Medicaid; authorize payments to a border city university-affiliated teaching hospital under certain conditions.

H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~ G1/2
26/HR26/R2286
PAGE 1 (RF\KW)

To: Medicaid
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Lamar

HOUSE BILL NO. 1379

AN ACT TO AUTHORIZE THE DIVISION OF MEDICAID TO MAKE PAYMENTS 1
TO A BORDER CITY UNIVERSITY-AFFILIATED PEDIATRIC TEACHING HOSPITAL 2
IF THE CENTERS FOR MEDICARE AND MEDICAID SERVICES APPROVE AN 3
INCREASE IN THE ANNUAL REQUEST FOR THE PROVIDER PAYMENT INITIATIVE 4
AUTHORIZED UNDER FEDERAL REGULATIONS IN AN AMOUNT EQUAL TO OR 5
GREATER THAN THE ESTIMATED ANNUAL PAYMENT TO BE MADE TO THE BORDER 6
CITY UNIVERSITY AFFILIATED PEDIATRIC TEACHING HOSPITAL; TO BRING 7
FORWARD SECTION 43-13-117, MISSISSIPPI CODE OF 1972, FOR THE 8
PURPOSE OF POSSIBLE AMENDMENT; AND FOR RELATED PURPOSES. 9
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 10
SECTION 1. (a) This section shall be known as the 11
"Mississippi Pediatric Access to Critical Health Care Protection 12
Act." 13
(b) To align with other similar payments and address 14
access to care needs, this section provides that the Division of 15
Medicaid may make payments to a border city university-affiliated 16
pediatric teaching hospital if the Centers for Medicare and 17
Medicaid Services (CMS) approve an increase in the annual request 18
for the provider payment initiative authorized under 42 CFR 19
Section 438.6(c) in an amount equal to or greater than the 20
estimated annual payment to be made to the border city 21
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 2 (RF\KW)

university-affiliated pediatric teaching hospital. The estimate 22
shall be based on the hospital's prior year Mississippi managed 23
care utilization. 24
(b) For the purposes of this section, the term "border 25
city university-affiliated pediatric teaching hospital" means an 26
out-of-state hospital located within a city bordering the eastern 27
bank of the Mississippi River and the State of Mississippi that 28
submits to the division a copy of a current and effective 29
affiliation agreement with an accredited university and other 30
documentation establishing that the hospital is 31
university-affiliated, is licensed and designated as a pediatric 32
hospital or pediatric primary hospital within its home state, 33
maintains at least five (5) different pediatric specialty training 34
programs and maintains at least one hundred (100) operated beds 35
dedicated exclusively for the treatment of patients under the age 36
of twenty-one (21) years. 37
(c) It is the intent of the Legislature that the cost 38
of providing services to Mississippi Medicaid beneficiaries under 39
the age of twenty-one (21) years who are treated by a border city 40
university-affiliated pediatric teaching hospital shall not exceed 41
the cost of providing the same services to individuals in 42
hospitals in the state. Further, it is the intent of the 43
Legislature that payments shall not result in any in-state 44
hospital receiving payments lower than they would otherwise 45
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 3 (RF\KW)

receive if not for the payments made to any border city 46
university-affiliated pediatric teaching hospital. 47
SECTION 2. Section 43-13-117, Mississippi Code of 1972, is 48
brought forward as follows: 49
43-13-117. (A) Medicaid as authorized by this article shall 50
include payment of part or all of the costs, at the discretion of 51
the division, with approval of the Governor and the Centers for 52
Medicare and Medicaid Services, of the following types of care and 53
services rendered to eligible applicants who have been determined 54
to be eligible for that care and services, within the limits of 55
state appropriations and federal matching funds: 56
(1) Inpatient hospital services. 57
(a) The division is authorized to implement an All 58
Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement 59
methodology for inpatient hospital services. 60
(b) No service benefits or reimbursement 61
limitations in this subsection (A)(1) shall apply to payments 62
under an APR-DRG or Ambulatory Payment Classification (APC) model 63
or a managed care program or similar model described in subsection 64
(H) of this section unless specifically authorized by the 65
division. 66
(2) Outpatient hospital services. 67
(a) Emergency services. 68
(b) Other outpatient hospital services. The 69
division shall allow benefits for other medically necessary 70
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 4 (RF\KW)

outpatient hospital services (such as chemotherapy, radiation, 71
surgery and therapy), including outpatient services in a clinic or 72
other facility that is not located inside the hospital, but that 73
has been designated as an outpatient facility by the hospital, and 74
that was in operation or under construction on July 1, 2009, 75
provided that the costs and charges associated with the operation 76
of the hospital clinic are included in the hospital's cost report. 77
In addition, the Medicare thirty-five-mile rule will apply to 78
those hospital clinics not located inside the hospital that are 79
constructed after July 1, 2009. Where the same services are 80
reimbursed as clinic services, the division may revise the rate or 81
methodology of outpatient reimbursement to maintain consistency, 82
efficiency, economy and quality of care. 83
(c) The division is authorized to implement an 84
Ambulatory Payment Classification (APC) methodology for outpatient 85
hospital services. The division shall give rural hospitals that 86
have fifty (50) or fewer licensed beds the option to not be 87
reimbursed for outpatient hospital services using the APC 88
methodology, but reimbursement for outpatient hospital services 89
provided by those hospitals shall be based on one hundred one 90
percent (101%) of the rate established under Medicare for 91
outpatient hospital services. Those hospitals choosing to not be 92
reimbursed under the APC methodology shall remain under cost-based 93
reimbursement for a two-year period. 94
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 5 (RF\KW)

(d) No service benefits or reimbursement 95
limitations in this subsection (A)(2) shall apply to payments 96
under an APR-DRG or APC model or a managed care program or similar 97
model described in subsection (H) of this section unless 98
specifically authorized by the division. 99
(3) Laboratory and x-ray services. 100
(4) Nursing facility services. 101
(a) The division shall make full payment to 102
nursing facilities for each day, not exceeding forty-two (42) days 103
per year, that a patient is absent from the facility on home 104
leave. Payment may be made for the following home leave days in 105
addition to the forty-two-day limitation: Christmas, the day 106
before Christmas, the day after Christmas, Thanksgiving, the day 107
before Thanksgiving and the day after Thanksgiving. 108
(b) From and after July 1, 1997, the division 109
shall implement the integrated case-mix payment and quality 110
monitoring system, which includes the fair rental system for 111
property costs and in which recapture of depreciation is 112
eliminated. The division may reduce the payment for hospital 113
leave and therapeutic home leave days to the lower of the case-mix 114
category as computed for the resident on leave using the 115
assessment being utilized for payment at that point in time, or a 116
case-mix score of 1.000 for nursing facilities, and shall compute 117
case-mix scores of residents so that only services provided at the 118
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 6 (RF\KW)

nursing facility are considered in calculating a facility's per 119
diem. 120
(c) From and after July 1, 1997, all state-owned 121
nursing facilities shall be reimbursed on a full reasonable cost 122
basis. 123
(d) On or after January 1, 2015, the division 124
shall update the case-mix payment system resource utilization 125
grouper and classifications and fair rental reimbursement system. 126
The division shall develop and implement a payment add-on to 127
reimburse nursing facilities for ventilator-dependent resident 128
services. 129
(e) The division shall develop and implement, not 130
later than January 1, 2001, a case-mix payment add-on determined 131
by time studies and other valid statistical data that will 132
reimburse a nursing facility for the additional cost of caring for 133
a resident who has a diagnosis of Alzheimer's or other related 134
dementia and exhibits symptoms that require special care. Any 135
such case-mix add-on payment shall be supported by a determination 136
of additional cost. The division shall also develop and implement 137
as part of the fair rental reimbursement system for nursing 138
facility beds, an Alzheimer's resident bed depreciation enhanced 139
reimbursement system that will provide an incentive to encourage 140
nursing facilities to convert or construct beds for residents with 141
Alzheimer's or other related dementia. 142
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 7 (RF\KW)

(f) The division shall develop and implement an 143
assessment process for long-term care services. The division may 144
provide the assessment and related functions directly or through 145
contract with the area agencies on aging. 146
The division shall apply for necessary federal waivers to 147
assure that additional services providing alternatives to nursing 148
facility care are made available to applicants for nursing 149
facility care. 150
(5) Periodic screening and diagnostic services for 151
individuals under age twenty-one (21) years as are needed to 152
identify physical and mental defects and to provide health care 153
treatment and other measures designed to correct or ameliorate 154
defects and physical and mental illness and conditions discovered 155
by the screening services, regardless of whether these services 156
are included in the state plan. The division may include in its 157
periodic screening and diagnostic program those discretionary 158
services authorized under the federal regulations adopted to 159
implement Title XIX of the federal Social Security Act, as 160
amended. The division, in obtaining physical therapy services, 161
occupational therapy services, and services for individuals with 162
speech, hearing and language disorders, may enter into a 163
cooperative agreement with the State Department of Education for 164
the provision of those services to handicapped students by public 165
school districts using state funds that are provided from the 166
appropriation to the Department of Education to obtain federal 167
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 8 (RF\KW)

matching funds through the division. The division, in obtaining 168
medical and mental health assessments, treatment, care and 169
services for children who are in, or at risk of being put in, the 170
custody of the Mississippi Department of Human Services may enter 171
into a cooperative agreement with the Mississippi Department of 172
Human Services for the provision of those services using state 173
funds that are provided from the appropriation to the Department 174
of Human Services to obtain federal matching funds through the 175
division. 176
(6) Physician services. Fees for physician's services 177
that are covered only by Medicaid shall be reimbursed at ninety 178
percent (90%) of the rate established on January 1, 2018, and as 179
may be adjusted each July thereafter, under Medicare. The 180
division may provide for a reimbursement rate for physician's 181
services of up to one hundred percent (100%) of the rate 182
established under Medicare for physician's services that are 183
provided after the normal working hours of the physician, as 184
determined in accordance with regulations of the division. The 185
division may reimburse eligible providers, as determined by the 186
division, for certain primary care services at one hundred percent 187
(100%) of the rate established under Medicare. The division shall 188
reimburse obstetricians and gynecologists for certain primary care 189
services as defined by the division at one hundred percent (100%) 190
of the rate established under Medicare. 191
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 9 (RF\KW)

(7) (a) Home health services for eligible persons, not 192
to exceed in cost the prevailing cost of nursing facility 193
services. All home health visits must be precertified as required 194
by the division. In addition to physicians, certified registered 195
nurse practitioners, physician assistants and clinical nurse 196
specialists are authorized to prescribe or order home health 197
services and plans of care, sign home health plans of care, 198
certify and recertify eligibility for home health services and 199
conduct the required initial face-to-face visit with the recipient 200
of the services. 201
(b) [Repealed] 202
(8) Emergency medical transportation services as 203
determined by the division. 204
(9) Prescription drugs and other covered drugs and 205
services as determined by the division. 206
The division shall establish a mandatory preferred drug list. 207
Drugs not on the mandatory preferred drug list shall be made 208
available by utilizing prior authorization procedures established 209
by the division. 210
The division may seek to establish relationships with other 211
states in order to lower acquisition costs of prescription drugs 212
to include single-source and innovator multiple-source drugs or 213
generic drugs. In addition, if allowed by federal law or 214
regulation, the division may seek to establish relationships with 215
and negotiate with other countries to facilitate the acquisition 216
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 10 (RF\KW)

of prescription drugs to include single-source and innovator 217
multiple-source drugs or generic drugs, if that will lower the 218
acquisition costs of those prescription drugs. 219
The division may allow for a combination of prescriptions for 220
single-source and innovator multiple-source drugs and generic 221
drugs to meet the needs of the beneficiaries. 222
The executive director may approve specific maintenance drugs 223
for beneficiaries with certain medical conditions, which may be 224
prescribed and dispensed in three-month supply increments. 225
Drugs prescribed for a resident of a psychiatric residential 226
treatment facility must be provided in true unit doses when 227
available. The division may require that drugs not covered by 228
Medicare Part D for a resident of a long-term care facility be 229
provided in true unit doses when available. Those drugs that were 230
originally billed to the division but are not used by a resident 231
in any of those facilities shall be returned to the billing 232
pharmacy for credit to the division, in accordance with the 233
guidelines of the State Board of Pharmacy and any requirements of 234
federal law and regulation. Drugs shall be dispensed to a 235
recipient and only one (1) dispensing fee per month may be 236
charged. The division shall develop a methodology for reimbursing 237
for restocked drugs, which shall include a restock fee as 238
determined by the division not exceeding Seven Dollars and 239
Eighty-two Cents ($7.82). 240
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 11 (RF\KW)

Except for those specific maintenance drugs approved by the 241
executive director, the division shall not reimburse for any 242
portion of a prescription that exceeds a thirty-one-day supply of 243
the drug based on the daily dosage. 244
The division is authorized to develop and implement a program 245
of payment for additional pharmacist services as determined by the 246
division. 247
All claims for drugs for dually eligible Medicare/Medicaid 248
beneficiaries that are paid for by Medicare must be submitted to 249
Medicare for payment before they may be processed by the 250
division's online payment system. 251
The division shall develop a pharmacy policy in which drugs 252
in tamper-resistant packaging that are prescribed for a resident 253
of a nursing facility but are not dispensed to the resident shall 254
be returned to the pharmacy and not billed to Medicaid, in 255
accordance with guidelines of the State Board of Pharmacy. 256
The division shall develop and implement a method or methods 257
by which the division will provide on a regular basis to Medicaid 258
providers who are authorized to prescribe drugs, information about 259
the costs to the Medicaid program of single-source drugs and 260
innovator multiple-source drugs, and information about other drugs 261
that may be prescribed as alternatives to those single-source 262
drugs and innovator multiple-source drugs and the costs to the 263
Medicaid program of those alternative drugs. 264
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 12 (RF\KW)

Notwithstanding any law or regulation, information obtained 265
or maintained by the division regarding the prescription drug 266
program, including trade secrets and manufacturer or labeler 267
pricing, is confidential and not subject to disclosure except to 268
other state agencies. 269
The dispensing fee for each new or refill prescription, 270
including nonlegend or over-the-counter drugs covered by the 271
division, shall be not less than Three Dollars and Ninety-one 272
Cents ($3.91), as determined by the division. 273
The division shall not reimburse for single-source or 274
innovator multiple-source drugs if there are equally effective 275
generic equivalents available and if the generic equivalents are 276
the least expensive. 277
It is the intent of the Legislature that the pharmacists 278
providers be reimbursed for the reasonable costs of filling and 279
dispensing prescriptions for Medicaid beneficiaries. 280
The division shall allow certain drugs, including 281
physician-administered drugs, and implantable drug system devices, 282
and medical supplies, with limited distribution or limited access 283
for beneficiaries and administered in an appropriate clinical 284
setting, to be reimbursed as either a medical claim or pharmacy 285
claim, as determined by the division. 286
It is the intent of the Legislature that the division and any 287
managed care entity described in subsection (H) of this section 288
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 13 (RF\KW)

encourage the use of Alpha-Hydroxyprogesterone Caproate (17P) to 289
prevent recurrent preterm birth. 290
(10) Dental and orthodontic services to be determined 291
by the division. 292
The division shall increase the amount of the reimbursement 293
rate for diagnostic and preventative dental services for each of 294
the fiscal years 2022, 2023 and 2024 by five percent (5%) above 295
the amount of the reimbursement rate for the previous fiscal year. 296
The division shall increase the amount of the reimbursement rate 297
for restorative dental services for each of the fiscal years 2023, 298
2024 and 2025 by five percent (5%) above the amount of the 299
reimbursement rate for the previous fiscal year. It is the intent 300
of the Legislature that the reimbursement rate revision for 301
preventative dental services will be an incentive to increase the 302
number of dentists who actively provide Medicaid services. This 303
dental services reimbursement rate revision shall be known as the 304
"James Russell Dumas Medicaid Dental Services Incentive Program." 305
The Medical Care Advisory Committee, assisted by the Division 306
of Medicaid, shall annually determine the effect of this incentive 307
by evaluating the number of dentists who are Medicaid providers, 308
the number who and the degree to which they are actively billing 309
Medicaid, the geographic trends of where dentists are offering 310
what types of Medicaid services and other statistics pertinent to 311
the goals of this legislative intent. This data shall annually be 312
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 14 (RF\KW)

presented to the Chair of the Senate Medicaid Committee and the 313
Chair of the House Medicaid Committee. 314
The division shall include dental services as a necessary 315
component of overall health services provided to children who are 316
eligible for services. 317
(11) Eyeglasses for all Medicaid beneficiaries who have 318
(a) had surgery on the eyeball or ocular muscle that results in a 319
vision change for which eyeglasses or a change in eyeglasses is 320
medically indicated within six (6) months of the surgery and is in 321
accordance with policies established by the division, or (b) one 322
(1) pair every five (5) years and in accordance with policies 323
established by the division. In either instance, the eyeglasses 324
must be prescribed by a physician skilled in diseases of the eye 325
or an optometrist, whichever the beneficiary may select. 326
(12) Intermediate care facility services. 327
(a) The division shall make full payment to all 328
intermediate care facilities for individuals with intellectual 329
disabilities for each day, not exceeding sixty-three (63) days per 330
year, that a patient is absent from the facility on home leave. 331
Payment may be made for the following home leave days in addition 332
to the sixty-three-day limitation: Christmas, the day before 333
Christmas, the day after Christmas, Thanksgiving, the day before 334
Thanksgiving and the day after Thanksgiving. 335
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 15 (RF\KW)

(b) All state-owned intermediate care facilities 336
for individuals with intellectual disabilities shall be reimbursed 337
on a full reasonable cost basis. 338
(c) Effective January 1, 2015, the division shall 339
update the fair rental reimbursement system for intermediate care 340
facilities for individuals with intellectual disabilities. 341
(13) Family planning services, including drugs, 342
supplies and devices, when those services are under the 343
supervision of a physician or nurse practitioner. 344
(14) Clinic services. Preventive, diagnostic, 345
therapeutic, rehabilitative or palliative services that are 346
furnished by a facility that is not part of a hospital but is 347
organized and operated to provide medical care to outpatients. 348
Clinic services include, but are not limited to: 349
(a) Services provided by ambulatory surgical 350
centers (ASCs) as defined in Section 41-75-1(a); and 351
(b) Dialysis center services. 352
(15) Home- and community-based services for the elderly 353
and disabled, as provided under Title XIX of the federal Social 354
Security Act, as amended, under waivers, subject to the 355
availability of funds specifically appropriated for that purpose 356
by the Legislature. 357
(16) Mental health services. Certain services provided 358
by a psychiatrist shall be reimbursed at up to one hundred percent 359
(100%) of the Medicare rate. Approved therapeutic and case 360
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 16 (RF\KW)

management services (a) provided by an approved regional mental 361
health/intellectual disability center established under Sections 362
41-19-31 through 41-19-39, or by another community mental health 363
service provider meeting the requirements of the Department of 364
Mental Health to be an approved mental health/intellectual 365
disability center if determined necessary by the Department of 366
Mental Health, using state funds that are provided in the 367
appropriation to the division to match federal funds, or (b) 368
provided by a facility that is certified by the State Department 369
of Mental Health to provide therapeutic and case management 370
services, to be reimbursed on a fee for service basis, or (c) 371
provided in the community by a facility or program operated by the 372
Department of Mental Health. Any such services provided by a 373
facility described in subparagraph (b) must have the prior 374
approval of the division to be reimbursable under this section. 375
(17) Durable medical equipment services and medical 376
supplies. Precertification of durable medical equipment and 377
medical supplies must be obtained as required by the division. 378
The Division of Medicaid may require durable medical equipment 379
providers to obtain a surety bond in the amount and to the 380
specifications as established by the Balanced Budget Act of 1997. 381
A maximum dollar amount of reimbursement for noninvasive 382
ventilators or ventilation treatments properly ordered and being 383
used in an appropriate care setting shall not be set by any health 384
maintenance organization, coordinated care organization, 385
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 17 (RF\KW)

provider-sponsored health plan, or other organization paid for 386
services on a capitated basis by the division under any managed 387
care program or coordinated care program implemented by the 388
division under this section. Reimbursement by these organizations 389
to durable medical equipment suppliers for home use of noninvasive 390
and invasive ventilators shall be on a continuous monthly payment 391
basis for the duration of medical need throughout a patient's 392
valid prescription period. 393
(18) (a) Notwithstanding any other provision of this 394
section to the contrary, as provided in the Medicaid state plan 395
amendment or amendments as defined in Section 43-13-145(10), the 396
division shall make additional reimbursement to hospitals that 397
serve a disproportionate share of low-income patients and that 398
meet the federal requirements for those payments as provided in 399
Section 1923 of the federal Social Security Act and any applicable 400
regulations. It is the intent of the Legislature that the 401
division shall draw down all available federal funds allotted to 402
the state for disproportionate share hospitals. However, from and 403
after January 1, 1999, public hospitals participating in the 404
Medicaid disproportionate share program may be required to 405
participate in an intergovernmental transfer program as provided 406
in Section 1903 of the federal Social Security Act and any 407
applicable regulations. 408
(b) (i) 1. The division may establish a Medicare 409
Upper Payment Limits Program, as defined in Section 1902(a)(30) of 410
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 18 (RF\KW)

the federal Social Security Act and any applicable federal 411
regulations, or an allowable delivery system or provider payment 412
initiative authorized under 42 CFR 438.6(c), for hospitals, 413
nursing facilities and physicians employed or contracted by 414
hospitals. 415
2. The division shall establish a 416
Medicaid Supplemental Payment Program, as permitted by the federal 417
Social Security Act and a comparable allowable delivery system or 418
provider payment initiative authorized under 42 CFR 438.6(c), for 419
emergency ambulance transportation providers in accordance with 420
this subsection (A)(18)(b). 421
(ii) The division shall assess each hospital, 422
nursing facility, and emergency ambulance transportation provider 423
for the sole purpose of financing the state portion of the 424
Medicare Upper Payment Limits Program or other program(s) 425
authorized under this subsection (A)(18)(b). The hospital 426
assessment shall be as provided in Section 43-13-145(4)(a), and 427
the nursing facility and the emergency ambulance transportation 428
assessments, if established, shall be based on Medicaid 429
utilization or other appropriate method, as determined by the 430
division, consistent with federal regulations. The assessments 431
will remain in effect as long as the state participates in the 432
Medicare Upper Payment Limits Program or other program(s) 433
authorized under this subsection (A)(18)(b). In addition to the 434
hospital assessment provided in Section 43-13-145(4)(a), hospitals 435
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 19 (RF\KW)

with physicians participating in the Medicare Upper Payment Limits 436
Program or other program(s) authorized under this subsection 437
(A)(18)(b) shall be required to participate in an 438
intergovernmental transfer or assessment, as determined by the 439
division, for the purpose of financing the state portion of the 440
physician UPL payments or other payment(s) authorized under this 441
subsection (A)(18)(b). 442
(iii) Subject to approval by the Centers for 443
Medicare and Medicaid Services (CMS) and the provisions of this 444
subsection (A)(18)(b), the division shall make additional 445
reimbursement to hospitals, nursing facilities, and emergency 446
ambulance transportation providers for the Medicare Upper Payment 447
Limits Program or other program(s) authorized under this 448
subsection (A)(18)(b), and, if the program is established for 449
physicians, shall make additional reimbursement for physicians, as 450
defined in Section 1902(a)(30) of the federal Social Security Act 451
and any applicable federal regulations, provided the assessment in 452
this subsection (A)(18)(b) is in effect. 453
(iv) Notwithstanding any other provision of 454
this article to the contrary, effective upon implementation of the 455
Mississippi Hospital Access Program (MHAP) provided in 456
subparagraph (c)(i) below, the hospital portion of the inpatient 457
Upper Payment Limits Program shall transition into and be replaced 458
by the MHAP program. However, the division is authorized to 459
develop and implement an alternative fee-for-service Upper Payment 460
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 20 (RF\KW)

Limits model in accordance with federal laws and regulations if 461
necessary to preserve supplemental funding. Further, the 462
division, in consultation with the hospital industry shall develop 463
alternative models for distribution of medical claims and 464
supplemental payments for inpatient and outpatient hospital 465
services, and such models may include, but shall not be limited to 466
the following: increasing rates for inpatient and outpatient 467
services; creating a low-income utilization pool of funds to 468
reimburse hospitals for the costs of uncompensated care, charity 469
care and bad debts as permitted and approved pursuant to federal 470
regulations and the Centers for Medicare and Medicaid Services; 471
supplemental payments based upon Medicaid utilization, quality, 472
service lines and/or costs of providing such services to Medicaid 473
beneficiaries and to uninsured patients. The goals of such 474
payment models shall be to ensure access to inpatient and 475
outpatient care and to maximize any federal funds that are 476
available to reimburse hospitals for services provided. Any such 477
documents required to achieve the goals described in this 478
paragraph shall be submitted to the Centers for Medicare and 479
Medicaid Services, with a proposed effective date of July 1, 2019, 480
to the extent possible, but in no event shall the effective date 481
of such payment models be later than July 1, 2020. The Chairmen 482
of the Senate and House Medicaid Committees shall be provided a 483
copy of the proposed payment model(s) prior to submission. 484
Effective July 1, 2018, and until such time as any payment 485
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 21 (RF\KW)

model(s) as described above become effective, the division, in 486
consultation with the hospital industry, is authorized to 487
implement a transitional program for inpatient and outpatient 488
payments and/or supplemental payments (including, but not limited 489
to, MHAP and directed payments), to redistribute available 490
supplemental funds among hospital providers, provided that when 491
compared to a hospital's prior year supplemental payments, 492
supplemental payments made pursuant to any such transitional 493
program shall not result in a decrease of more than five percent 494
(5%) and shall not increase by more than the amount needed to 495
maximize the distribution of the available funds. 496
(v) 1. To preserve and improve access to 497
ambulance transportation provider services, the division shall 498
seek CMS approval to make ambulance service access payments as set 499
forth in this subsection (A)(18)(b) for all covered emergency 500
ambulance services rendered on or after July 1, 2022, and shall 501
make such ambulance service access payments for all covered 502
services rendered on or after the effective date of CMS approval. 503
2. The division shall calculate the 504
ambulance service access payment amount as the balance of the 505
portion of the Medical Care Fund related to ambulance 506
transportation service provider assessments plus any federal 507
matching funds earned on the balance, up to, but not to exceed, 508
the upper payment limit gap for all emergency ambulance service 509
providers. 510
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 22 (RF\KW)

3. a. Except for ambulance services 511
exempt from the assessment provided in this paragraph (18)(b), all 512
ambulance transportation service providers shall be eligible for 513
ambulance service access payments each state fiscal year as set 514
forth in this paragraph (18)(b). 515
b. In addition to any other funds 516
paid to ambulance transportation service providers for emergency 517
medical services provided to Medicaid beneficiaries, each eligible 518
ambulance transportation service provider shall receive ambulance 519
service access payments each state fiscal year equal to the 520
ambulance transportation service provider's upper payment limit 521
gap. Subject to approval by the Centers for Medicare and Medicaid 522
Services, ambulance service access payments shall be made no less 523
than on a quarterly basis. 524
c. As used in this paragraph 525
(18)(b)(v), the term "upper payment limit gap" means the 526
difference between the total amount that the ambulance 527
transportation service provider received from Medicaid and the 528
average amount that the ambulance transportation service provider 529
would have received from commercial insurers for those services 530
reimbursed by Medicaid. 531
4. An ambulance service access payment 532
shall not be used to offset any other payment by the division for 533
emergency or nonemergency services to Medicaid beneficiaries. 534
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 23 (RF\KW)

(c) (i) Not later than December l, 2015, the 535
division shall, subject to approval by the Centers for Medicare 536
and Medicaid Services (CMS), establish, implement and operate a 537
Mississippi Hospital Access Program (MHAP) for the purpose of 538
protecting patient access to hospital care through hospital 539
inpatient reimbursement programs provided in this section designed 540
to maintain total hospital reimbursement for inpatient services 541
rendered by in-state hospitals and the out-of-state hospital that 542
is authorized by federal law to submit intergovernmental transfers 543
(IGTs) to the State of Mississippi and is classified as Level I 544
trauma center located in a county contiguous to the state line at 545
the maximum levels permissible under applicable federal statutes 546
and regulations, at which time the current inpatient Medicare 547
Upper Payment Limits (UPL) Program for hospital inpatient services 548
shall transition to the MHAP. 549
(ii) Subject to approval by the Centers for 550
Medicare and Medicaid Services (CMS), the MHAP shall provide 551
increased inpatient capitation (PMPM) payments to managed care 552
entities contracting with the division pursuant to subsection (H) 553
of this section to support availability of hospital services or 554
such other payments permissible under federal law necessary to 555
accomplish the intent of this subsection. 556
(iii) The intent of this subparagraph (c) is 557
that effective for all inpatient hospital Medicaid services during 558
state fiscal year 2016, and so long as this provision shall remain 559
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 24 (RF\KW)

in effect hereafter, the division shall to the fullest extent 560
feasible replace the additional reimbursement for hospital 561
inpatient services under the inpatient Medicare Upper Payment 562
Limits (UPL) Program with additional reimbursement under the MHAP 563
and other payment programs for inpatient and/or outpatient 564
payments which may be developed under the authority of this 565
paragraph. 566
(iv) The division shall assess each hospital 567
as provided in Section 43-13-145(4)(a) for the purpose of 568
financing the state portion of the MHAP, supplemental payments and 569
such other purposes as specified in Section 43-13-145. The 570
assessment will remain in effect as long as the MHAP and 571
supplemental payments are in effect. 572
(19) (a) Perinatal risk management services. The 573
division shall promulgate regulations to be effective from and 574
after October 1, 1988, to establish a comprehensive perinatal 575
system for risk assessment of all pregnant and infant Medicaid 576
recipients and for management, education and follow-up for those 577
who are determined to be at risk. Services to be performed 578
include case management, nutrition assessment/counseling, 579
psychosocial assessment/counseling and health education. The 580
division shall contract with the State Department of Health to 581
provide services within this paragraph (Perinatal High Risk 582
Management/Infant Services System (PHRM/ISS)). The State 583
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 25 (RF\KW)

Department of Health shall be reimbursed on a full reasonable cost 584
basis for services provided under this subparagraph (a). 585
(b) Early intervention system services. The 586
division shall cooperate with the State Department of Health, 587
acting as lead agency, in the development and implementation of a 588
statewide system of delivery of early intervention services, under 589
Part C of the Individuals with Disabilities Education Act (IDEA). 590
The State Department of Health shall certify annually in writing 591
to the executive director of the division the dollar amount of 592
state early intervention funds available that will be utilized as 593
a certified match for Medicaid matching funds. Those funds then 594
shall be used to provide expanded targeted case management 595
services for Medicaid eligible children with special needs who are 596
eligible for the state's early intervention system. 597
Qualifications for persons providing service coordination shall be 598
determined by the State Department of Health and the Division of 599
Medicaid. 600
(20) Home- and community-based services for physically 601
disabled approved services as allowed by a waiver from the United 602
States Department of Health and Human Services for home- and 603
community-based services for physically disabled people using 604
state funds that are provided from the appropriation to the State 605
Department of Rehabilitation Services and used to match federal 606
funds under a cooperative agreement between the division and the 607
department, provided that funds for these services are 608
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 26 (RF\KW)

specifically appropriated to the Department of Rehabilitation 609
Services. 610
(21) Nurse practitioner services. Services furnished 611
by a registered nurse who is licensed and certified by the 612
Mississippi Board of Nursing as a nurse practitioner, including, 613
but not limited to, nurse anesthetists, nurse midwives, family 614
nurse practitioners, family planning nurse practitioners, 615
pediatric nurse practitioners, obstetrics-gynecology nurse 616
practitioners and neonatal nurse practitioners, under regulations 617
adopted by the division. Reimbursement for those services shall 618
not exceed ninety percent (90%) of the reimbursement rate for 619
comparable services rendered by a physician. The division may 620
provide for a reimbursement rate for nurse practitioner services 621
of up to one hundred percent (100%) of the reimbursement rate for 622
comparable services rendered by a physician for nurse practitioner 623
services that are provided after the normal working hours of the 624
nurse practitioner, as determined in accordance with regulations 625
of the division. 626
(22) Ambulatory services delivered in federally 627
qualified health centers, rural health centers and clinics of the 628
local health departments of the State Department of Health for 629
individuals eligible for Medicaid under this article based on 630
reasonable costs as determined by the division. Federally 631
qualified health centers shall be reimbursed by the Medicaid 632
prospective payment system as approved by the Centers for Medicare 633
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 27 (RF\KW)

and Medicaid Services. The division shall recognize federally 634
qualified health centers (FQHCs), rural health clinics (RHCs) and 635
community mental health centers (CMHCs) as both an originating and 636
distant site provider for the purposes of telehealth 637
reimbursement. The division is further authorized and directed to 638
reimburse FQHCs, RHCs and CMHCs for both distant site and 639
originating site services when such services are appropriately 640
provided by the same organization. 641
(23) Inpatient psychiatric services. 642
(a) Inpatient psychiatric services to be 643
determined by the division for recipients under age twenty-one 644
(21) that are provided under the direction of a physician in an 645
inpatient program in a licensed acute care psychiatric facility or 646
in a licensed psychiatric residential treatment facility, before 647
the recipient reaches age twenty-one (21) or, if the recipient was 648
receiving the services immediately before he or she reached age 649
twenty-one (21), before the earlier of the date he or she no 650
longer requires the services or the date he or she reaches age 651
twenty-two (22), as provided by federal regulations. From and 652
after January 1, 2015, the division shall update the fair rental 653
reimbursement system for psychiatric residential treatment 654
facilities. Precertification of inpatient days and residential 655
treatment days must be obtained as required by the division. From 656
and after July 1, 2009, all state-owned and state-operated 657
facilities that provide inpatient psychiatric services to persons 658
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 28 (RF\KW)

under age twenty-one (21) who are eligible for Medicaid 659
reimbursement shall be reimbursed for those services on a full 660
reasonable cost basis. 661
(b) The division may reimburse for services 662
provided by a licensed freestanding psychiatric hospital to 663
Medicaid recipients over the age of twenty-one (21) in a method 664
and manner consistent with the provisions of Section 43-13-117.5. 665
(24) [Deleted] 666
(25) [Deleted] 667
(26) Hospice care. As used in this paragraph, the term 668
"hospice care" means a coordinated program of active professional 669
medical attention within the home and outpatient and inpatient 670
care that treats the terminally ill patient and family as a unit, 671
employing a medically directed interdisciplinary team. The 672
program provides relief of severe pain or other physical symptoms 673
and supportive care to meet the special needs arising out of 674
physical, psychological, spiritual, social and economic stresses 675
that are experienced during the final stages of illness and during 676
dying and bereavement and meets the Medicare requirements for 677
participation as a hospice as provided in federal regulations. 678
(27) Group health plan premiums and cost-sharing if it 679
is cost-effective as defined by the United States Secretary of 680
Health and Human Services. 681
(28) Other health insurance premiums that are 682
cost-effective as defined by the United States Secretary of Health 683
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 29 (RF\KW)

and Human Services. Medicare eligible must have Medicare Part B 684
before other insurance premiums can be paid. 685
(29) The Division of Medicaid may apply for a waiver 686
from the United States Department of Health and Human Services for 687
home- and community-based services for developmentally disabled 688
people using state funds that are provided from the appropriation 689
to the State Department of Mental Health and/or funds transferred 690
to the department by a political subdivision or instrumentality of 691
the state and used to match federal funds under a cooperative 692
agreement between the division and the department, provided that 693
funds for these services are specifically appropriated to the 694
Department of Mental Health and/or transferred to the department 695
by a political subdivision or instrumentality of the state. 696
(30) Pediatric skilled nursing services as determined 697
by the division and in a manner consistent with regulations 698
promulgated by the Mississippi State Department of Health. 699
(31) Targeted case management services for children 700
with special needs, under waivers from the United States 701
Department of Health and Human Services, using state funds that 702
are provided from the appropriation to the Mississippi Department 703
of Human Services and used to match federal funds under a 704
cooperative agreement between the division and the department. 705
(32) Care and services provided in Christian Science 706
Sanatoria listed and certified by the Commission for Accreditation 707
of Christian Science Nursing Organizations/Facilities, Inc., 708
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 30 (RF\KW)

rendered in connection with treatment by prayer or spiritual means 709
to the extent that those services are subject to reimbursement 710
under Section 1903 of the federal Social Security Act. 711
(33) Podiatrist services. 712
(34) Assisted living services as provided through 713
home- and community-based services under Title XIX of the federal 714
Social Security Act, as amended, subject to the availability of 715
funds specifically appropriated for that purpose by the 716
Legislature. 717
(35) Services and activities authorized in Sections 718
43-27-101 and 43-27-103, using state funds that are provided from 719
the appropriation to the Mississippi Department of Human Services 720
and used to match federal funds under a cooperative agreement 721
between the division and the department. 722
(36) Nonemergency transportation services for 723
Medicaid-eligible persons as determined by the division. The PEER 724
Committee shall conduct a performance evaluation of the 725
nonemergency transportation program to evaluate the administration 726
of the program and the providers of transportation services to 727
determine the most cost-effective ways of providing nonemergency 728
transportation services to the patients served under the program. 729
The performance evaluation shall be completed and provided to the 730
members of the Senate Medicaid Committee and the House Medicaid 731
Committee not later than January 1, 2019, and every two (2) years 732
thereafter. 733
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 31 (RF\KW)

(37) [Deleted] 734
(38) Chiropractic services. A chiropractor's manual 735
manipulation of the spine to correct a subluxation, if x-ray 736
demonstrates that a subluxation exists and if the subluxation has 737
resulted in a neuromusculoskeletal condition for which 738
manipulation is appropriate treatment, and related spinal x-rays 739
performed to document these conditions. Reimbursement for 740
chiropractic services shall not exceed Seven Hundred Dollars 741
($700.00) per year per beneficiary. 742
(39) Dually eligible Medicare/Medicaid beneficiaries. 743
The division shall pay the Medicare deductible and coinsurance 744
amounts for services available under Medicare, as determined by 745
the division. From and after July 1, 2009, the division shall 746
reimburse crossover claims for inpatient hospital services and 747
crossover claims covered under Medicare Part B in the same manner 748
that was in effect on January 1, 2008, unless specifically 749
authorized by the Legislature to change this method. 750
(40) [Deleted] 751
(41) Services provided by the State Department of 752
Rehabilitation Services for the care and rehabilitation of persons 753
with spinal cord injuries or traumatic brain injuries, as allowed 754
under waivers from the United States Department of Health and 755
Human Services, using up to seventy-five percent (75%) of the 756
funds that are appropriated to the Department of Rehabilitation 757
Services from the Spinal Cord and Head Injury Trust Fund 758
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 32 (RF\KW)

established under Section 37-33-261 and used to match federal 759
funds under a cooperative agreement between the division and the 760
department. 761
(42) [Deleted] 762
(43) The division shall provide reimbursement, 763
according to a payment schedule developed by the division, for 764
smoking cessation medications for pregnant women during their 765
pregnancy and other Medicaid-eligible women who are of 766
child-bearing age. 767
(44) Nursing facility services for the severely 768
disabled. 769
(a) Severe disabilities include, but are not 770
limited to, spinal cord injuries, closed-head injuries and 771
ventilator-dependent patients. 772
(b) Those services must be provided in a long-term 773
care nursing facility dedicated to the care and treatment of 774
persons with severe disabilities. 775
(45) Physician assistant services. Services furnished 776
by a physician assistant who is licensed by the State Board of 777
Medical Licensure and is practicing with physician supervision 778
under regulations adopted by the board, under regulations adopted 779
by the division. Reimbursement for those services shall not 780
exceed ninety percent (90%) of the reimbursement rate for 781
comparable services rendered by a physician. The division may 782
provide for a reimbursement rate for physician assistant services 783
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 33 (RF\KW)

of up to one hundred percent (100%) or the reimbursement rate for 784
comparable services rendered by a physician for physician 785
assistant services that are provided after the normal working 786
hours of the physician assistant, as determined in accordance with 787
regulations of the division. 788
(46) The division shall make application to the federal 789
Centers for Medicare and Medicaid Services (CMS) for a waiver to 790
develop and provide services for children with serious emotional 791
disturbances as defined in Section 43-14-1(1), which may include 792
home- and community-based services, case management services or 793
managed care services through mental health providers certified by 794
the Department of Mental Health. The division may implement and 795
provide services under this waivered program only if funds for 796
these services are specifically appropriated for this purpose by 797
the Legislature, or if funds are voluntarily provided by affected 798
agencies. 799
(47) (a) The division may develop and implement 800
disease management programs for individuals with high-cost chronic 801
diseases and conditions, including the use of grants, waivers, 802
demonstrations or other projects as necessary. 803
(b) Participation in any disease management 804
program implemented under this paragraph (47) is optional with the 805
individual. An individual must affirmatively elect to participate 806
in the disease management program in order to participate, and may 807
elect to discontinue participation in the program at any time. 808
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 34 (RF\KW)

(48) Pediatric long-term acute care hospital services. 809
(a) Pediatric long-term acute care hospital 810
services means services provided to eligible persons under 811
twenty-one (21) years of age by a freestanding Medicare-certified 812
hospital that has an average length of inpatient stay greater than 813
twenty-five (25) days and that is primarily engaged in providing 814
chronic or long-term medical care to persons under twenty-one (21) 815
years of age. 816
(b) The services under this paragraph (48) shall 817
be reimbursed as a separate category of hospital services. 818
(49) The division may establish copayments and/or 819
coinsurance for any Medicaid services for which copayments and/or 820
coinsurance are allowable under federal law or regulation. 821
(50) Services provided by the State Department of 822
Rehabilitation Services for the care and rehabilitation of persons 823
who are deaf and blind, as allowed under waivers from the United 824
States Department of Health and Human Services to provide home- 825
and community-based services using state funds that are provided 826
from the appropriation to the State Department of Rehabilitation 827
Services or if funds are voluntarily provided by another agency. 828
(51) Upon determination of Medicaid eligibility and in 829
association with annual redetermination of Medicaid eligibility, 830
beneficiaries shall be encouraged to undertake a physical 831
examination that will establish a base-line level of health and 832
identification of a usual and customary source of care (a medical 833
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 35 (RF\KW)

home) to aid utilization of disease management tools. This 834
physical examination and utilization of these disease management 835
tools shall be consistent with current United States Preventive 836
Services Task Force or other recognized authority recommendations. 837
For persons who are determined ineligible for Medicaid, the 838
division will provide information and direction for accessing 839
medical care and services in the area of their residence. 840
(52) Notwithstanding any provisions of this article, 841
the division may pay enhanced reimbursement fees related to trauma 842
care, as determined by the division in conjunction with the State 843
Department of Health, using funds appropriated to the State 844
Department of Health for trauma care and services and used to 845
match federal funds under a cooperative agreement between the 846
division and the State Department of Health. The division, in 847
conjunction with the State Department of Health, may use grants, 848
waivers, demonstrations, enhanced reimbursements, Upper Payment 849
Limits Programs, supplemental payments, or other projects as 850
necessary in the development and implementation of this 851
reimbursement program. 852
(53) Targeted case management services for high-cost 853
beneficiaries may be developed by the division for all services 854
under this section. 855
(54) [Deleted] 856
(55) Therapy services. The plan of care for therapy 857
services may be developed to cover a period of treatment for up to 858
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 36 (RF\KW)

six (6) months, but in no event shall the plan of care exceed a 859
six-month period of treatment. The projected period of treatment 860
must be indicated on the initial plan of care and must be updated 861
with each subsequent revised plan of care. Based on medical 862
necessity, the division shall approve certification periods for 863
less than or up to six (6) months, but in no event shall the 864
certification period exceed the period of treatment indicated on 865
the plan of care. The appeal process for any reduction in therapy 866
services shall be consistent with the appeal process in federal 867
regulations. 868
(56) Prescribed pediatric extended care centers 869
services for medically dependent or technologically dependent 870
children with complex medical conditions that require continual 871
care as prescribed by the child's attending physician, as 872
determined by the division. 873
(57) No Medicaid benefit shall restrict coverage for 874
medically appropriate treatment prescribed by a physician and 875
agreed to by a fully informed individual, or if the individual 876
lacks legal capacity to consent by a person who has legal 877
authority to consent on his or her behalf, based on an 878
individual's diagnosis with a terminal condition. As used in this 879
paragraph (57), "terminal condition" means any aggressive 880
malignancy, chronic end-stage cardiovascular or cerebral vascular 881
disease, or any other disease, illness or condition which a 882
physician diagnoses as terminal. 883
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 37 (RF\KW)

(58) Treatment services for persons with opioid 884
dependency or other highly addictive substance use disorders. The 885
division is authorized to reimburse eligible providers for 886
treatment of opioid dependency and other highly addictive 887
substance use disorders, as determined by the division. Treatment 888
related to these conditions shall not count against any physician 889
visit limit imposed under this section. 890
(59) The division shall allow beneficiaries between the 891
ages of ten (10) and eighteen (18) years to receive vaccines 892
through a pharmacy venue. The division and the State Department 893
of Health shall coordinate and notify OB-GYN providers that the 894
Vaccines for Children program is available to providers free of 895
charge. 896
(60) Border city university-affiliated pediatric 897
teaching hospital. 898
(a) Payments may only be made to a border city 899
university-affiliated pediatric teaching hospital if the Centers 900
for Medicare and Medicaid Services (CMS) approve an increase in 901
the annual request for the provider payment initiative authorized 902
under 42 CFR Section 438.6(c) in an amount equal to or greater 903
than the estimated annual payment to be made to the border city 904
university-affiliated pediatric teaching hospital. The estimate 905
shall be based on the hospital's prior year Mississippi managed 906
care utilization. 907
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 38 (RF\KW)

(b) As used in this paragraph (60), the term 908
"border city university-affiliated pediatric teaching hospital" 909
means an out-of-state hospital located within a city bordering the 910
eastern bank of the Mississippi River and the State of Mississippi 911
that submits to the division a copy of a current and effective 912
affiliation agreement with an accredited university and other 913
documentation establishing that the hospital is 914
university-affiliated, is licensed and designated as a pediatric 915
hospital or pediatric primary hospital within its home state, 916
maintains at least five (5) different pediatric specialty training 917
programs, and maintains at least one hundred (100) operated beds 918
dedicated exclusively for the treatment of patients under the age 919
of twenty-one (21) years. 920
(c) The cost of providing services to Mississippi 921
Medicaid beneficiaries under the age of twenty-one (21) years who 922
are treated by a border city university-affiliated pediatric 923
teaching hospital shall not exceed the cost of providing the same 924
services to individuals in hospitals in the state. 925
(d) It is the intent of the Legislature that 926
payments shall not result in any in-state hospital receiving 927
payments lower than they would otherwise receive if not for the 928
payments made to any border city university-affiliated pediatric 929
teaching hospital. 930
(e) This paragraph (60) shall stand repealed on 931
July 1, 2024. 932
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 39 (RF\KW)

(61) Services described in Section 41-140-3 that are 933
provided by certified community health workers employed and 934
supervised by a Medicaid provider. Reimbursement for these 935
services shall be provided only if the division has received 936
approval from the Centers for Medicare and Medicaid Services for a 937
state plan amendment, waiver or alternative payment model for 938
services delivered by certified community health workers. 939
(B) Planning and development districts participating in the 940
home- and community-based services program for the elderly and 941
disabled as case management providers shall be reimbursed for case 942
management services at the maximum rate approved by the Centers 943
for Medicare and Medicaid Services (CMS). 944
(C) The division may pay to those providers who participate 945
in and accept patient referrals from the division's emergency room 946
redirection program a percentage, as determined by the division, 947
of savings achieved according to the performance measures and 948
reduction of costs required of that program. Federally qualified 949
health centers may participate in the emergency room redirection 950
program, and the division may pay those centers a percentage of 951
any savings to the Medicaid program achieved by the centers' 952
accepting patient referrals through the program, as provided in 953
this subsection (C). 954
(D) (1) As used in this subsection (D), the following terms 955
shall be defined as provided in this paragraph, except as 956
otherwise provided in this subsection: 957
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 40 (RF\KW)

(a) "Committees" means the Medicaid Committees of 958
the House of Representatives and the Senate, and "committee" means 959
either one of those committees. 960
(b) "Rate change" means an increase, decrease or 961
other change in the payments or rates of reimbursement, or a 962
change in any payment methodology that results in an increase, 963
decrease or other change in the payments or rates of 964
reimbursement, to any Medicaid provider that renders any services 965
authorized to be provided to Medicaid recipients under this 966
article. 967
(2) Whenever the Division of Medicaid proposes a rate 968
change, the division shall give notice to the chairmen of the 969
committees at least thirty (30) calendar days before the proposed 970
rate change is scheduled to take effect. The division shall 971
furnish the chairmen with a concise summary of each proposed rate 972
change along with the notice, and shall furnish the chairmen with 973
a copy of any proposed rate change upon request. The division 974
also shall provide a summary and copy of any proposed rate change 975
to any other member of the Legislature upon request. 976
(3) If the chairman of either committee or both 977
chairmen jointly object to the proposed rate change or any part 978
thereof, the chairman or chairmen shall notify the division and 979
provide the reasons for their objection in writing not later than 980
seven (7) calendar days after receipt of the notice from the 981
division. The chairman or chairmen may make written 982
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 41 (RF\KW)

recommendations to the division for changes to be made to a 983
proposed rate change. 984
(4) (a) The chairman of either committee or both 985
chairmen jointly may hold a committee meeting to review a proposed 986
rate change. If either chairman or both chairmen decide to hold a 987
meeting, they shall notify the division of their intention in 988
writing within seven (7) calendar days after receipt of the notice 989
from the division, and shall set the date and time for the meeting 990
in their notice to the division, which shall not be later than 991
fourteen (14) calendar days after receipt of the notice from the 992
division. 993
(b) After the committee meeting, the committee or 994
committees may object to the proposed rate change or any part 995
thereof. The committee or committees shall notify the division 996
and the reasons for their objection in writing not later than 997
seven (7) calendar days after the meeting. The committee or 998
committees may make written recommendations to the division for 999
changes to be made to a proposed rate change. 1000
(5) If both chairmen notify the division in writing 1001
within seven (7) calendar days after receipt of the notice from 1002
the division that they do not object to the proposed rate change 1003
and will not be holding a meeting to review the proposed rate 1004
change, the proposed rate change will take effect on the original 1005
date as scheduled by the division or on such other date as 1006
specified by the division. 1007
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 42 (RF\KW)

(6) (a) If there are any objections to a proposed rate 1008
change or any part thereof from either or both of the chairmen or 1009
the committees, the division may withdraw the proposed rate 1010
change, make any of the recommended changes to the proposed rate 1011
change, or not make any changes to the proposed rate change. 1012
(b) If the division does not make any changes to 1013
the proposed rate change, it shall notify the chairmen of that 1014
fact in writing, and the proposed rate change shall take effect on 1015
the original date as scheduled by the division or on such other 1016
date as specified by the division. 1017
(c) If the division makes any changes to the 1018
proposed rate change, the division shall notify the chairmen of 1019
its actions in writing, and the revised proposed rate change shall 1020
take effect on the date as specified by the division. 1021
(7) Nothing in this subsection (D) shall be construed 1022
as giving the chairmen or the committees any authority to veto, 1023
nullify or revise any rate change proposed by the division. The 1024
authority of the chairmen or the committees under this subsection 1025
shall be limited to reviewing, making objections to and making 1026
recommendations for changes to rate changes proposed by the 1027
division. 1028
(E) Notwithstanding any provision of this article, no new 1029
groups or categories of recipients and new types of care and 1030
services may be added without enabling legislation from the 1031
Mississippi Legislature, except that the division may authorize 1032
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 43 (RF\KW)

those changes without enabling legislation when the addition of 1033
recipients or services is ordered by a court of proper authority. 1034
(F) The executive director shall keep the Governor advised 1035
on a timely basis of the funds available for expenditure and the 1036
projected expenditures. Notwithstanding any other provisions of 1037
this article, if current or projected expenditures of the division 1038
are reasonably anticipated to exceed the amount of funds 1039
appropriated to the division for any fiscal year, the Governor, 1040
after consultation with the executive director, shall take all 1041
appropriate measures to reduce costs, which may include, but are 1042
not limited to: 1043
(1) Reducing or discontinuing any or all services that 1044
are deemed to be optional under Title XIX of the Social Security 1045
Act; 1046
(2) Reducing reimbursement rates for any or all service 1047
types; 1048
(3) Imposing additional assessments on health care 1049
providers; or 1050
(4) Any additional cost-containment measures deemed 1051
appropriate by the Governor. 1052
To the extent allowed under federal law, any reduction to 1053
services or reimbursement rates under this subsection (F) shall be 1054
accompanied by a reduction, to the fullest allowable amount, to 1055
the profit margin and administrative fee portions of capitated 1056
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 44 (RF\KW)

payments to organizations described in paragraph (1) of subsection 1057
(H). 1058
Beginning in fiscal year 2010 and in fiscal years thereafter, 1059
when Medicaid expenditures are projected to exceed funds available 1060
for the fiscal year, the division shall submit the expected 1061
shortfall information to the PEER Committee not later than 1062
December 1 of the year in which the shortfall is projected to 1063
occur. PEER shall review the computations of the division and 1064
report its findings to the Legislative Budget Office not later 1065
than January 7 in any year. 1066
(G) Notwithstanding any other provision of this article, it 1067
shall be the duty of each provider participating in the Medicaid 1068
program to keep and maintain books, documents and other records as 1069
prescribed by the Division of Medicaid in accordance with federal 1070
laws and regulations. 1071
(H) (1) Notwithstanding any other provision of this 1072
article, the division is authorized to implement (a) a managed 1073
care program, (b) a coordinated care program, (c) a coordinated 1074
care organization program, (d) a health maintenance organization 1075
program, (e) a patient-centered medical home program, (f) an 1076
accountable care organization program, (g) provider-sponsored 1077
health plan, or (h) any combination of the above programs. As a 1078
condition for the approval of any program under this subsection 1079
(H)(1), the division shall require that no managed care program, 1080
coordinated care program, coordinated care organization program, 1081
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 45 (RF\KW)

health maintenance organization program, or provider-sponsored 1082
health plan may: 1083
(a) Pay providers at a rate that is less than the 1084
Medicaid All Patient Refined Diagnosis Related Groups (APR-DRG) 1085
reimbursement rate; 1086
(b) Override the medical decisions of hospital 1087
physicians or staff regarding patients admitted to a hospital for 1088
an emergency medical condition as defined by 42 US Code Section 1089
1395dd. This restriction (b) does not prohibit the retrospective 1090
review of the appropriateness of the determination that an 1091
emergency medical condition exists by chart review or coding 1092
algorithm, nor does it prohibit prior authorization for 1093
nonemergency hospital admissions; 1094
(c) Pay providers at a rate that is less than the 1095
normal Medicaid reimbursement rate. It is the intent of the 1096
Legislature that all managed care entities described in this 1097
subsection (H), in collaboration with the division, develop and 1098
implement innovative payment models that incentivize improvements 1099
in health care quality, outcomes, or value, as determined by the 1100
division. Participation in the provider network of any managed 1101
care, coordinated care, provider-sponsored health plan, or similar 1102
contractor shall not be conditioned on the provider's agreement to 1103
accept such alternative payment models; 1104
(d) Implement a prior authorization and 1105
utilization review program for medical services, transportation 1106
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 46 (RF\KW)

services and prescription drugs that is more stringent than the 1107
prior authorization processes used by the division in its 1108
administration of the Medicaid program. Not later than December 1109
2, 2021, the contractors that are receiving capitated payments 1110
under a managed care delivery system established under this 1111
subsection (H) shall submit a report to the Chairmen of the House 1112
and Senate Medicaid Committees on the status of the prior 1113
authorization and utilization review program for medical services, 1114
transportation services and prescription drugs that is required to 1115
be implemented under this subparagraph (d); 1116
(e) [Deleted] 1117
(f) Implement a preferred drug list that is more 1118
stringent than the mandatory preferred drug list established by 1119
the division under subsection (A)(9) of this section; 1120
(g) Implement a policy which denies beneficiaries 1121
with hemophilia access to the federally funded hemophilia 1122
treatment centers as part of the Medicaid Managed Care network of 1123
providers. 1124
Each health maintenance organization, coordinated care 1125
organization, provider-sponsored health plan, or other 1126
organization paid for services on a capitated basis by the 1127
division under any managed care program or coordinated care 1128
program implemented by the division under this section shall use a 1129
clear set of level of care guidelines in the determination of 1130
medical necessity and in all utilization management practices, 1131
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 47 (RF\KW)

including the prior authorization process, concurrent reviews, 1132
retrospective reviews and payments, that are consistent with 1133
widely accepted professional standards of care. Organizations 1134
participating in a managed care program or coordinated care 1135
program implemented by the division may not use any additional 1136
criteria that would result in denial of care that would be 1137
determined appropriate and, therefore, medically necessary under 1138
those levels of care guidelines. 1139
(2) Notwithstanding any provision of this section, the 1140
recipients eligible for enrollment into a Medicaid Managed Care 1141
Program authorized under this subsection (H) may include only 1142
those categories of recipients eligible for participation in the 1143
Medicaid Managed Care Program as of January 1, 2021, the 1144
Children's Health Insurance Program (CHIP), and the CMS-approved 1145
Section 1115 demonstration waivers in operation as of January 1, 1146
2021. No expansion of Medicaid Managed Care Program contracts may 1147
be implemented by the division without enabling legislation from 1148
the Mississippi Legislature. 1149
(3) (a) Any contractors receiving capitated payments 1150
under a managed care delivery system established in this section 1151
shall provide to the Legislature and the division statistical data 1152
to be shared with provider groups in order to improve patient 1153
access, appropriate utilization, cost savings and health outcomes 1154
not later than October 1 of each year. Additionally, each 1155
contractor shall disclose to the Chairmen of the Senate and House 1156
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 48 (RF\KW)

Medicaid Committees the administrative expenses costs for the 1157
prior calendar year, and the number of full-equivalent employees 1158
located in the State of Mississippi dedicated to the Medicaid and 1159
CHIP lines of business as of June 30 of the current year. 1160
(b) The division and the contractors participating 1161
in the managed care program, a coordinated care program or a 1162
provider-sponsored health plan shall be subject to annual program 1163
reviews or audits performed by the Office of the State Auditor, 1164
the PEER Committee, the Department of Insurance and/or independent 1165
third parties. 1166
(c) Those reviews shall include, but not be 1167
limited to, at least two (2) of the following items: 1168
(i) The financial benefit to the State of 1169
Mississippi of the managed care program, 1170
(ii) The difference between the premiums paid 1171
to the managed care contractors and the payments made by those 1172
contractors to health care providers, 1173
(iii) Compliance with performance measures 1174
required under the contracts, 1175
(iv) Administrative expense allocation 1176
methodologies, 1177
(v) Whether nonprovider payments assigned as 1178
medical expenses are appropriate, 1179
(vi) Capitated arrangements with related 1180
party subcontractors, 1181
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 49 (RF\KW)

(vii) Reasonableness of corporate 1182
allocations, 1183
(viii) Value-added benefits and the extent to 1184
which they are used, 1185
(ix) The effectiveness of subcontractor 1186
oversight, including subcontractor review, 1187
(x) Whether health care outcomes have been 1188
improved, and 1189
(xi) The most common claim denial codes to 1190
determine the reasons for the denials. 1191
The audit reports shall be considered public documents and 1192
shall be posted in their entirety on the division's website. 1193
(4) All health maintenance organizations, coordinated 1194
care organizations, provider-sponsored health plans, or other 1195
organizations paid for services on a capitated basis by the 1196
division under any managed care program or coordinated care 1197
program implemented by the division under this section shall 1198
reimburse all providers in those organizations at rates no lower 1199
than those provided under this section for beneficiaries who are 1200
not participating in those programs. 1201
(5) No health maintenance organization, coordinated 1202
care organization, provider-sponsored health plan, or other 1203
organization paid for services on a capitated basis by the 1204
division under any managed care program or coordinated care 1205
program implemented by the division under this section shall 1206
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 50 (RF\KW)

require its providers or beneficiaries to use any pharmacy that 1207
ships, mails or delivers prescription drugs or legend drugs or 1208
devices. 1209
(6) (a) Not later than December 1, 2021, the 1210
contractors who are receiving capitated payments under a managed 1211
care delivery system established under this subsection (H) shall 1212
develop and implement a uniform credentialing process for 1213
providers. Under that uniform credentialing process, a provider 1214
who meets the criteria for credentialing will be credentialed with 1215
all of those contractors and no such provider will have to be 1216
separately credentialed by any individual contractor in order to 1217
receive reimbursement from the contractor. Not later than 1218
December 2, 2021, those contractors shall submit a report to the 1219
Chairmen of the House and Senate Medicaid Committees on the status 1220
of the uniform credentialing process for providers that is 1221
required under this subparagraph (a). 1222
(b) If those contractors have not implemented a 1223
uniform credentialing process as described in subparagraph (a) by 1224
December 1, 2021, the division shall develop and implement, not 1225
later than July 1, 2022, a single, consolidated credentialing 1226
process by which all providers will be credentialed. Under the 1227
division's single, consolidated credentialing process, no such 1228
contractor shall require its providers to be separately 1229
credentialed by the contractor in order to receive reimbursement 1230
from the contractor, but those contractors shall recognize the 1231
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 51 (RF\KW)

credentialing of the providers by the division's credentialing 1232
process. 1233
(c) The division shall require a uniform provider 1234
credentialing application that shall be used in the credentialing 1235
process that is established under subparagraph (a) or (b). If the 1236
contractor or division, as applicable, has not approved or denied 1237
the provider credentialing application within sixty (60) days of 1238
receipt of the completed application that includes all required 1239
information necessary for credentialing, then the contractor or 1240
division, upon receipt of a written request from the applicant and 1241
within five (5) business days of its receipt, shall issue a 1242
temporary provider credential/enrollment to the applicant if the 1243
applicant has a valid Mississippi professional or occupational 1244
license to provide the health care services to which the 1245
credential/enrollment would apply. The contractor or the division 1246
shall not issue a temporary credential/enrollment if the applicant 1247
has reported on the application a history of medical or other 1248
professional or occupational malpractice claims, a history of 1249
substance abuse or mental health issues, a criminal record, or a 1250
history of medical or other licensing board, state or federal 1251
disciplinary action, including any suspension from participation 1252
in a federal or state program. The temporary 1253
credential/enrollment shall be effective upon issuance and shall 1254
remain in effect until the provider's credentialing/enrollment 1255
application is approved or denied by the contractor or division. 1256
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 52 (RF\KW)

The contractor or division shall render a final decision regarding 1257
credentialing/enrollment of the provider within sixty (60) days 1258
from the date that the temporary provider credential/enrollment is 1259
issued to the applicant. 1260
(d) If the contractor or division does not render 1261
a final decision regarding credentialing/enrollment of the 1262
provider within the time required in subparagraph (c), the 1263
provider shall be deemed to be credentialed by and enrolled with 1264
all of the contractors and eligible to receive reimbursement from 1265
the contractors. 1266
(7) (a) Each contractor that is receiving capitated 1267
payments under a managed care delivery system established under 1268
this subsection (H) shall provide to each provider for whom the 1269
contractor has denied the coverage of a procedure that was ordered 1270
or requested by the provider for or on behalf of a patient, a 1271
letter that provides a detailed explanation of the reasons for the 1272
denial of coverage of the procedure and the name and the 1273
credentials of the person who denied the coverage. The letter 1274
shall be sent to the provider in electronic format. 1275
(b) After a contractor that is receiving capitated 1276
payments under a managed care delivery system established under 1277
this subsection (H) has denied coverage for a claim submitted by a 1278
provider, the contractor shall issue to the provider within sixty 1279
(60) days a final ruling of denial of the claim that allows the 1280
provider to have a state fair hearing and/or agency appeal with 1281
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 53 (RF\KW)

the division. If a contractor does not issue a final ruling of 1282
denial within sixty (60) days as required by this subparagraph 1283
(b), the provider's claim shall be deemed to be automatically 1284
approved and the contractor shall pay the amount of the claim to 1285
the provider. 1286
(c) After a contractor has issued a final ruling 1287
of denial of a claim submitted by a provider, the division shall 1288
conduct a state fair hearing and/or agency appeal on the matter of 1289
the disputed claim between the contractor and the provider within 1290
sixty (60) days, and shall render a decision on the matter within 1291
thirty (30) days after the date of the hearing and/or appeal. 1292
(8) It is the intention of the Legislature that the 1293
division evaluate the feasibility of using a single vendor to 1294
administer pharmacy benefits provided under a managed care 1295
delivery system established under this subsection (H). Providers 1296
of pharmacy benefits shall cooperate with the division in any 1297
transition to a carve-out of pharmacy benefits under managed care. 1298
(9) The division shall evaluate the feasibility of 1299
using a single vendor to administer dental benefits provided under 1300
a managed care delivery system established in this subsection (H). 1301
Providers of dental benefits shall cooperate with the division in 1302
any transition to a carve-out of dental benefits under managed 1303
care. 1304
(10) It is the intent of the Legislature that any 1305
contractor receiving capitated payments under a managed care 1306
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 54 (RF\KW)

delivery system established in this section shall implement 1307
innovative programs to improve the health and well-being of 1308
members diagnosed with prediabetes and diabetes. 1309
(11) It is the intent of the Legislature that any 1310
contractors receiving capitated payments under a managed care 1311
delivery system established under this subsection (H) shall work 1312
with providers of Medicaid services to improve the utilization of 1313
long-acting reversible contraceptives (LARCs). Not later than 1314
December 1, 2021, any contractors receiving capitated payments 1315
under a managed care delivery system established under this 1316
subsection (H) shall provide to the Chairmen of the House and 1317
Senate Medicaid Committees and House and Senate Public Health 1318
Committees a report of LARC utilization for State Fiscal Years 1319
2018 through 2020 as well as any programs, initiatives, or efforts 1320
made by the contractors and providers to increase LARC 1321
utilization. This report shall be updated annually to include 1322
information for subsequent state fiscal years. 1323
(12) The division is authorized to make not more than 1324
one (1) emergency extension of the contracts that are in effect on 1325
July 1, 2021, with contractors who are receiving capitated 1326
payments under a managed care delivery system established under 1327
this subsection (H), as provided in this paragraph (12). The 1328
maximum period of any such extension shall be one (1) year, and 1329
under any such extensions, the contractors shall be subject to all 1330
of the provisions of this subsection (H). The extended contracts 1331
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 55 (RF\KW)

shall be revised to incorporate any provisions of this subsection 1332
(H). 1333
(I) [Deleted] 1334
(J) There shall be no cuts in inpatient and outpatient 1335
hospital payments, or allowable days or volumes, as long as the 1336
hospital assessment provided in Section 43-13-145 is in effect. 1337
This subsection (J) shall not apply to decreases in payments that 1338
are a result of: reduced hospital admissions, audits or payments 1339
under the APR-DRG or APC models, or a managed care program or 1340
similar model described in subsection (H) of this section. 1341
(K) In the negotiation and execution of such contracts 1342
involving services performed by actuarial firms, the Executive 1343
Director of the Division of Medicaid may negotiate a limitation on 1344
liability to the state of prospective contractors. 1345
(L) The Division of Medicaid shall reimburse for services 1346
provided to eligible Medicaid beneficiaries by a licensed birthing 1347
center in a method and manner to be determined by the division in 1348
accordance with federal laws and federal regulations. The 1349
division shall seek any necessary waivers, make any required 1350
amendments to its State Plan or revise any contracts authorized 1351
under subsection (H) of this section as necessary to provide the 1352
services authorized under this subsection. As used in this 1353
subsection, the term "birthing centers" shall have the meaning as 1354
defined in Section 41-77-1(a), which is a publicly or privately 1355
owned facility, place or institution constructed, renovated, 1356
H. B. No. 1379 *HR26/R2286* ~ OFFICIAL ~
26/HR26/R2286
PAGE 56 (RF\KW)
ST: Medicaid; authorize payments to a border
city university-affiliated teaching hospital
under certain conditions.
leased or otherwise established where nonemergency births are 1357
planned to occur away from the mother's usual residence following 1358
a documented period of prenatal care for a normal uncomplicated 1359
pregnancy which has been determined to be low risk through a 1360
formal risk-scoring examination. 1361
(M) This section shall stand repealed on July 1, 2028. 1362
SECTION 3. This act shall take effect and be in force from 1363
and after July 1, 2026. 1364