1624
service access payments each state fiscal year equal to the 1625
ambulance transportation service provider's upper payment limit 1626
gap. Subject to approval by the Centers for Medicare and Medicaid 1627
Services, ambulance service access payments shall be made no less 1628
than on a quarterly basis. 1629
c. As used in this paragraph 1630
(18)(b)(v), the term "upper payment limit gap" means the 1631
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difference between the total amount that the ambulance 1632
transportation service provider received from Medicaid and the 1633
average amount that the ambulance transportation service provider 1634
would have received from commercial insurers for those services 1635
reimbursed by Medicaid. 1636
4. An ambulance service access payment 1637
shall not be used to offset any other payment by the * * * 1638
commission for emergency or nonemergency services to Medicaid 1639
beneficiaries. 1640
(c) (i) Not later than December l, 2015, 1641
the * * * commission shall, subject to approval by the Centers for 1642
Medicare and Medicaid Services (CMS), establish, implement and 1643
operate a Mississippi Hospital Access Program (MHAP) for the 1644
purpose of protecting patient access to hospital care through 1645
hospital inpatient reimbursement programs provided in this section 1646
designed to maintain total hospital reimbursement for inpatient 1647
services rendered by in-state hospitals and the out-of-state 1648
hospital that is authorized by federal law to submit 1649
intergovernmental transfers (IGTs) to the State of Mississippi and 1650
is classified as Level I trauma center located in a county 1651
contiguous to the state line at the maximum levels permissible 1652
under applicable federal statutes and regulations, at which time 1653
the current inpatient Medicare Upper Payment Limits (UPL) Program 1654
for hospital inpatient services shall transition to the MHAP. 1655
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(ii) Subject to approval by the Centers for 1656
Medicare and Medicaid Services (CMS), the MHAP shall provide 1657
increased inpatient capitation (PMPM) payments to managed care 1658
entities contracting with the * * * commission pursuant to 1659
subsection (H) of this section to support availability of hospital 1660
services or such other payments permissible under federal law 1661
necessary to accomplish the intent of this subsection. 1662
(iii) The intent of this subparagraph (c) is 1663
that effective for all inpatient hospital Medicaid services during 1664
state fiscal year 2016, and so long as this provision shall remain 1665
in effect hereafter, the * * * commission shall to the fullest 1666
extent feasible replace the additional reimbursement for hospital 1667
inpatient services under the inpatient Medicare Upper Payment 1668
Limits (UPL) Program with additional reimbursement under the MHAP 1669
and other payment programs for inpatient and/or outpatient 1670
payments which may be developed under the authority of this 1671
paragraph. 1672
(iv) The * * * commission shall assess each 1673
hospital as provided in Section 43-13-145(4)(a) for the purpose of 1674
financing the state portion of the MHAP, supplemental payments and 1675
such other purposes as specified in Section 43-13-145. The 1676
assessment will remain in effect as long as the MHAP and 1677
supplemental payments are in effect. 1678
(19) (a) Perinatal risk management services. 1679
The * * * commission shall promulgate regulations to be effective 1680
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from and after October 1, 1988, to establish a comprehensive 1681
perinatal system for risk assessment of all pregnant and infant 1682
Medicaid recipients and for management, education and follow-up 1683
for those who are determined to be at risk. Services to be 1684
performed include case management, nutrition 1685
assessment/counseling, psychosocial assessment/counseling and 1686
health education. The * * * commission shall contract with the 1687
State Department of Health to provide services within this 1688
paragraph (Perinatal High Risk Management/Infant Services System 1689
(PHRM/ISS)). The State Department of Health shall be reimbursed 1690
on a full reasonable cost basis for services provided under this 1691
subparagraph (a). 1692
(b) Early intervention system services. The * * * 1693
commission shall cooperate with the State Department of Health, 1694
acting as lead agency, in the development and implementation of a 1695
statewide system of delivery of early intervention services, under 1696
Part C of the Individuals with Disabilities Education Act (IDEA). 1697
The State Department of Health shall certify annually in writing 1698
to the executive director of the * * * commission the dollar 1699
amount of state early intervention funds available that will be 1700
utilized as a certified match for Medicaid matching funds. Those 1701
funds then shall be used to provide expanded targeted case 1702
management services for Medicaid eligible children with special 1703
needs who are eligible for the state's early intervention system. 1704
Qualifications for persons providing service coordination shall be 1705
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determined by the State Department of Health and the * * * 1706
Commission of Medicaid. 1707
(20) Home- and community-based services for physically 1708
disabled approved services as allowed by a waiver from the United 1709
States Department of Health and Human Services for home- and 1710
community-based services for physically disabled people using 1711
state funds that are provided from the appropriation to the State 1712
Department of Rehabilitation Services and used to match federal 1713
funds under a cooperative agreement between the * * * commission 1714
and the department, provided that funds for these services are 1715
specifically appropriated to the Department of Rehabilitation 1716
Services. 1717
(21) Nurse practitioner services. Services furnished 1718
by a registered nurse who is licensed and certified by the 1719
Mississippi Board of Nursing as a nurse practitioner, including, 1720
but not limited to, nurse anesthetists, nurse midwives, family 1721
nurse practitioners, family planning nurse practitioners, 1722
pediatric nurse practitioners, obstetrics-gynecology nurse 1723
practitioners and neonatal nurse practitioners, under regulations 1724
adopted by the * * * commission. Reimbursement for those services 1725
shall not exceed ninety percent (90%) of the reimbursement rate 1726
for comparable services rendered by a physician. The * * * 1727
commission may provide for a reimbursement rate for nurse 1728
practitioner services of up to one hundred percent (100%) of the 1729
reimbursement rate for comparable services rendered by a physician 1730
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for nurse practitioner services that are provided after the normal 1731
working hours of the nurse practitioner, as determined in 1732
accordance with regulations of the * * * commission. 1733
(22) Ambulatory services delivered in federally 1734
qualified health centers, rural health centers and clinics of the 1735
local health departments of the State Department of Health for 1736
individuals eligible for Medicaid under this article based on 1737
reasonable costs as determined by the * * * commission. Federally 1738
qualified health centers shall be reimbursed by the Medicaid 1739
prospective payment system as approved by the Centers for Medicare 1740
and Medicaid Services. The * * * commission shall recognize 1741
federally qualified health centers (FQHCs), rural health clinics 1742
(RHCs) and community mental health centers (CMHCs) as both an 1743
originating and distant site provider for the purposes of 1744
telehealth reimbursement. The * * * commission is further 1745
authorized and directed to reimburse FQHCs, RHCs and CMHCs for 1746
both distant site and originating site services when such services 1747
are appropriately provided by the same organization. 1748
(23) Inpatient psychiatric services. 1749
(a) Inpatient psychiatric services to be 1750
determined by the * * * commission for recipients under age 1751
twenty-one (21) that are provided under the direction of a 1752
physician in an inpatient program in a licensed acute care 1753
psychiatric facility or in a licensed psychiatric residential 1754
treatment facility, before the recipient reaches age twenty-one 1755
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(21) or, if the recipient was receiving the services immediately 1756
before he or she reached age twenty-one (21), before the earlier 1757
of the date he or she no longer requires the services or the date 1758
he or she reaches age twenty-two (22), as provided by federal 1759
regulations. From and after January 1, 2015, the * * * commission 1760
shall update the fair rental reimbursement system for psychiatric 1761
residential treatment facilities. Precertification of inpatient 1762
days and residential treatment days must be obtained as required 1763
by the * * * commission. From and after July 1, 2009, all 1764
state-owned and state-operated facilities that provide inpatient 1765
psychiatric services to persons under age twenty-one (21) who are 1766
eligible for Medicaid reimbursement shall be reimbursed for those 1767
services on a full reasonable cost basis. 1768
(b) The * * * commission may reimburse for 1769
services provided by a licensed freestanding psychiatric hospital 1770
to Medicaid recipients over the age of twenty-one (21) in a method 1771
and manner consistent with the provisions of Section 43-13-117.5. 1772
(24) [Deleted] 1773
(25) [Deleted] 1774
(26) Hospice care. As used in this paragraph, the term 1775
"hospice care" means a coordinated program of active professional 1776
medical attention within the home and outpatient and inpatient 1777
care that treats the terminally ill patient and family as a unit, 1778
employing a medically directed interdisciplinary team. The 1779
program provides relief of severe pain or other physical symptoms 1780
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and supportive care to meet the special needs arising out of 1781
physical, psychological, spiritual, social and economic stresses 1782
that are experienced during the final stages of illness and during 1783
dying and bereavement and meets the Medicare requirements for 1784
participation as a hospice as provided in federal regulations. 1785
(27) Group health plan premiums and cost-sharing if it 1786
is cost-effective as defined by the United States Secretary of 1787
Health and Human Services. 1788
(28) Other health insurance premiums that are 1789
cost-effective as defined by the United States Secretary of Health 1790
and Human Services. Medicare eligible must have Medicare Part B 1791
before other insurance premiums can be paid. 1792
(29) The * * * commission may apply for a waiver from 1793
the United States Department of Health and Human Services for 1794
home- and community-based services for developmentally disabled 1795
people using state funds that are provided from the appropriation 1796
to the State Department of Mental Health and/or funds transferred 1797
to the department by a political subdivision or instrumentality of 1798
the state and used to match federal funds under a cooperative 1799
agreement between the * * * commission and the department, 1800
provided that funds for these services are specifically 1801
appropriated to the Department of Mental Health and/or transferred 1802
to the department by a political subdivision or instrumentality of 1803
the state. 1804
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(30) Pediatric skilled nursing services as determined 1805
by the * * * commission and in a manner consistent with 1806
regulations promulgated by the Mississippi State Department of 1807
Health. 1808
(31) Targeted case management services for children 1809
with special needs, under waivers from the United States 1810
Department of Health and Human Services, using state funds that 1811
are provided from the appropriation to the Mississippi Department 1812
of Human Services and used to match federal funds under a 1813
cooperative agreement between the * * * commission and the 1814
department. 1815
(32) Care and services provided in Christian Science 1816
Sanatoria listed and certified by the Commission for Accreditation 1817
of Christian Science Nursing Organizations/Facilities, Inc., 1818
rendered in connection with treatment by prayer or spiritual means 1819
to the extent that those services are subject to reimbursement 1820
under Section 1903 of the federal Social Security Act. 1821
(33) Podiatrist services. 1822
(34) Assisted living services as provided through 1823
home- and community-based services under Title XIX of the federal 1824
Social Security Act, as amended, subject to the availability of 1825
funds specifically appropriated for that purpose by the 1826
Legislature. 1827
(35) Services and activities authorized in Sections 1828
43-27-101 and 43-27-103, using state funds that are provided from 1829
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the appropriation to the Mississippi Department of Human Services 1830
and used to match federal funds under a cooperative agreement 1831
between the * * * commission and the department. 1832
(36) Nonemergency transportation services for 1833
Medicaid-eligible persons as determined by the * * * commission. 1834
The PEER Committee shall conduct a performance evaluation of the 1835
nonemergency transportation program to evaluate the administration 1836
of the program and the providers of transportation services to 1837
determine the most cost-effective ways of providing nonemergency 1838
transportation services to the patients served under the program. 1839
The performance evaluation shall be completed and provided to the 1840
members of the Senate Medicaid Committee and the House Medicaid 1841
Committee not later than January 1, 2019, and every two (2) years 1842
thereafter. 1843
(37) [Deleted] 1844
(38) Chiropractic services. A chiropractor's manual 1845
manipulation of the spine to correct a subluxation, if x-ray 1846
demonstrates that a subluxation exists and if the subluxation has 1847
resulted in a neuromusculoskeletal condition for which 1848
manipulation is appropriate treatment, and related spinal x-rays 1849
performed to document these conditions. Reimbursement for 1850
chiropractic services shall not exceed Seven Hundred Dollars 1851
($700.00) per year per beneficiary. 1852
(39) Dually eligible Medicare/Medicaid beneficiaries. 1853
The * * * commission shall pay the Medicare deductible and 1854
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coinsurance amounts for services available under Medicare, as 1855
determined by the * * * commission. From and after July 1, 2009, 1856
the * * * commission shall reimburse crossover claims for 1857
inpatient hospital services and crossover claims covered under 1858
Medicare Part B in the same manner that was in effect on January 1859
1, 2008, unless specifically authorized by the Legislature to 1860
change this method. 1861
(40) [Deleted] 1862
(41) Services provided by the State Department of 1863
Rehabilitation Services for the care and rehabilitation of persons 1864
with spinal cord injuries or traumatic brain injuries, as allowed 1865
under waivers from the United States Department of Health and 1866
Human Services, using up to seventy-five percent (75%) of the 1867
funds that are appropriated to the Department of Rehabilitation 1868
Services from the Spinal Cord and Head Injury Trust Fund 1869
established under Section 37-33-261 and used to match federal 1870
funds under a cooperative agreement between the * * * commission 1871
and the department. 1872
(42) [Deleted] 1873
(43) The * * * commission shall provide reimbursement, 1874
according to a payment schedule developed by the * * * commission, 1875
for smoking cessation medications for pregnant women during their 1876
pregnancy and other Medicaid-eligible women who are of 1877
child-bearing age. 1878
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(44) Nursing facility services for the severely 1879
disabled. 1880
(a) Severe disabilities include, but are not 1881
limited to, spinal cord injuries, closed-head injuries and 1882
ventilator-dependent patients. 1883
(b) Those services must be provided in a long-term 1884
care nursing facility dedicated to the care and treatment of 1885
persons with severe disabilities. 1886
(45) Physician assistant services. Services furnished 1887
by a physician assistant who is licensed by the State Board of 1888
Medical Licensure and is practicing with physician supervision 1889
under regulations adopted by the board, under regulations adopted 1890
by the * * * commission. Reimbursement for those services shall 1891
not exceed ninety percent (90%) of the reimbursement rate for 1892
comparable services rendered by a physician. The * * * commission 1893
may provide for a reimbursement rate for physician assistant 1894
services of up to one hundred percent (100%) or the reimbursement 1895
rate for comparable services rendered by a physician for physician 1896
assistant services that are provided after the normal working 1897
hours of the physician assistant, as determined in accordance with 1898
regulations of the * * * commission. 1899
(46) The * * * commission shall make application to the 1900
federal Centers for Medicare and Medicaid Services (CMS) for a 1901
waiver to develop and provide services for children with serious 1902
emotional disturbances as defined in Section 43-14-1(1), which may 1903
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include home- and community-based services, case management 1904
services or managed care services through mental health providers 1905
certified by the Department of Mental Health. The * * * 1906
commission may implement and provide services under this waivered 1907
program only if funds for these services are specifically 1908
appropriated for this purpose by the Legislature, or if funds are 1909
voluntarily provided by affected agencies. 1910
(47) (a) The * * * commission may develop and 1911
implement disease management programs for individuals with 1912
high-cost chronic diseases and conditions, including the use of 1913
grants, waivers, demonstrations or other projects as necessary. 1914
(b) Participation in any disease management 1915
program implemented under this paragraph (47) is optional with the 1916
individual. An individual must affirmatively elect to participate 1917
in the disease management program in order to participate, and may 1918
elect to discontinue participation in the program at any time. 1919
(48) Pediatric long-term acute care hospital services. 1920
(a) Pediatric long-term acute care hospital 1921
services means services provided to eligible persons under 1922
twenty-one (21) years of age by a freestanding Medicare-certified 1923
hospital that has an average length of inpatient stay greater than 1924
twenty-five (25) days and that is primarily engaged in providing 1925
chronic or long-term medical care to persons under twenty-one (21) 1926
years of age. 1927
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(b) The services under this paragraph (48) shall 1928
be reimbursed as a separate category of hospital services. 1929
(49) The * * * commission may establish copayments 1930
and/or coinsurance for any Medicaid services for which copayments 1931
and/or coinsurance are allowable under federal law or regulation. 1932
(50) Services provided by the State Department of 1933
Rehabilitation Services for the care and rehabilitation of persons 1934
who are deaf and blind, as allowed under waivers from the United 1935
States Department of Health and Human Services to provide home- 1936
and community-based services using state funds that are provided 1937
from the appropriation to the State Department of Rehabilitation 1938
Services or if funds are voluntarily provided by another agency. 1939
(51) Upon determination of Medicaid eligibility and in 1940
association with annual redetermination of Medicaid eligibility, 1941
beneficiaries shall be encouraged to undertake a physical 1942
examination that will establish a base-line level of health and 1943
identification of a usual and customary source of care (a medical 1944
home) to aid utilization of disease management tools. This 1945
physical examination and utilization of these disease management 1946
tools shall be consistent with current United States Preventive 1947
Services Task Force or other recognized authority recommendations. 1948
For persons who are determined ineligible for Medicaid, 1949
the * * * commission will provide information and direction for 1950
accessing medical care and services in the area of their 1951
residence. 1952
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(52) Notwithstanding any provisions of this article, 1953
the * * * commission may pay enhanced reimbursement fees related 1954
to trauma care, as determined by the * * * commission in 1955
conjunction with the State Department of Health, using funds 1956
appropriated to the State Department of Health for trauma care and 1957
services and used to match federal funds under a cooperative 1958
agreement between the * * * commission and the State Department of 1959
Health. The * * * commission, in conjunction with the State 1960
Department of Health, may use grants, waivers, demonstrations, 1961
enhanced reimbursements, Upper Payment Limits Programs, 1962
supplemental payments, or other projects as necessary in the 1963
development and implementation of this reimbursement program. 1964
(53) Targeted case management services for high-cost 1965
beneficiaries may be developed by the * * * commission for all 1966
services under this section. 1967
(54) [Deleted] 1968
(55) Therapy services. The plan of care for therapy 1969
services may be developed to cover a period of treatment for up to 1970
six (6) months, but in no event shall the plan of care exceed a 1971
six-month period of treatment. The projected period of treatment 1972
must be indicated on the initial plan of care and must be updated 1973
with each subsequent revised plan of care. Based on medical 1974
necessity, the * * * commission shall approve certification 1975
periods for less than or up to six (6) months, but in no event 1976
shall the certification period exceed the period of treatment 1977
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indicated on the plan of care. The appeal process for any 1978
reduction in therapy services shall be consistent with the appeal 1979
process in federal regulations. 1980
(56) Prescribed pediatric extended care centers 1981
services for medically dependent or technologically dependent 1982
children with complex medical conditions that require continual 1983
care as prescribed by the child's attending physician, as 1984
determined by the * * * commission. 1985
(57) No Medicaid benefit shall restrict coverage for 1986
medically appropriate treatment prescribed by a physician and 1987
agreed to by a fully informed individual, or if the individual 1988
lacks legal capacity to consent by a person who has legal 1989
authority to consent on his or her behalf, based on an 1990
individual's diagnosis with a terminal condition. As used in this 1991
paragraph (57), "terminal condition" means any aggressive 1992
malignancy, chronic end-stage cardiovascular or cerebral vascular 1993
disease, or any other disease, illness or condition which a 1994
physician diagnoses as terminal. 1995
(58) Treatment services for persons with opioid 1996
dependency or other highly addictive substance use disorders. 1997
The * * * commission is authorized to reimburse eligible providers 1998
for treatment of opioid dependency and other highly addictive 1999
substance use disorders, as determined by the * * * commission. 2000
Treatment related to these conditions shall not count against any 2001
physician visit limit imposed under this section. 2002
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(59) The * * * commission shall allow beneficiaries 2003
between the ages of ten (10) and eighteen (18) years to receive 2004
vaccines through a pharmacy venue. The * * * commission and the 2005
State Department of Health shall coordinate and notify OB-GYN 2006
providers that the Vaccines for Children program is available to 2007
providers free of charge. 2008
(60) Border city university-affiliated pediatric 2009
teaching hospital. 2010
(a) Payments may only be made to a border city 2011
university-affiliated pediatric teaching hospital if the Centers 2012
for Medicare and Medicaid Services (CMS) approve an increase in 2013
the annual request for the provider payment initiative authorized 2014
under 42 CFR Section 438.6(c) in an amount equal to or greater 2015
than the estimated annual payment to be made to the border city 2016
university-affiliated pediatric teaching hospital. The estimate 2017
shall be based on the hospital's prior year Mississippi managed 2018
care utilization. 2019
(b) As used in this paragraph (60), the term 2020
"border city university-affiliated pediatric teaching hospital" 2021
means an out-of-state hospital located within a city bordering the 2022
eastern bank of the Mississippi River and the State of Mississippi 2023
that submits to the * * * commission a copy of a current and 2024
effective affiliation agreement with an accredited university and 2025
other documentation establishing that the hospital is 2026
university-affiliated, is licensed and designated as a pediatric 2027
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hospital or pediatric primary hospital within its home state, 2028
maintains at least five (5) different pediatric specialty training 2029
programs, and maintains at least one hundred (100) operated beds 2030
dedicated exclusively for the treatment of patients under the age 2031
of twenty-one (21) years. 2032
(c) The cost of providing services to Mississippi 2033
Medicaid beneficiaries under the age of twenty-one (21) years who 2034
are treated by a border city university-affiliated pediatric 2035
teaching hospital shall not exceed the cost of providing the same 2036
services to individuals in hospitals in the state. 2037
(d) It is the intent of the Legislature that 2038
payments shall not result in any in-state hospital receiving 2039
payments lower than they would otherwise receive if not for the 2040
payments made to any border city university-affiliated pediatric 2041
teaching hospital. 2042
(e) This paragraph (60) shall stand repealed on 2043
July 1, 2024. 2044
(61) Services described in Section 41-140-3 that are 2045
provided by certified community health workers employed and 2046
supervised by a Medicaid provider. Reimbursement for these 2047
services shall be provided only if the * * * commission has 2048
received approval from the Centers for Medicare and Medicaid 2049
Services for a state plan amendment, waiver or alternative payment 2050
model for services delivered by certified community health 2051
workers. 2052
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(B) Planning and development districts participating in the 2053
home- and community-based services program for the elderly and 2054
disabled as case management providers shall be reimbursed for case 2055
management services at the maximum rate approved by the Centers 2056
for Medicare and Medicaid Services (CMS). 2057
(C) The * * * commission may pay to those providers who 2058
participate in and accept patient referrals from the * * * 2059
commission's emergency room redirection program a percentage, as 2060
determined by the * * * commission, of savings achieved according 2061
to the performance measures and reduction of costs required of 2062
that program. Federally qualified health centers may participate 2063
in the emergency room redirection program, and the * * * 2064
commission may pay those centers a percentage of any savings to 2065
the Medicaid program achieved by the centers' accepting patient 2066
referrals through the program, as provided in this subsection (C). 2067
(D) (1) As used in this subsection (D), the following terms 2068
shall be defined as provided in this paragraph, except as 2069
otherwise provided in this subsection: 2070
(a) "Committees" means the Medicaid Committees of 2071
the House of Representatives and the Senate, and "committee" means 2072
either one of those committees. 2073
(b) "Rate change" means an increase, decrease or 2074
other change in the payments or rates of reimbursement, or a 2075
change in any payment methodology that results in an increase, 2076
decrease or other change in the payments or rates of 2077
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reimbursement, to any Medicaid provider that renders any services 2078
authorized to be provided to Medicaid recipients under this 2079
article. 2080
(2) Whenever the * * * commission proposes a rate 2081
change, the * * * commission shall give notice to the chairmen of 2082
the committees at least thirty (30) calendar days before the 2083
proposed rate change is scheduled to take effect. The * * * 2084
commission shall furnish the chairmen with a concise summary of 2085
each proposed rate change along with the notice, and shall furnish 2086
the chairmen with a copy of any proposed rate change upon request. 2087
The * * * commission also shall provide a summary and copy of any 2088
proposed rate change to any other member of the Legislature upon 2089
request. 2090
(3) If the chairman of either committee or both 2091
chairmen jointly object to the proposed rate change or any part 2092
thereof, the chairman or chairmen shall notify the * * * 2093
commission and provide the reasons for their objection in writing 2094
not later than seven (7) calendar days after receipt of the notice 2095
from the * * * commission. The chairman or chairmen may make 2096
written recommendations to the * * * commission for changes to be 2097
made to a proposed rate change. 2098
(4) (a) The chairman of either committee or both 2099
chairmen jointly may hold a committee meeting to review a proposed 2100
rate change. If either chairman or both chairmen decide to hold a 2101
meeting, they shall notify the * * * commission of their intention 2102
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in writing within seven (7) calendar days after receipt of the 2103
notice from the * * * commission, and shall set the date and time 2104
for the meeting in their notice to the * * * commission, which 2105
shall not be later than fourteen (14) calendar days after receipt 2106
of the notice from the * * * commission. 2107
(b) After the committee meeting, the committee or 2108
committees may object to the proposed rate change or any part 2109
thereof. The committee or committees shall notify the * * * 2110
commission and the reasons for their objection in writing not 2111
later than seven (7) calendar days after the meeting. The 2112
committee or committees may make written recommendations to 2113
the * * * commission for changes to be made to a proposed rate 2114
change. 2115
(5) If both chairmen notify the * * * commission in 2116
writing within seven (7) calendar days after receipt of the notice 2117
from the * * * commission that they do not object to the proposed 2118
rate change and will not be holding a meeting to review the 2119
proposed rate change, the proposed rate change will take effect on 2120
the original date as scheduled by the * * * commission or on such 2121
other date as specified by the * * * commission. 2122
(6) (a) If there are any objections to a proposed rate 2123
change or any part thereof from either or both of the chairmen or 2124
the committees, the * * * commission may withdraw the proposed 2125
rate change, make any of the recommended changes to the proposed 2126
rate change, or not make any changes to the proposed rate change. 2127
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(b) If the * * * commission does not make any 2128
changes to the proposed rate change, it shall notify the chairmen 2129
of that fact in writing, and the proposed rate change shall take 2130
effect on the original date as scheduled by the * * * commission 2131
or on such other date as specified by the * * * commission. 2132
(c) If the * * *commission makes any changes to 2133
the proposed rate change, the * * * commission shall notify the 2134
chairmen of its actions in writing, and the revised proposed rate 2135
change shall take effect on the date as specified by the * * * 2136
commission. 2137
(7) Nothing in this subsection (D) shall be construed 2138
as giving the chairmen or the committees any authority to veto, 2139
nullify or revise any rate change proposed by the * * * 2140
commission. The authority of the chairmen or the committees under 2141
this subsection shall be limited to reviewing, making objections 2142
to and making recommendations for changes to rate changes proposed 2143
by the * * * commission. 2144
(E) Notwithstanding any provision of this article, no new 2145
groups or categories of recipients and new types of care and 2146
services may be added without enabling legislation from the 2147
Mississippi Legislature, except that the * * * commission may 2148
authorize those changes without enabling legislation when the 2149
addition of recipients or services is ordered by a court of proper 2150
authority. 2151
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(F) The executive director shall keep the * * * commission 2152
advised on a timely basis of the funds available for expenditure 2153
and the projected expenditures. Notwithstanding any other 2154
provisions of this article, if current or projected expenditures 2155
of the * * * commission are reasonably anticipated to exceed the 2156
amount of funds appropriated to the * * * commission for any 2157
fiscal year, the * * * commission shall take all appropriate 2158
measures to reduce costs, which may include, but are not limited 2159
to: 2160
(1) Reducing or discontinuing any or all services that 2161
are deemed to be optional under Title XIX of the Social Security 2162
Act; 2163
(2) Reducing reimbursement rates for any or all service 2164
types; 2165
(3) Imposing additional assessments on health care 2166
providers; or 2167
(4) Any additional cost-containment measures deemed 2168
appropriate by the * * * commission. 2169
To the extent allowed under federal law, any reduction to 2170
services or reimbursement rates under this subsection (F) shall be 2171
accompanied by a reduction, to the fullest allowable amount, to 2172
the profit margin and administrative fee portions of capitated 2173
payments to organizations described in paragraph (1) of subsection 2174
(H). 2175
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Beginning in fiscal year 2010 and in fiscal years thereafter, 2176
when Medicaid expenditures are projected to exceed funds available 2177
for the fiscal year, the * * * commission shall submit the 2178
expected shortfall information to the PEER Committee not later 2179
than December 1 of the year in which the shortfall is projected to 2180
occur. PEER shall review the computations of the * * * commission 2181
and report its findings to the Legislative Budget Office not later 2182
than January 7 in any year. 2183
(G) Notwithstanding any other provision of this article, it 2184
shall be the duty of each provider participating in the Medicaid 2185
program to keep and maintain books, documents and other records as 2186
prescribed by the * * * commission in accordance with federal laws 2187
and regulations. 2188
(H) (1) Notwithstanding any other provision of this 2189
article, the * * * commission is authorized to implement (a) a 2190
managed care program, (b) a coordinated care program, (c) a 2191
coordinated care organization program, (d) a health maintenance 2192
organization program, (e) a patient-centered medical home program, 2193
(f) an accountable care organization program, (g) 2194
provider-sponsored health plan, or (h) any combination of the 2195
above programs. As a condition for the approval of any program 2196
under this subsection (H)(1), the * * * commission shall require 2197
that no managed care program, coordinated care program, 2198
coordinated care organization program, health maintenance 2199
organization program, or provider-sponsored health plan may: 2200
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(a) Pay providers at a rate that is less than the 2201
Medicaid All Patient Refined Diagnosis Related Groups (APR-DRG) 2202
reimbursement rate; 2203
(b) Override the medical decisions of hospital 2204
physicians or staff regarding patients admitted to a hospital for 2205
an emergency medical condition as defined by 42 US Code Section 2206
1395dd. This restriction (b) does not prohibit the retrospective 2207
review of the appropriateness of the determination that an 2208
emergency medical condition exists by chart review or coding 2209
algorithm, nor does it prohibit prior authorization for 2210
nonemergency hospital admissions; 2211
(c) Pay providers at a rate that is less than the 2212
normal Medicaid reimbursement rate. It is the intent of the 2213
Legislature that all managed care entities described in this 2214
subsection (H), in collaboration with the * * * commission, 2215
develop and implement innovative payment models that incentivize 2216
improvements in health care quality, outcomes, or value, as 2217
determined by the * * * commission. Participation in the provider 2218
network of any managed care, coordinated care, provider-sponsored 2219
health plan, or similar contractor shall not be conditioned on the 2220
provider's agreement to accept such alternative payment models; 2221
(d) Implement a prior authorization and 2222
utilization review program for medical services, transportation 2223
services and prescription drugs that is more stringent than the 2224
prior authorization processes used by the * * * commission in its 2225
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administration of the Medicaid program. Not later than December 2226
2, 2021, the contractors that are receiving capitated payments 2227
under a managed care delivery system established under this 2228
subsection (H) shall submit a report to the Chairmen of the House 2229
and Senate Medicaid Committees on the status of the prior 2230
authorization and utilization review program for medical services, 2231
transportation services and prescription drugs that is required to 2232
be implemented under this subparagraph (d); 2233
(e) [Deleted] 2234
(f) Implement a preferred drug list that is more 2235
stringent than the mandatory preferred drug list established by 2236
the * * * commission under subsection (A)(9) of this section; 2237
(g) Implement a policy which denies beneficiaries 2238
with hemophilia access to the federally funded hemophilia 2239
treatment centers as part of the Medicaid Managed Care network of 2240
providers. 2241
Each health maintenance organization, coordinated care 2242
organization, provider-sponsored health plan, or other 2243
organization paid for services on a capitated basis by the * * * 2244
commission under any managed care program or coordinated care 2245
program implemented by the * * * commission under this section 2246
shall use a clear set of level of care guidelines in the 2247
determination of medical necessity and in all utilization 2248
management practices, including the prior authorization process, 2249
concurrent reviews, retrospective reviews and payments, that are 2250
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consistent with widely accepted professional standards of care. 2251
Organizations participating in a managed care program or 2252
coordinated care program implemented by the * * * commission may 2253
not use any additional criteria that would result in denial of 2254
care that would be determined appropriate and, therefore, 2255
medically necessary under those levels of care guidelines. 2256
(2) Notwithstanding any provision of this section, the 2257
recipients eligible for enrollment into a Medicaid Managed Care 2258
Program authorized under this subsection (H) may include only 2259
those categories of recipients eligible for participation in the 2260
Medicaid Managed Care Program as of January 1, 2021, the 2261
Children's Health Insurance Program (CHIP), and the CMS-approved 2262
Section 1115 demonstration waivers in operation as of January 1, 2263
2021. No expansion of Medicaid Managed Care Program contracts may 2264
be implemented by the * * * commission without enabling 2265
legislation from the Mississippi Legislature. 2266
(3) (a) Any contractors receiving capitated payments 2267
under a managed care delivery system established in this section 2268
shall provide to the Legislature and the * * * commission 2269
statistical data to be shared with provider groups in order to 2270
improve patient access, appropriate utilization, cost savings and 2271
health outcomes not later than October 1 of each year. 2272
Additionally, each contractor shall disclose to the Chairmen of 2273
the Senate and House Medicaid Committees the administrative 2274
expenses costs for the prior calendar year, and the number of 2275
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full-equivalent employees located in the State of Mississippi 2276
dedicated to the Medicaid and CHIP lines of business as of June 30 2277
of the current year. 2278
(b) The * * * commission and the contractors 2279
participating in the managed care program, a coordinated care 2280
program or a provider-sponsored health plan shall be subject to 2281
annual program reviews or audits performed by the Office of the 2282
State Auditor, the PEER Committee, the Department of Insurance 2283
and/or independent third parties. 2284
(c) Those reviews shall include, but not be 2285
limited to, at least two (2) of the following items: 2286
(i) The financial benefit to the State of 2287
Mississippi of the managed care program, 2288
(ii) The difference between the premiums paid 2289
to the managed care contractors and the payments made by those 2290
contractors to health care providers, 2291
(iii) Compliance with performance measures 2292
required under the contracts, 2293
(iv) Administrative expense allocation 2294
methodologies, 2295
(v) Whether nonprovider payments assigned as 2296
medical expenses are appropriate, 2297
(vi) Capitated arrangements with related 2298
party subcontractors, 2299
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(vii) Reasonableness of corporate 2300
allocations, 2301
(viii) Value-added benefits and the extent to 2302
which they are used, 2303
(ix) The effectiveness of subcontractor 2304
oversight, including subcontractor review, 2305
(x) Whether health care outcomes have been 2306
improved, and 2307
(xi) The most common claim denial codes to 2308
determine the reasons for the denials. 2309
The audit reports shall be considered public documents and 2310
shall be posted in their entirety on the * * * commission's 2311
website. 2312
(4) All health maintenance organizations, coordinated 2313
care organizations, provider-sponsored health plans, or other 2314
organizations paid for services on a capitated basis by the * * * 2315
commission under any managed care program or coordinated care 2316
program implemented by the * * * commission under this section 2317
shall reimburse all providers in those organizations at rates no 2318
lower than those provided under this section for beneficiaries who 2319
are not participating in those programs. 2320
(5) No health maintenance organization, coordinated 2321
care organization, provider-sponsored health plan, or other 2322
organization paid for services on a capitated basis by the * * * 2323
commission under any managed care program or coordinated care 2324
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program implemented by the * * * commission under this section 2325
shall require its providers or beneficiaries to use any pharmacy 2326
that ships, mails or delivers prescription drugs or legend drugs 2327
or devices. 2328
(6) (a) Not later than December 1, 2021, the 2329
contractors who are receiving capitated payments under a managed 2330
care delivery system established under this subsection (H) shall 2331
develop and implement a uniform credentialing process for 2332
providers. Under that uniform credentialing process, a provider 2333
who meets the criteria for credentialing will be credentialed with 2334
all of those contractors and no such provider will have to be 2335
separately credentialed by any individual contractor in order to 2336
receive reimbursement from the contractor. Not later than 2337
December 2, 2021, those contractors shall submit a report to the 2338
Chairmen of the House and Senate Medicaid Committees on the status 2339
of the uniform credentialing process for providers that is 2340
required under this subparagraph (a). 2341
(b) If those contractors have not implemented a 2342
uniform credentialing process as described in subparagraph (a) by 2343
December 1, 2021, the * * * commission shall develop and 2344
implement, not later than July 1, 2022, a single, consolidated 2345
credentialing process by which all providers will be credentialed. 2346
Under the * * * commission's single, consolidated credentialing 2347
process, no such contractor shall require its providers to be 2348
separately credentialed by the contractor in order to receive 2349
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reimbursement from the contractor, but those contractors shall 2350
recognize the credentialing of the providers by the * * * 2351
commission's credentialing process. 2352
(c) The * * * commission shall require a uniform 2353
provider credentialing application that shall be used in the 2354
credentialing process that is established under subparagraph (a) 2355
or (b). If the contractor or * * * commission, as applicable, has 2356
not approved or denied the provider credentialing application 2357
within sixty (60) days of receipt of the completed application 2358
that includes all required information necessary for 2359
credentialing, then the contractor or * * * commission, upon 2360
receipt of a written request from the applicant and within five 2361
(5) business days of its receipt, shall issue a temporary provider 2362
credential/enrollment to the applicant if the applicant has a 2363
valid Mississippi professional or occupational license to provide 2364
the health care services to which the credential/enrollment would 2365
apply. The contractor or the * * * commission shall not issue a 2366
temporary credential/enrollment if the applicant has reported on 2367
the application a history of medical or other professional or 2368
occupational malpractice claims, a history of substance abuse or 2369
mental health issues, a criminal record, or a history of medical 2370
or other licensing board, state or federal disciplinary action, 2371
including any suspension from participation in a federal or state 2372
program. The temporary credential/enrollment shall be effective 2373
upon issuance and shall remain in effect until the provider's 2374
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credentialing/enrollment application is approved or denied by the 2375
contractor or * * * commission. The contractor or * * * 2376
commission shall render a final decision regarding 2377
credentialing/enrollment of the provider within sixty (60) days 2378
from the date that the temporary provider credential/enrollment is 2379
issued to the applicant. 2380
(d) If the contractor or * * * commission does not 2381
render a final decision regarding credentialing/enrollment of the 2382
provider within the time required in subparagraph (c), the 2383
provider shall be deemed to be credentialed by and enrolled with 2384
all of the contractors and eligible to receive reimbursement from 2385
the contractors. 2386
(7) (a) Each contractor that is receiving capitated 2387
payments under a managed care delivery system established under 2388
this subsection (H) shall provide to each provider for whom the 2389
contractor has denied the coverage of a procedure that was ordered 2390
or requested by the provider for or on behalf of a patient, a 2391
letter that provides a detailed explanation of the reasons for the 2392
denial of coverage of the procedure and the name and the 2393
credentials of the person who denied the coverage. The letter 2394
shall be sent to the provider in electronic format. 2395
(b) After a contractor that is receiving capitated 2396
payments under a managed care delivery system established under 2397
this subsection (H) has denied coverage for a claim submitted by a 2398
provider, the contractor shall issue to the provider within sixty 2399
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(60) days a final ruling of denial of the claim that allows the 2400
provider to have a state fair hearing and/or agency appeal with 2401
the * * * commission. If a contractor does not issue a final 2402
ruling of denial within sixty (60) days as required by this 2403
subparagraph (b), the provider's claim shall be deemed to be 2404
automatically approved and the contractor shall pay the amount of 2405
the claim to the provider. 2406
(c) After a contractor has issued a final ruling 2407
of denial of a claim submitted by a provider, the * * * commission 2408
shall conduct a state fair hearing and/or agency appeal on the 2409
matter of the disputed claim between the contractor and the 2410
provider within sixty (60) days, and shall render a decision on 2411
the matter within thirty (30) days after the date of the hearing 2412
and/or appeal. 2413
(8) It is the intention of the Legislature that 2414
the * * * commission evaluate the feasibility of using a single 2415
vendor to administer pharmacy benefits provided under a managed 2416
care delivery system established under this subsection (H). 2417
Providers of pharmacy benefits shall cooperate with the * * * 2418
commission in any transition to a carve-out of pharmacy benefits 2419
under managed care. 2420
(9) The * * * commission shall evaluate the feasibility 2421
of using a single vendor to administer dental benefits provided 2422
under a managed care delivery system established in this 2423
subsection (H). Providers of dental benefits shall cooperate with 2424
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the * * * commission in any transition to a carve-out of dental 2425
benefits under managed care. 2426
(10) It is the intent of the Legislature that any 2427
contractor receiving capitated payments under a managed care 2428
delivery system established in this section shall implement 2429
innovative programs to improve the health and well-being of 2430
members diagnosed with prediabetes and diabetes. 2431
(11) It is the intent of the Legislature that any 2432
contractors receiving capitated payments under a managed care 2433
delivery system established under this subsection (H) shall work 2434
with providers of Medicaid services to improve the utilization of 2435
long-acting reversible contraceptives (LARCs). Not later than 2436
December 1, 2021, any contractors receiving capitated payments 2437
under a managed care delivery system established under this 2438
subsection (H) shall provide to the Chairmen of the House and 2439
Senate Medicaid Committees and House and Senate Public Health 2440
Committees a report of LARC utilization for State Fiscal Years 2441
2018 through 2020 as well as any programs, initiatives, or efforts 2442
made by the contractors and providers to increase LARC 2443
utilization. This report shall be updated annually to include 2444
information for subsequent state fiscal years. 2445
(12) The * * * commission is authorized to make not 2446
more than one (1) emergency extension of the contracts that are in 2447
effect on July 1, 2021, with contractors who are receiving 2448
capitated payments under a managed care delivery system 2449
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established under this subsection (H), as provided in this 2450
paragraph (12). The maximum period of any such extension shall be 2451
one (1) year, and under any such extensions, the contractors shall 2452
be subject to all of the provisions of this subsection (H). The 2453
extended contracts shall be revised to incorporate any provisions 2454
of this subsection (H). 2455
(I) [Deleted] 2456
(J) There shall be no cuts in inpatient and outpatient 2457
hospital payments, or allowable days or volumes, as long as the 2458
hospital assessment provided in Section 43-13-145 is in effect. 2459
This subsection (J) shall not apply to decreases in payments that 2460
are a result of: reduced hospital admissions, audits or payments 2461
under the APR-DRG or APC models, or a managed care program or 2462
similar model described in subsection (H) of this section. 2463
(K) In the negotiation and execution of such contracts 2464
involving services performed by actuarial firms, the * * * 2465
commission may negotiate a limitation on liability to the state of 2466
prospective contractors. 2467
(L) The * * * commission shall reimburse for services 2468
provided to eligible Medicaid beneficiaries by a licensed birthing 2469
center in a method and manner to be determined by the * * * 2470
commission in accordance with federal laws and federal 2471
regulations. The * * * commission shall seek any necessary 2472
waivers, make any required amendments to its State Plan or revise 2473
any contracts authorized under subsection (H) of this section as 2474
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necessary to provide the services authorized under this 2475
subsection. As used in this subsection, the term "birthing 2476
centers" shall have the meaning as defined in Section 41-77-1(a), 2477
which is a publicly or privately owned facility, place or 2478
institution constructed, renovated, leased or otherwise 2479
established where nonemergency births are planned to occur away 2480
from the mother's usual residence following a documented period of 2481
prenatal care for a normal uncomplicated pregnancy which has been 2482
determined to be low risk through a formal risk-scoring 2483
examination. 2484
(M) This section shall stand repealed on July 1, 2028. 2485
SECTION 10. Section 43-13-120, Mississippi Code of 1972, is 2486
amended as follows: 2487
43-13-120. (1) Any person who is a Medicaid recipient and 2488
is receiving medical assistance for services provided in a 2489
long-term care facility under the provisions of Section 2490
43-13-117 * * *, who dies intestate and leaves no known heirs, 2491
shall have deemed, through his acceptance of such medical 2492
assistance, the * * * commission as his beneficiary to all such 2493
funds in an amount not to exceed Two Hundred Fifty Dollars 2494
($250.00) which are in his possession at the time of his death. 2495
Such funds, together with any accrued interest thereon, shall be 2496
reported by the long-term care facility to the State Treasurer in 2497
the manner provided in subsection (2). 2498
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(2) The report of such funds shall be verified, shall be on 2499
a form prescribed or approved by the Treasurer, and shall include 2500
(a) the name of the deceased person and his last known address 2501
prior to entering the long-term care facility; (b) the name and 2502
last known address of each person who may possess an interest in 2503
such funds; and (c) any other information which the Treasurer 2504
prescribes by regulation as necessary for the administration of 2505
this section. The report shall be filed with the Treasurer prior 2506
to November 1 of each year in which the long-term care facility 2507
has provided services to a person or persons having funds to which 2508
this section applies. 2509
(3) Within one hundred twenty (120) days from November 1 of 2510
each year in which a report is made pursuant to subsection (2), 2511
the Treasurer shall cause notice to be published in a newspaper 2512
having general circulation in the county of this state in which is 2513
located the last known address of the person or persons named in 2514
the report who may possess an interest in such funds, or if no 2515
such person is named in the report, in the county in which is 2516
located the last known address of the deceased person prior to 2517
entering the long-term care facility. If no address is given in 2518
the report or if the address is outside of this state, the notice 2519
shall be published in a newspaper having general circulation in 2520
the county in which the facility is located. The notice shall 2521
contain (a) the name of the deceased person; (b) his last known 2522
address prior to entering the facility; (c) the name and last 2523
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known address of each person named in the report who may possess 2524
an interest in such funds; and (d) a statement that any person 2525
possessing an interest in such funds must make a claim therefor to 2526
the Treasurer within ninety (90) days after such publication date 2527
or the funds will become the property of the State of Mississippi. 2528
In any year in which the Treasurer publishes a notice of abandoned 2529
property under Section 89-12-27, the Treasurer may combine the 2530
notice required by this section with the notice of abandoned 2531
property. The cost to the Treasurer of publishing the notice 2532
required by this section shall be paid by the * * * commission. 2533
(4) Each long-term care facility that makes a report of 2534
funds of a deceased person under this section shall pay over and 2535
deliver such funds, together with any accrued interest thereon, to 2536
the Treasurer not later than ten (10) days after notice of such 2537
funds has been published by the Treasurer as provided in 2538
subsection (3). If a claim to such funds is not made by any 2539
person having an interest therein within ninety (90) days of the 2540
published notice, the Treasurer shall place such funds in the 2541
special account in the State Treasury to the credit of the * * * 2542
Mississippi Medicaid Commission to be expended by the * * * 2543
commission for the purposes provided under Mississippi Medicaid 2544
Law. 2545
(5) This section shall not be applicable to any Medicaid 2546
patient in a long-term care facility of a state institution listed 2547
in Section 41-7-73, who has a personal deposit fund as provided 2548
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for in Section 41-7-90, and shall not be applicable to amounts in 2549
Mississippi ABLE accounts created under Section 43-28-1 et seq. 2550
unless otherwise required by the United States Social Security 2551
Act, 42 USC Section 1396p(b). 2552
SECTION 11. Section 43-13-121, Mississippi Code of 1972, is 2553
amended as follows: 2554
43-13-121. (1) The commission shall administer the Medicaid 2555
program under the provisions of this article, and may do the 2556
following: 2557
(a) Adopt and promulgate reasonable rules, regulations 2558
and standards * * * and in accordance with the Administrative 2559
Procedures Law, Section 25-43-1.101 et seq.: 2560
(i) Establishing methods and procedures as may be 2561
necessary for the proper and efficient administration of this 2562
article; 2563
(ii) Providing Medicaid to all qualified 2564
recipients under the provisions of this article as the * * * 2565
commission may determine and within the limits of appropriated 2566
funds; 2567
(iii) Establishing reasonable fees, charges and 2568
rates for medical services and drugs; in doing so, the * * * 2569
commission shall fix all of those fees, charges and rates at the 2570
minimum levels absolutely necessary to provide the medical 2571
assistance authorized by this article, and shall not change any of 2572
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those fees, charges or rates except as may be authorized in 2573
Section 43-13-117; 2574
(iv) Providing for fair and impartial hearings; 2575
(v) Providing safeguards for preserving the 2576
confidentiality of records; and 2577
(vi) For detecting and processing fraudulent 2578
practices and abuses of the program; 2579
(b) Receive and expend state, federal and other funds 2580
in accordance with court judgments or settlements and agreements 2581
between the State of Mississippi and the federal government, the 2582
rules and regulations promulgated by the * * * commission, and 2583
within the limitations and restrictions of this article and within 2584
the limits of funds available for that purpose; 2585
(c) Subject to the limits imposed by this article and 2586
subject to the provisions of subsection (8) of this section, to 2587
submit a Medicaid plan to the United States Department of Health 2588
and Human Services for approval under the provisions of the 2589
federal Social Security Act, to act for the state in making 2590
negotiations relative to the submission and approval of that plan, 2591
to make such arrangements, not inconsistent with the law, as may 2592
be required by or under federal law to obtain and retain that 2593
approval and to secure for the state the benefits of the 2594
provisions of that law. 2595
No agreements, specifically including the general plan for 2596
the operation of the Medicaid program in this state, shall be made 2597
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by and between the * * * commission and the United States 2598
Department of Health and Human Services unless the Attorney 2599
General of the State of Mississippi has reviewed the agreements, 2600
specifically including the operational plan, and has certified in 2601
writing to the * * * commission that the agreements, including the 2602
plan of operation, have been drawn strictly in accordance with the 2603
terms and requirements of this article; 2604
(d) In accordance with the purposes and intent of this 2605
article and in compliance with its provisions, provide for aged 2606
persons otherwise eligible for the benefits provided under Title 2607
XVIII of the federal Social Security Act by expenditure of funds 2608
available for those purposes; 2609
(e) To make reports to the United States Department of 2610
Health and Human Services as from time to time may be required by 2611
that federal department and to the Mississippi Legislature as 2612
provided in this section; 2613
(f) Define and determine the scope, duration and amount 2614
of Medicaid that may be provided in accordance with this article 2615
and establish priorities therefor in conformity with this article; 2616
(g) Cooperate and contract with other state agencies 2617
for the purpose of coordinating Medicaid provided under this 2618
article and eliminating duplication and inefficiency in the 2619
Medicaid program; 2620
(h) Adopt and use an official seal of the * * * 2621
commission; 2622
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(i) Sue in its own name on behalf of the State of 2623
Mississippi and employ legal counsel on a contingency basis with 2624
the approval of the Attorney General; 2625
(j) To recover any and all payments incorrectly made by 2626
the * * * commission to a recipient or provider from the recipient 2627
or provider receiving the payments. The * * * commission shall be 2628
authorized to collect any overpayments to providers sixty (60) 2629
days after the conclusion of any administrative appeal unless the 2630
matter is appealed to a court of proper jurisdiction and bond is 2631
posted. Any appeal filed after July 1, 2015, shall be to the 2632
Chancery Court of the First Judicial District of Hinds County, 2633
Mississippi, within sixty (60) days after the date that the * * * 2634
commission has notified the provider by certified mail sent to the 2635
proper address of the provider on file with the * * * commission 2636
and the provider has signed for the certified mail notice, or 2637
sixty (60) days after the date of the final decision if the 2638
provider does not sign for the certified mail notice. To recover 2639
those payments, the * * * commission may use the following 2640
methods, in addition to any other methods available to the * * * 2641
commission: 2642
(i) The * * * commission shall report to the 2643
Department of Revenue the name of any current or former Medicaid 2644
recipient who has received medical services rendered during a 2645
period of established Medicaid ineligibility and who has not 2646
reimbursed the * * * commission for the related medical service 2647
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payment(s). The Department of Revenue shall withhold from the 2648
state tax refund of the individual, and pay to the * * * 2649
commission, the amount of the payment(s) for medical services 2650
rendered to the ineligible individual that have not been 2651
reimbursed to the * * * commission for the related medical service 2652
payment(s). 2653
(ii) The * * * commission shall report to the 2654
Department of Revenue the name of any Medicaid provider to whom 2655
payments were incorrectly made that the * * * commission has not 2656
been able to recover by other methods available to the * * * 2657
commission. The Department of Revenue shall withhold from the 2658
state tax refund of the provider, and pay to the * * * commission, 2659
the amount of the payments that were incorrectly made to the 2660
provider that have not been recovered by other available methods; 2661
(k) To recover any and all payments by the * * * 2662
commission fraudulently obtained by a recipient or provider. 2663
Additionally, if recovery of any payments fraudulently obtained by 2664
a recipient or provider is made in any court, then, upon motion of 2665
the * * * commission, the judge of the court may award twice the 2666
payments recovered as damages; 2667
(l) Have full, complete and plenary power and authority 2668
to conduct such investigations as it may deem necessary and 2669
requisite of alleged or suspected violations or abuses of the 2670
provisions of this article or of the regulations adopted under 2671
this article, including, but not limited to, fraudulent or 2672
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unlawful act or deed by applicants for Medicaid or other benefits, 2673
or payments made to any person, firm or corporation under the 2674
terms, conditions and authority of this article, to suspend or 2675
disqualify any provider of services, applicant or recipient for 2676
gross abuse, fraudulent or unlawful acts for such periods, 2677
including permanently, and under such conditions as the * * * 2678
commission deems proper and just, including the imposition of a 2679
legal rate of interest on the amount improperly or incorrectly 2680
paid. Recipients who are found to have misused or abused Medicaid 2681
benefits may be locked into one (1) physician and/or one (1) 2682
pharmacy of the recipient's choice for a reasonable amount of time 2683
in order to educate and promote appropriate use of medical 2684
services, in accordance with federal regulations. If an 2685
administrative hearing becomes necessary, the * * * commission 2686
may, if the provider does not succeed in his or her defense, tax 2687
the costs of the administrative hearing, including the costs of 2688
the court reporter or stenographer and transcript, to the 2689
provider. The convictions of a recipient or a provider in a state 2690
or federal court for abuse, fraudulent or unlawful acts under this 2691
chapter shall constitute an automatic disqualification of the 2692
recipient or automatic disqualification of the provider from 2693
participation under the Medicaid program. 2694
A conviction, for the purposes of this chapter, shall include 2695
a judgment entered on a plea of nolo contendere or a 2696
nonadjudicated guilty plea and shall have the same force as a 2697
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judgment entered pursuant to a guilty plea or a conviction 2698
following trial. A certified copy of the judgment of the court of 2699
competent jurisdiction of the conviction shall constitute prima 2700
facie evidence of the conviction for disqualification purposes; 2701
(m) Establish and provide such methods of 2702
administration as may be necessary for the proper and efficient 2703
operation of the Medicaid program, fully utilizing computer 2704
equipment as may be necessary to oversee and control all current 2705
expenditures for purposes of this article, and to closely monitor 2706
and supervise all recipient payments and vendors rendering 2707
services under this article. Notwithstanding any other provision 2708
of state law, the * * * commission is authorized to enter into a 2709
ten-year contract(s) with a vendor(s) to provide services 2710
described in this paragraph (m). Notwithstanding any provision of 2711
law to the contrary, the * * * commission is authorized to extend 2712
its Medicaid Management Information System, including all related 2713
components and services, and Decision Support System, including 2714
all related components and services, contracts in effect on June 2715
30, 2020, for a period not to exceed two (2) years without 2716
complying with state procurement regulations; 2717
(n) To cooperate and contract with the federal 2718
government for the purpose of providing Medicaid to Vietnamese and 2719
Cambodian refugees, under the provisions of Public Law 94-23 and 2720
Public Law 94-24, including any amendments to those laws, only to 2721
the extent that the Medicaid assistance and the administrative 2722
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cost related thereto are one hundred percent (100%) reimbursable 2723
by the federal government. For the purposes of Section 43-13-117, 2724
persons receiving Medicaid under Public Law 94-23 and Public Law 2725
94-24, including any amendments to those laws, shall not be 2726
considered a new group or category of recipient; and 2727
(o) The * * * commission shall impose penalties upon 2728
Medicaid only, Title XIX participating long-term care facilities 2729
found to be in noncompliance with * * * commission and 2730
certification standards in accordance with federal and state 2731
regulations, including interest at the same rate calculated by the 2732
United States Department of Health and Human Services and/or the 2733
Centers for Medicare and Medicaid Services (CMS) under federal 2734
regulations. 2735
(2) The * * * commission also shall exercise such additional 2736
powers and perform such other duties as may be conferred upon 2737
the * * * commission by act of the Legislature. 2738
(3) The * * * commission, and the State Department of Health 2739
as the agency for licensure of health care facilities and 2740
certification and inspection for the Medicaid and/or Medicare 2741
programs, shall contract for or otherwise provide for the 2742
consolidation of on-site inspections of health care facilities 2743
that are necessitated by the respective programs and functions of 2744
the * * * commission and the department. 2745
(4) The * * * commission and its hearing officers shall have 2746
power to preserve and enforce order during hearings; to issue 2747
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subpoenas for, to administer oaths to and to compel the attendance 2748
and testimony of witnesses, or the production of books, papers, 2749
documents and other evidence, or the taking of depositions before 2750
any designated individual competent to administer oaths; to 2751
examine witnesses; and to do all things conformable to law that 2752
may be necessary to enable them effectively to discharge the 2753
duties of their office. In compelling the attendance and 2754
testimony of witnesses, or the production of books, papers, 2755
documents and other evidence, or the taking of depositions, as 2756
authorized by this section, the * * * commission or its hearing 2757
officers may designate an individual employed by the * * * 2758
commission or some other suitable person to execute and return 2759
that process, whose action in executing and returning that process 2760
shall be as lawful as if done by the sheriff or some other proper 2761
officer authorized to execute and return process in the county 2762
where the witness may reside. In carrying out the investigatory 2763
powers under the provisions of this article, the executive 2764
director or other * * * person or persons designated by the 2765
commission may examine, obtain, copy or reproduce the books, 2766
papers, documents, medical charts, prescriptions and other records 2767
relating to medical care and services furnished by the provider to 2768
a recipient or designated recipients of Medicaid services under 2769
investigation. In the absence of the voluntary submission of the 2770
books, papers, documents, medical charts, prescriptions and other 2771
records, the * * * commission may issue and serve subpoenas 2772
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instantly upon the provider, his or her agent, servant or employee 2773
for the production of the books, papers, documents, medical 2774
charts, prescriptions or other records during an audit or 2775
investigation of the provider. If any provider or his or her 2776
agent, servant or employee refuses to produce the records after 2777
being duly subpoenaed, the * * * commission may certify those 2778
facts and institute contempt proceedings in the manner, time and 2779
place as authorized by law for administrative proceedings. As an 2780
additional remedy, the * * * commission may recover all amounts 2781
paid to the provider covering the period of the audit or 2782
investigation, inclusive of a legal rate of interest and a 2783
reasonable attorney's fee and costs of court if suit becomes 2784
necessary. * * * Commission staff shall have immediate access to 2785
the provider's physical location, facilities, records, documents, 2786
books, and any other records relating to medical care and services 2787
rendered to recipients during regular business hours. 2788
(5) If any person in proceedings before the * * * commission 2789
disobeys or resists any lawful order or process, or misbehaves 2790
during a hearing or so near the place thereof as to obstruct the 2791
hearing, or neglects to produce, after having been ordered to do 2792
so, any pertinent book, paper or document, or refuses to appear 2793
after having been subpoenaed, or upon appearing refuses to take 2794
the oath as a witness, or after having taken the oath refuses to 2795
be examined according to law, the * * * commission shall certify 2796
the facts to any court having jurisdiction in the place in which 2797
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it is sitting, and the court shall thereupon, in a summary manner, 2798
hear the evidence as to the acts complained of, and if the 2799
evidence so warrants, punish that person in the same manner and to 2800
the same extent as for a contempt committed before the court, or 2801
commit that person upon the same condition as if the doing of the 2802
forbidden act had occurred with reference to the process of, or in 2803
the presence of, the court. 2804
(6) In suspending or terminating any provider from 2805
participation in the Medicaid program, the * * * commission shall 2806
preclude the provider from submitting claims for payment, either 2807
personally or through any clinic, group, corporation or other 2808
association to the * * * commission or its fiscal agents for any 2809
services or supplies provided under the Medicaid program except 2810
for those services or supplies provided before the suspension or 2811
termination. No clinic, group, corporation or other association 2812
that is a provider of services shall submit claims for payment to 2813
the * * * commission or its fiscal agents for any services or 2814
supplies provided by a person within that organization who has 2815
been suspended or terminated from participation in the Medicaid 2816
program except for those services or supplies provided before the 2817
suspension or termination. When this provision is violated by a 2818
provider of services that is a clinic, group, corporation or other 2819
association, the * * * commission may suspend or terminate that 2820
organization from participation. Suspension may be applied by 2821
the * * * commission to all known affiliates of a provider, 2822
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provided that each decision to include an affiliate is made on a 2823
case-by-case basis after giving due regard to all relevant facts 2824
and circumstances. The violation, failure or inadequacy of 2825
performance may be imputed to a person with whom the provider is 2826
affiliated where that conduct was accomplished within the course 2827
of his or her official duty or was effectuated by him or her with 2828
the knowledge or approval of that person. 2829
(7) The * * * commission may deny or revoke enrollment in 2830
the Medicaid program to a provider if any of the following are 2831
found to be applicable to the provider, his or her agent, a 2832
managing employee or any person having an ownership interest equal 2833
to five percent (5%) or greater in the provider: 2834
(a) Failure to truthfully or fully disclose any and all 2835
information required, or the concealment of any and all 2836
information required, on a claim, a provider application or a 2837
provider agreement, or the making of a false or misleading 2838
statement to the * * * commission relative to the Medicaid 2839
program. 2840
(b) Previous or current exclusion, suspension, 2841
termination from or the involuntary withdrawing from participation 2842
in the Medicaid program, any other state's Medicaid program, 2843
Medicare or any other public or private health or health insurance 2844
program. If the * * * commission ascertains that a provider has 2845
been convicted of a felony under federal or state law for an 2846
offense that the * * * commission determines is detrimental to the 2847
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best interest of the program or of Medicaid beneficiaries, 2848
the * * * commission may refuse to enter into an agreement with 2849
that provider, or may terminate or refuse to renew an existing 2850
agreement. 2851
(c) Conviction under federal or state law of a criminal 2852
offense relating to the delivery of any goods, services or 2853
supplies, including the performance of management or 2854
administrative services relating to the delivery of the goods, 2855
services or supplies, under the Medicaid program, any other 2856
state's Medicaid program, Medicare or any other public or private 2857
health or health insurance program. 2858
(d) Conviction under federal or state law of a criminal 2859
offense relating to the neglect or abuse of a patient in 2860
connection with the delivery of any goods, services or supplies. 2861
(e) Conviction under federal or state law of a criminal 2862
offense relating to the unlawful manufacture, distribution, 2863
prescription or dispensing of a controlled substance. 2864
(f) Conviction under federal or state law of a criminal 2865
offense relating to fraud, theft, embezzlement, breach of 2866
fiduciary responsibility or other financial misconduct. 2867
(g) Conviction under federal or state law of a criminal 2868
offense punishable by imprisonment of a year or more that involves 2869
moral turpitude, or acts against the elderly, children or infirm. 2870
(h) Conviction under federal or state law of a criminal 2871
offense in connection with the interference or obstruction of any 2872
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investigation into any criminal offense listed in paragraphs (c) 2873
through (i) of this subsection. 2874
(i) Sanction for a violation of federal or state laws 2875
or rules relative to the Medicaid program, any other state's 2876
Medicaid program, Medicare or any other public health care or 2877
health insurance program. 2878
(j) Revocation of license or certification. 2879
(k) Failure to pay recovery properly assessed or 2880
pursuant to an approved repayment schedule under the Medicaid 2881
program. 2882
(l) Failure to meet any condition of enrollment. 2883
(8) (a) As used in this subsection (8), the following terms 2884
shall be defined as provided in this paragraph, except as 2885
otherwise provided in this subsection: 2886
(i) "Committees" means the Medicaid Committees of 2887
the House of Representatives and the Senate, and "committee" means 2888
either one of those committees. 2889
(ii) "State Plan" means the agreement between the 2890
State of Mississippi and the federal government regarding the 2891
nature and scope of Mississippi's Medicaid Program. 2892
(iii) "State Plan Amendment" means a change to the 2893
State Plan, which must be approved by the Centers for Medicare and 2894
Medicaid Services (CMS) before its implementation. 2895
(b) Whenever the * * * commission proposes a State Plan 2896
Amendment, the * * * commission shall give notice to the chairmen 2897
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of the committees at least thirty (30) calendar days before the 2898
proposed State Plan Amendment is filed with CMS. The * * * 2899
commission shall furnish the chairmen with a concise summary of 2900
each proposed State Plan Amendment along with the notice, and 2901
shall furnish the chairmen with a copy of any proposed State Plan 2902
Amendment upon request. The * * * commission also shall provide a 2903
summary and copy of any proposed State Plan Amendment to any other 2904
member of the Legislature upon request. 2905
(c) If the chairman of either committee or both 2906
chairmen jointly object to the proposed State Plan Amendment or 2907
any part thereof, the chairman or chairmen shall notify the * * * 2908
commission and provide the reasons for their objection in writing 2909
not later than seven (7) calendar days after receipt of the notice 2910
from the * * * commission. The chairman or chairmen may make 2911
written recommendations to the * * * commission for changes to be 2912
made to a proposed State Plan Amendment. 2913
(d) (i) The chairman of either committee or both 2914
chairmen jointly may hold a committee meeting to review a proposed 2915
State Plan Amendment. If either chairman or both chairmen decide 2916
to hold a meeting, they shall notify the * * * commission of their 2917
intention in writing within seven (7) calendar days after receipt 2918
of the notice from the * * * commission, and shall set the date 2919
and time for the meeting in their notice to the * * * commission, 2920
which shall not be later than fourteen (14) calendar days after 2921
receipt of the notice from the * * * commission. 2922
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(ii) After the committee meeting, the committee or 2923
committees may object to the proposed State Plan Amendment or any 2924
part thereof. The committee or committees shall notify the * * * 2925
commission and the reasons for their objection in writing not 2926
later than seven (7) calendar days after the meeting. The 2927
committee or committees may make written recommendations to 2928
the * * * commission for changes to be made to a proposed State 2929
Plan Amendment. 2930
(e) If both chairmen notify the * * * commission in 2931
writing within seven (7) calendar days after receipt of the notice 2932
from the * * * commission that they do not object to the proposed 2933
State Plan Amendment and will not be holding a meeting to review 2934
the proposed State Plan Amendment, the * * * commission may 2935
proceed to file the proposed State Plan Amendment with CMS. 2936
(f) (i) If there are any objections to a proposed rate 2937
change or any part thereof from either or both of the chairmen or 2938
the committees, the * * * commission may withdraw the proposed 2939
State Plan Amendment, make any of the recommended changes to the 2940
proposed State Plan Amendment, or not make any changes to the 2941
proposed State Plan Amendment. 2942
(ii) If the * * * commission does not make any 2943
changes to the proposed State Plan Amendment, it shall notify the 2944
chairmen of that fact in writing, and may proceed to file the 2945
State Plan Amendment with CMS. 2946
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(iii) If the * * * commission makes any changes to 2947
the proposed State Plan Amendment, the * * * commission shall 2948
notify the chairmen of its actions in writing, and may proceed to 2949
file the State Plan Amendment with CMS. 2950
(g) Nothing in this subsection (8) shall be construed 2951
as giving the chairmen or the committees any authority to veto, 2952
nullify or revise any State Plan Amendment proposed by the * * * 2953
commission. The authority of the chairmen or the committees under 2954
this subsection shall be limited to reviewing, making objections 2955
to and making recommendations for changes to State Plan Amendments 2956
proposed by the * * * commission. 2957
(i) If the * * * commission does not make any 2958
changes to the proposed State Plan Amendment, it shall notify the 2959
chairmen of that fact in writing, and may proceed to file the 2960
proposed State Plan Amendment with CMS. 2961
(ii) If the * * * commission makes any changes to 2962
the proposed State Plan Amendment, the * * * commission shall 2963
notify the chairmen of the changes in writing, and may proceed to 2964
file the proposed State Plan Amendment with CMS. 2965
(h) Nothing in this subsection (8) shall be construed 2966
as giving the chairmen of the committees any authority to veto, 2967
nullify or revise any State Plan Amendment proposed by the * * * 2968
commission. The authority of the chairmen of the committees under 2969
this subsection shall be limited to reviewing, making objections 2970
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to and making recommendations for suggested changes to State Plan 2971
Amendments proposed by the * * * commission. 2972
SECTION 12. Section 43-13-123, Mississippi Code of 1972, is 2973
amended as follows: 2974
43-13-123. The determination of the method of providing 2975
payment of claims under this article shall be made by the * * * 2976
commission, * * * which methods may be: 2977
(a) By contract with insurance companies licensed to do 2978
business in the State of Mississippi or with nonprofit hospital 2979
service corporations, medical or dental service corporations, 2980
authorized to do business in Mississippi to underwrite on an 2981
insured premium approach, such medical assistance benefits as may 2982
be available, and any carrier selected under the provisions of 2983
this article is expressly authorized and empowered to undertake 2984
the performance of the requirements of that contract. 2985
(b) By contract with an insurance company licensed to 2986
do business in the State of Mississippi or with nonprofit hospital 2987
service, medical or dental service organizations, or other 2988
organizations including data processing companies, authorized to 2989
do business in Mississippi to act as fiscal agent. 2990
The * * * commission shall obtain services to be provided 2991
under either of the above-described provisions in accordance with 2992
the * * * Public Procurement Review Board procurement regulations. 2993
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The authorization of the foregoing methods shall not preclude 2994
other methods of providing payment of claims through direct 2995
operation of the program by the state or its agencies. 2996
SECTION 13. Section 43-13-125, Mississippi Code of 1972, is 2997
amended as follows: 2998
43-13-125. (1) If Medicaid is provided to a recipient under 2999
this article for injuries, disease or sickness caused under 3000
circumstances creating a cause of action in favor of the recipient 3001
against any person, firm, corporation, political subdivision or 3002
other state agency, then the * * * commission shall be entitled to 3003
recover the proceeds that may result from the exercise of any 3004
rights of recovery that the recipient may have against any such 3005
person, firm, corporation, political subdivision or other state 3006
agency, to the extent of the * * * commission's interest on behalf 3007
of the recipient. The recipient shall execute and deliver 3008
instruments and papers to do whatever is necessary to secure those 3009
rights and shall do nothing after Medicaid is provided to 3010
prejudice the subrogation rights of the * * * commission. Court 3011
orders or agreements for reimbursement of Medicaid's interest 3012
shall direct those payments to the * * * commission, which shall 3013
be authorized to endorse any and all, including, but not limited 3014
to, multipayee checks, drafts, money orders, or other negotiable 3015
instruments representing Medicaid payment recoveries that are 3016
received. In accordance with Section 43-13-305, endorsement of 3017
multipayee checks, drafts, money orders or other negotiable 3018
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instruments by the * * * commission shall be deemed endorsed by 3019
the recipient. All payments must be remitted to the * * * 3020
commission within sixty (60) days from the date of a settlement or 3021
the entry of a final judgment; failure to do so hereby authorizes 3022
the * * * commission to assert its rights under Sections 43-13-307 3023
and 43-13-315, plus interest. 3024
The * * * commission may compromise or settle any such claim 3025
and execute a release of any claim it has by virtue of this 3026
section at the * * * commission's sole discretion. Nothing in 3027
this section shall be construed to require the * * * commission to 3028
compromise any such claim. 3029
(2) The acceptance of Medicaid under this article or the 3030
making of a claim under this article shall not affect the right of 3031
a recipient or his or her legal representative to recover 3032
Medicaid's interest as an element of damages in any action at law; 3033
however, a copy of the pleadings shall be certified to the * * * 3034
commission at the time of the institution of suit, and proof of 3035
that notice shall be filed of record in that action. The * * * 3036
commission may, at any time before the trial on the facts, join in 3037
that action or may intervene in that action. Any amount recovered 3038
by a recipient or his or her legal representative shall be applied 3039
as follows: 3040
(a) The reasonable costs of the collection, including 3041
attorney's fees, as approved and allowed by the court in which 3042
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that action is pending, or in case of settlement without suit, by 3043
the legal representative of the * * * commission; 3044
(b) The amount of Medicaid's interest on behalf of the 3045
recipient; or such amount as may be arrived at by the legal 3046
representative of the * * * commission and the recipient's 3047
attorney; and 3048
(c) Any excess shall be awarded to the recipient. 3049
(3) No compromise of any claim by the recipient or his or 3050
her legal representative shall be binding upon or affect the 3051
rights of the * * * commission against the third party unless 3052
the * * * commission has entered into the compromise in writing. 3053
The recipient or his or her legal representative maintain the 3054
absolute duty to notify the * * * commission of the institution of 3055
legal proceedings, and the third party and his or her insurer 3056
maintain the absolute duty to notify the * * * commission of a 3057
proposed compromise for which the * * * commission has an 3058
interest. The aforementioned absolute duties may not be delegated 3059
or assigned by contract or otherwise. Any compromise effected by 3060
the recipient or his or her legal representative with the third 3061
party in the absence of advance notification to and approved by 3062
the * * * commission shall constitute conclusive evidence of the 3063
liability of the third party, and the * * * commission, in 3064
litigating its claim against the third party, shall be required 3065
only to prove the amount and correctness of its claim relating to 3066
the injury, disease or sickness. If the recipient or his or her 3067
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legal representative fails to notify the * * * commission of the 3068
institution of legal proceedings against a third party for which 3069
the * * * commission has a cause of action, the facts relating to 3070
negligence and the liability of the third party, if judgment is 3071
rendered for the recipient, shall constitute conclusive evidence 3072
of liability in a subsequent action maintained by the * * * 3073
commission and only the amount and correctness of the * * * 3074
commission's claim relating to injuries, disease or sickness shall 3075
be tried before the court. The * * * commission shall be 3076
authorized in bringing that action against the third party and his 3077
or her insurer jointly or against the insurer alone. 3078
(4) Nothing in this section shall be construed to diminish 3079
or otherwise restrict the subrogation rights of the * * * 3080
commission against a third party for Medicaid provided by 3081
the * * * commission to the recipient as a result of injuries, 3082
disease or sickness caused under circumstances creating a cause of 3083
action in favor of the recipient against such a third party. 3084
(5) Any amounts recovered by the * * * commission under this 3085
section shall, by the * * * commission, be placed to the credit of 3086
the funds appropriated for benefits under this article 3087
proportionate to the amounts provided by the state and federal 3088
governments respectively. 3089
SECTION 14. Section 43-13-139, Mississippi Code of 1972, is 3090
amended as follows: 3091
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43-13-139. Nothing contained in this article shall be 3092
construed to prevent the * * * commission, in * * * its 3093
discretion, from discontinuing or limiting medical assistance to 3094
any individuals who are classified or deemed to be within any 3095
optional group or optional category of recipients as prescribed 3096
under Title XIX of the federal Social Security Act or the 3097
implementing federal regulations. If the Congress or the United 3098
States Department of Health and Human Services ceases to provide 3099
federal matching funds for any group or category of recipients or 3100
any type of care and services, the * * * commission shall cease 3101
state funding for such group or category or such type of care and 3102
services, notwithstanding any provision of this article. If any 3103
state plan amendment submitted to comply with the provisions of 3104
Section 43-13-117 is disapproved by the United States Department 3105
of Health and Human Services, the * * * commission may operate 3106
under the state plan as previously approved by the United States 3107
Department of Health and Human Services in order to preserve 3108
federal matching funds. The * * * commission shall provide notice 3109
of the disapproval to the Chairmen of the House and Senate 3110
Medicaid Committees. 3111
SECTION 15. Section 43-13-145, Mississippi Code of 1972, is 3112
amended as follows: 3113
43-13-145. (1) (a) Upon each nursing facility licensed by 3114
the State of Mississippi, there is levied an assessment in an 3115
amount set by the * * * commission, equal to the maximum rate 3116
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allowed by federal law or regulation, for each licensed and 3117
occupied bed of the facility. 3118
(b) A nursing facility is exempt from the assessment 3119
levied under this subsection if the facility is operated under the 3120
direction and control of: 3121
(i) The United States Veterans Administration or 3122
other agency or department of the United States government; or 3123
(ii) The State Veterans Affairs Board. 3124
(2) (a) Upon each intermediate care facility for 3125
individuals with intellectual disabilities licensed by the State 3126
of Mississippi, there is levied an assessment in an amount set by 3127
the * * * commission, equal to the maximum rate allowed by federal 3128
law or regulation, for each licensed and occupied bed of the 3129
facility. 3130
(b) An intermediate care facility for individuals with 3131
intellectual disabilities is exempt from the assessment levied 3132
under this subsection if the facility is operated under the 3133
direction and control of: 3134
(i) The United States Veterans Administration or 3135
other agency or department of the United States government; 3136
(ii) The State Veterans Affairs Board; or 3137
(iii) The University of Mississippi Medical 3138
Center. 3139
(3) (a) Upon each psychiatric residential treatment 3140
facility licensed by the State of Mississippi, there is levied an 3141
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assessment in an amount set by the * * * commission, equal to the 3142
maximum rate allowed by federal law or regulation, for each 3143
licensed and occupied bed of the facility. 3144
(b) A psychiatric residential treatment facility is 3145
exempt from the assessment levied under this subsection if the 3146
facility is operated under the direction and control of: 3147
(i) The United States Veterans Administration or 3148
other agency or department of the United States government; 3149
(ii) The University of Mississippi Medical Center; 3150
or 3151
(iii) A state agency or a state facility that 3152
either provides its own state match through intergovernmental 3153
transfer or certification of funds to the * * * commission. 3154
(4) Hospital assessment. 3155
(a) (i) Subject to and upon fulfillment of the 3156
requirements and conditions of paragraph (f) below, and 3157
notwithstanding any other provisions of this section, an annual 3158
assessment on each hospital licensed in the state is imposed on 3159
each non-Medicare hospital inpatient day as defined below at a 3160
rate that is determined by dividing the sum prescribed in this 3161
subparagraph (i), plus the nonfederal share necessary to maximize 3162
the Disproportionate Share Hospital (DSH) and Medicare Upper 3163
Payment Limits (UPL) Program payments and hospital access payments 3164
and such other supplemental payments as may be developed pursuant 3165
to Section 43-13-117(A)(18), by the total number of non-Medicare 3166
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hospital inpatient days as defined below for all licensed 3167
Mississippi hospitals, except as provided in paragraph (d) below. 3168
If the state-matching funds percentage for the Mississippi 3169
Medicaid program is sixteen percent (16%) or less, the sum used in 3170
the formula under this subparagraph (i) shall be Seventy-four 3171
Million Dollars ($74,000,000.00). If the state-matching funds 3172
percentage for the Mississippi Medicaid program is twenty-four 3173
percent (24%) or higher, the sum used in the formula under this 3174
subparagraph (i) shall be One Hundred Four Million Dollars 3175
($104,000,000.00). If the state-matching funds percentage for the 3176
Mississippi Medicaid program is between sixteen percent (16%) and 3177
twenty-four percent (24%), the sum used in the formula under this 3178
subparagraph (i) shall be a pro rata amount determined as follows: 3179
the current state-matching funds percentage rate minus sixteen 3180
percent (16%) divided by eight percent (8%) multiplied by Thirty 3181
Million Dollars ($30,000,000.00) and add that amount to 3182
Seventy-four Million Dollars ($74,000,000.00). However, no 3183
assessment in a quarter under this subparagraph (i) may exceed the 3184
assessment in the previous quarter by more than Three Million 3185
Seven Hundred Fifty Thousand Dollars ($3,750,000.00) (which would 3186
be Fifteen Million Dollars ($15,000,000.00) on an annualized 3187
basis). The * * * commission shall publish the state-matching 3188
funds percentage rate applicable to the Mississippi Medicaid 3189
program on the tenth day of the first month of each quarter and 3190
the assessment determined under the formula prescribed above shall 3191
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be applicable in the quarter following any adjustment in that 3192
state-matching funds percentage rate. The * * * commission shall 3193
notify each hospital licensed in the state as to any projected 3194
increases or decreases in the assessment determined under this 3195
subparagraph (i). However, if the Centers for Medicare and 3196
Medicaid Services (CMS) does not approve the provision in Section 3197
43-13-117(39) requiring the * * * commission to reimburse 3198
crossover claims for inpatient hospital services and crossover 3199
claims covered under Medicare Part B for dually eligible 3200
beneficiaries in the same manner that was in effect on January 1, 3201
2008, the sum that otherwise would have been used in the formula 3202
under this subparagraph (i) shall be reduced by Seven Million 3203
Dollars ($7,000,000.00). 3204
(ii) In addition to the assessment provided under 3205
subparagraph (i), an additional annual assessment on each hospital 3206
licensed in the state is imposed on each non-Medicare hospital 3207
inpatient day as defined below at a rate that is determined by 3208
dividing twenty-five percent (25%) of any provider reductions in 3209
the Medicaid program as authorized in Section 43-13-117(F) for 3210
that fiscal year up to the following maximum amount, plus the 3211
nonfederal share necessary to maximize the Disproportionate Share 3212
Hospital (DSH) and inpatient Medicare Upper Payment Limits (UPL) 3213
Program payments and inpatient hospital access payments, by the 3214
total number of non-Medicare hospital inpatient days as defined 3215
below for all licensed Mississippi hospitals: in fiscal year 3216
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2010, the maximum amount shall be Twenty-four Million Dollars 3217
($24,000,000.00); in fiscal year 2011, the maximum amount shall be 3218
Thirty-two Million Dollars ($32,000,000.00); and in fiscal year 3219
2012 and thereafter, the maximum amount shall be Forty Million 3220
Dollars ($40,000,000.00). Any such deficit in the Medicaid 3221
program shall be reviewed by the PEER Committee as provided in 3222
Section 43-13-117(F). 3223
(iii) In addition to the assessments provided in 3224
subparagraphs (i) and (ii), an additional annual assessment on 3225
each hospital licensed in the state is imposed pursuant to the 3226
provisions of Section 43-13-117(F) if the cost-containment 3227
measures described therein have been implemented and there are 3228
insufficient funds in the Health Care Trust Fund to reconcile any 3229
remaining deficit in any fiscal year. If the * * * commission 3230
institutes any other additional cost-containment measures on any 3231
program or programs authorized under the Medicaid program pursuant 3232
to Section 43-13-117(F), hospitals shall be responsible for 3233
twenty-five percent (25%) of any such additional imposed provider 3234
cuts, which shall be in the form of an additional assessment not 3235
to exceed the twenty-five percent (25%) of provider expenditure 3236
reductions. Such additional assessment shall be imposed on each 3237
non-Medicare hospital inpatient day in the same manner as 3238
assessments are imposed under subparagraphs (i) and (ii). 3239
(b) Definitions. 3240
(i) [Deleted] 3241
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(ii) For purposes of this subsection (4): 3242
1. "Non-Medicare hospital inpatient day" 3243
means total hospital inpatient days including subcomponent days 3244
less Medicare inpatient days including subcomponent days from the 3245
hospital's most recent Medicare cost report for the second 3246
calendar year preceding the beginning of the state fiscal year, on 3247
file with CMS per the CMS HCRIS database, or cost report submitted 3248
to the * * * commission if the HCRIS database is not available to 3249
the * * * commission, as of June 1 of each year. 3250
a. Total hospital inpatient days shall 3251
be the sum of Worksheet S-3, Part 1, column 8 row 14, column 8 row 3252
16, and column 8 row 17, excluding column 8 rows 5 and 6. 3253
b. Hospital Medicare inpatient days 3254
shall be the sum of Worksheet S-3, Part 1, column 6 row 14, column 3255
6 row 16.00, and column 6 row 17, excluding column 6 rows 5 and 6. 3256
c. Inpatient days shall not include 3257
residential treatment or long-term care days. 3258
2. "Subcomponent inpatient day" means the 3259
number of days of care charged to a beneficiary for inpatient 3260
hospital rehabilitation and psychiatric care services in units of 3261
full days. A day begins at midnight and ends twenty-four (24) 3262
hours later. A part of a day, including the day of admission and 3263
day on which a patient returns from leave of absence, counts as a 3264
full day. However, the day of discharge, death, or a day on which 3265
a patient begins a leave of absence is not counted as a day unless 3266
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discharge or death occur on the day of admission. If admission 3267
and discharge or death occur on the same day, the day is 3268
considered a day of admission and counts as one (1) subcomponent 3269
inpatient day. 3270
(c) The assessment provided in this subsection is 3271
intended to satisfy and not be in addition to the assessment and 3272
intergovernmental transfers provided in Section 43-13-117(A)(18). 3273
Nothing in this section shall be construed to authorize any state 3274
agency, division or department, or county, municipality or other 3275
local governmental unit to license for revenue, levy or impose any 3276
other tax, fee or assessment upon hospitals in this state not 3277
authorized by a specific statute. 3278
(d) Hospitals operated by the United States Department 3279
of Veterans Affairs and state-operated facilities that provide 3280
only inpatient and outpatient psychiatric services shall not be 3281
subject to the hospital assessment provided in this subsection. 3282
(e) Multihospital systems, closure, merger, change of 3283
ownership and new hospitals. 3284
(i) If a hospital conducts, operates or maintains 3285
more than one (1) hospital licensed by the State Department of 3286
Health, the provider shall pay the hospital assessment for each 3287
hospital separately. 3288
(ii) Notwithstanding any other provision in this 3289
section, if a hospital subject to this assessment operates or 3290
conducts business only for a portion of a fiscal year, the 3291
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assessment for the state fiscal year shall be adjusted by 3292
multiplying the assessment by a fraction, the numerator of which 3293
is the number of days in the year during which the hospital 3294
operates, and the denominator of which is three hundred sixty-five 3295
(365). Immediately upon ceasing to operate, the hospital shall 3296
pay the assessment for the year as so adjusted (to the extent not 3297
previously paid). 3298
(iii) The * * * commission shall determine the tax 3299
for new hospitals and hospitals that undergo a change of ownership 3300
in accordance with this section, using the best available 3301
information, as determined by the * * * commission. 3302
(f) Applicability. 3303
The hospital assessment imposed by this subsection shall not 3304
take effect and/or shall cease to be imposed if: 3305
(i) The assessment is determined to be an 3306
impermissible tax under Title XIX of the Social Security Act; or 3307
(ii) CMS revokes its approval of the * * * 3308
commission's 2009 Medicaid State Plan Amendment for the 3309
methodology for DSH payments to hospitals under Section 3310
43-13-117(A)(18). 3311
(5) Each health care facility that is subject to the 3312
provisions of this section shall keep and preserve such suitable 3313
books and records as may be necessary to determine the amount of 3314
assessment for which it is liable under this section. The books 3315
and records shall be kept and preserved for a period of not less 3316
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than five (5) years, during which time those books and records 3317
shall be open for examination during business hours by the * * * 3318
commission, the Department of Revenue, the Office of the Attorney 3319
General and the State Department of Health. 3320
(6) [Deleted] 3321
(7) All assessments collected under this section shall be 3322
deposited in the Medical Care Fund created by Section 43-13-143. 3323
(8) The assessment levied under this section shall be in 3324
addition to any other assessments, taxes or fees levied by law, 3325
and the assessment shall constitute a debt due the State of 3326
Mississippi from the time the assessment is due until it is paid. 3327
(9) (a) If a health care facility that is liable for 3328
payment of an assessment levied by the * * * commission does not 3329
pay the assessment when it is due, the * * * commission shall give 3330
written notice to the health care facility demanding payment of 3331
the assessment within ten (10) days from the date of delivery of 3332
the notice. If the health care facility fails or refuses to pay 3333
the assessment after receiving the notice and demand from 3334
the * * * commission, the * * * commission shall withhold from any 3335
Medicaid reimbursement payments that are due to the health care 3336
facility the amount of the unpaid assessment and a penalty of ten 3337
percent (10%) of the amount of the assessment, plus the legal rate 3338
of interest until the assessment is paid in full. If the health 3339
care facility does not participate in the Medicaid program, 3340
the * * * commission shall turn over to the Office of the Attorney 3341
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General the collection of the unpaid assessment by civil action. 3342
In any such civil action, the Office of the Attorney General shall 3343
collect the amount of the unpaid assessment and a penalty of ten 3344
percent (10%) of the amount of the assessment, plus the legal rate 3345
of interest until the assessment is paid in full. 3346
(b) As an additional or alternative method for 3347
collecting unpaid assessments levied by the * * * commission, if a 3348
health care facility fails or refuses to pay the assessment after 3349
receiving notice and demand from the * * * commission, the * * * 3350
commission may file a notice of a tax lien with the chancery clerk 3351
of the county in which the health care facility is located, for 3352
the amount of the unpaid assessment and a penalty of ten percent 3353
(10%) of the amount of the assessment, plus the legal rate of 3354
interest until the assessment is paid in full. Immediately upon 3355
receipt of notice of the tax lien for the assessment, the chancery 3356
clerk shall forward the notice to the circuit clerk who shall 3357
enter the notice of the tax lien as a judgment upon the judgment 3358
roll and show in the appropriate columns the name of the health 3359
care facility as judgment debtor, the name of the * * * commission 3360
as judgment creditor, the amount of the unpaid assessment, and the 3361
date and time of enrollment. The judgment shall be valid as 3362
against mortgagees, pledgees, entrusters, purchasers, judgment 3363
creditors and other persons from the time of filing with the 3364
clerk. The amount of the judgment shall be a debt due the State 3365
of Mississippi and remain a lien upon the tangible property of the 3366
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health care facility until the judgment is satisfied. The 3367
judgment shall be the equivalent of any enrolled judgment of a 3368
court of record and shall serve as authority for the issuance of 3369
writs of execution, writs of attachment or other remedial writs. 3370
(10) (a) To further the provisions of Section 3371
43-13-117(A)(18), the * * * commission shall submit to the Centers 3372
for Medicare and Medicaid Services (CMS) any documents regarding 3373
the hospital assessment established under subsection (4) of this 3374
section. In addition to defining the assessment established in 3375
subsection (4) of this section if necessary, the documents shall 3376
describe any supplement payment programs and/or payment 3377
methodologies as authorized in Section 43-13-117(A)(18) if 3378
necessary. 3379
(b) All hospitals satisfying the minimum federal DSH 3380
eligibility requirements (Section 1923(d) of the Social Security 3381
Act) may, subject to OBRA 1993 payment limitations, receive a DSH 3382
payment. This DSH payment shall expend the balance of the federal 3383
DSH allotment and associated state share not utilized in DSH 3384
payments to state-owned institutions for treatment of mental 3385
diseases. The payment to each hospital shall be calculated by 3386
applying a uniform percentage to the uninsured costs of each 3387
eligible hospital, excluding state-owned institutions for 3388
treatment of mental diseases; however, that percentage for a 3389
state-owned teaching hospital located in Hinds County shall be 3390
multiplied by a factor of two (2). 3391
H. B. No. 130 *HR26/R147* ~ OFFICIAL ~
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(11) The * * * commission shall implement DSH and 3392
supplemental payment calculation methodologies that result in the 3393
maximization of available federal funds. 3394
(12) The DSH payments shall be paid on or before December 3395
31, March 31, and June 30 of each fiscal year, in increments of 3396
one-third (1/3) of the total calculated DSH amounts. Supplemental 3397
payments developed pursuant to Section 43-13-117(A)(18) shall be 3398
paid monthly. 3399
(13) Payment. 3400
(a) The hospital assessment as described in subsection 3401
(4) for the nonfederal share necessary to maximize the Medicare 3402
Upper Payments Limits (UPL) Program payments and hospital access 3403
payments and such other supplemental payments as may be developed 3404
pursuant to Section 43-3-117(A)(18) shall be assessed and 3405
collected monthly no later than the fifteenth calendar day of each 3406
month. 3407
(b) The hospital assessment as described in subsection 3408
(4) for the nonfederal share necessary to maximize the 3409
Disproportionate Share Hospital (DSH) payments shall be assessed 3410
and collected on December 15, March 15 and June 15. 3411
(c) The annual hospital assessment and any additional 3412
hospital assessment as described in subsection (4) shall be 3413
assessed and collected on September 15 and on the 15th of each 3414
month from December through June. 3415
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ST: Medicaid; create Medicaid Commission to
administer program and abolish Division of
Medicaid.
(14) If for any reason any part of the plan for annual DSH 3416
and supplemental payment programs to hospitals provided under 3417
subsection (10) of this section and/or developed pursuant to 3418
Section 43-13-117(A)(18) is not approved by CMS, the remainder of 3419
the plan shall remain in full force and effect. 3420
(15) Nothing in this section shall prevent the * * * 3421
commission from facilitating participation in Medicaid 3422
supplemental hospital payment programs by a hospital located in a 3423
county contiguous to the State of Mississippi that is also 3424
authorized by federal law to submit intergovernmental transfers 3425
(IGTs) to the State of Mississippi to fund the state share of the 3426
hospital's supplemental and/or MHAP payments. 3427
(16) This section shall stand repealed on July 1, 2028. 3428
SECTION 16. This act shall take effect and be in force from 3429
and after July 1, 2026. 3430