Medicaid; exempt Medicare-certified long-term acute hospitals from hospital assessment.

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To: Medicaid
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Hulum

HOUSE BILL NO. 1554

AN ACT TO AMEND SECTION 43-13-145, MISSISSIPPI CODE OF 1972, 1
TO EXEMPT MEDICARE-CERTIFIED LONG-TERM ACUTE CARE HOSPITALS FROM 2
THE HOSPITAL ASSESSMENT FOR THE MEDICAID PROGRAM, SUBJECT TO 3
APPROVAL BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES; AND 4
FOR RELATED PURPOSES. 5
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 6
SECTION 1. Section 43-13-145, Mississippi Code of 1972, is 7
amended as follows: 8
43-13-145. (1) (a) Upon each nursing facility licensed by 9
the State of Mississippi, there is levied an assessment in an 10
amount set by the division, equal to the maximum rate allowed by 11
federal law or regulation, for each licensed and occupied bed of 12
the facility. 13
(b) A nursing facility is exempt from the assessment 14
levied under this subsection if the facility is operated under the 15
direction and control of: 16
(i) The United States Veterans Administration or 17
other agency or department of the United States government; or 18
(ii) The State Veterans Affairs Board. 19
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(2) (a) Upon each intermediate care facility for 20
individuals with intellectual disabilities licensed by the State 21
of Mississippi, there is levied an assessment in an amount set by 22
the division, equal to the maximum rate allowed by federal law or 23
regulation, for each licensed and occupied bed of the facility. 24
(b) An intermediate care facility for individuals with 25
intellectual disabilities is exempt from the assessment levied 26
under this subsection if the facility is operated under the 27
direction and control of: 28
(i) The United States Veterans Administration or 29
other agency or department of the United States government; 30
(ii) The State Veterans Affairs Board; or 31
(iii) The University of Mississippi Medical 32
Center. 33
(3) (a) Upon each psychiatric residential treatment 34
facility licensed by the State of Mississippi, there is levied an 35
assessment in an amount set by the division, equal to the maximum 36
rate allowed by federal law or regulation, for each licensed and 37
occupied bed of the facility. 38
(b) A psychiatric residential treatment facility is 39
exempt from the assessment levied under this subsection if the 40
facility is operated under the direction and control of: 41
(i) The United States Veterans Administration or 42
other agency or department of the United States government; 43
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(ii) The University of Mississippi Medical Center; 44
or 45
(iii) A state agency or a state facility that 46
either provides its own state match through intergovernmental 47
transfer or certification of funds to the division. 48
(4) Hospital assessment. 49
(a) (i) Subject to and upon fulfillment of the 50
requirements and conditions of paragraph (f) below, and 51
notwithstanding any other provisions of this section, an annual 52
assessment on each hospital licensed in the state is imposed on 53
each non-Medicare hospital inpatient day as defined below at a 54
rate that is determined by dividing the sum prescribed in this 55
subparagraph (i), plus the nonfederal share necessary to maximize 56
the Disproportionate Share Hospital (DSH) and Medicare Upper 57
Payment Limits (UPL) Program payments and hospital access payments 58
and such other supplemental payments as may be developed pursuant 59
to Section 43-13-117(A)(18), by the total number of non-Medicare 60
hospital inpatient days as defined below for all licensed 61
Mississippi hospitals, except as provided in paragraph (d) below. 62
If the state-matching funds percentage for the Mississippi 63
Medicaid program is sixteen percent (16%) or less, the sum used in 64
the formula under this subparagraph (i) shall be Seventy-four 65
Million Dollars ($74,000,000.00). If the state-matching funds 66
percentage for the Mississippi Medicaid program is twenty-four 67
percent (24%) or higher, the sum used in the formula under this 68
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subparagraph (i) shall be One Hundred Four Million Dollars 69
($104,000,000.00). If the state-matching funds percentage for the 70
Mississippi Medicaid program is between sixteen percent (16%) and 71
twenty-four percent (24%), the sum used in the formula under this 72
subparagraph (i) shall be a pro rata amount determined as follows: 73
the current state-matching funds percentage rate minus sixteen 74
percent (16%) divided by eight percent (8%) multiplied by Thirty 75
Million Dollars ($30,000,000.00) and add that amount to 76
Seventy-four Million Dollars ($74,000,000.00). However, no 77
assessment in a quarter under this subparagraph (i) may exceed the 78
assessment in the previous quarter by more than Three Million 79
Seven Hundred Fifty Thousand Dollars ($3,750,000.00) (which would 80
be Fifteen Million Dollars ($15,000,000.00) on an annualized 81
basis). The division shall publish the state-matching funds 82
percentage rate applicable to the Mississippi Medicaid program on 83
the tenth day of the first month of each quarter and the 84
assessment determined under the formula prescribed above shall be 85
applicable in the quarter following any adjustment in that 86
state-matching funds percentage rate. The division shall notify 87
each hospital licensed in the state as to any projected increases 88
or decreases in the assessment determined under this subparagraph 89
(i). However, if the Centers for Medicare and Medicaid Services 90
(CMS) does not approve the provision in Section 43-13-117(39) 91
requiring the division to reimburse crossover claims for inpatient 92
hospital services and crossover claims covered under Medicare Part 93
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B for dually eligible beneficiaries in the same manner that was in 94
effect on January 1, 2008, the sum that otherwise would have been 95
used in the formula under this subparagraph (i) shall be reduced 96
by Seven Million Dollars ($7,000,000.00). 97
(ii) In addition to the assessment provided under 98
subparagraph (i), an additional annual assessment on each hospital 99
licensed in the state is imposed on each non-Medicare hospital 100
inpatient day as defined below at a rate that is determined by 101
dividing twenty-five percent (25%) of any provider reductions in 102
the Medicaid program as authorized in Section 43-13-117(F) for 103
that fiscal year up to the following maximum amount, plus the 104
nonfederal share necessary to maximize the Disproportionate Share 105
Hospital (DSH) and inpatient Medicare Upper Payment Limits (UPL) 106
Program payments and inpatient hospital access payments, by the 107
total number of non-Medicare hospital inpatient days as defined 108
below for all licensed Mississippi hospitals: in fiscal year 109
2010, the maximum amount shall be Twenty-four Million Dollars 110
($24,000,000.00); in fiscal year 2011, the maximum amount shall be 111
Thirty-two Million Dollars ($32,000,000.00); and in fiscal year 112
2012 and thereafter, the maximum amount shall be Forty Million 113
Dollars ($40,000,000.00). Any such deficit in the Medicaid 114
program shall be reviewed by the PEER Committee as provided in 115
Section 43-13-117(F). 116
(iii) In addition to the assessments provided in 117
subparagraphs (i) and (ii), an additional annual assessment on 118
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each hospital licensed in the state is imposed pursuant to the 119
provisions of Section 43-13-117(F) if the cost-containment 120
measures described therein have been implemented and there are 121
insufficient funds in the Health Care Trust Fund to reconcile any 122
remaining deficit in any fiscal year. If the Governor institutes 123
any other additional cost-containment measures on any program or 124
programs authorized under the Medicaid program pursuant to Section 125
43-13-117(F), hospitals shall be responsible for twenty-five 126
percent (25%) of any such additional imposed provider cuts, which 127
shall be in the form of an additional assessment not to exceed the 128
twenty-five percent (25%) of provider expenditure reductions. 129
Such additional assessment shall be imposed on each non-Medicare 130
hospital inpatient day in the same manner as assessments are 131
imposed under subparagraphs (i) and (ii). 132
(b) Definitions. 133
(i) [Deleted] 134
(ii) For purposes of this subsection (4): 135
1. "Non-Medicare hospital inpatient day" 136
means total hospital inpatient days including subcomponent days 137
less Medicare inpatient days including subcomponent days from the 138
hospital's most recent Medicare cost report for the second 139
calendar year preceding the beginning of the state fiscal year, on 140
file with CMS per the CMS HCRIS database, or cost report submitted 141
to the Division if the HCRIS database is not available to the 142
division, as of June 1 of each year. 143
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a. Total hospital inpatient days shall 144
be the sum of Worksheet S-3, Part 1, column 8 row 14, column 8 row 145
16, and column 8 row 17, excluding column 8 rows 5 and 6. 146
b. Hospital Medicare inpatient days 147
shall be the sum of Worksheet S-3, Part 1, column 6 row 14, column 148
6 row 16.00, and column 6 row 17, excluding column 6 rows 5 and 6. 149
c. Inpatient days shall not include 150
residential treatment or long-term care days. 151
2. "Subcomponent inpatient day" means the 152
number of days of care charged to a beneficiary for inpatient 153
hospital rehabilitation and psychiatric care services in units of 154
full days. A day begins at midnight and ends twenty-four (24) 155
hours later. A part of a day, including the day of admission and 156
day on which a patient returns from leave of absence, counts as a 157
full day. However, the day of discharge, death, or a day on which 158
a patient begins a leave of absence is not counted as a day unless 159
discharge or death occur on the day of admission. If admission 160
and discharge or death occur on the same day, the day is 161
considered a day of admission and counts as one (1) subcomponent 162
inpatient day. 163
(c) The assessment provided in this subsection is 164
intended to satisfy and not be in addition to the assessment and 165
intergovernmental transfers provided in Section 43-13-117(A)(18). 166
Nothing in this section shall be construed to authorize any state 167
agency, division or department, or county, municipality or other 168
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local governmental unit to license for revenue, levy or impose any 169
other tax, fee or assessment upon hospitals in this state not 170
authorized by a specific statute. 171
(d) (i) Hospitals operated by the United States 172
Department of Veterans Affairs * * *, (ii) state-operated 173
facilities that provide only inpatient and outpatient psychiatric 174
services, and (iii) Medicare-certified long-term acute care 175
hospitals, subject to approval by the Centers for Medicare and 176
Medicaid Services, shall not be subject to the hospital assessment 177
provided in this subsection. 178
(e) Multihospital systems, closure, merger, change of 179
ownership and new hospitals. 180
(i) If a hospital conducts, operates or maintains 181
more than one (1) hospital licensed by the State Department of 182
Health, the provider shall pay the hospital assessment for each 183
hospital separately. 184
(ii) Notwithstanding any other provision in this 185
section, if a hospital subject to this assessment operates or 186
conducts business only for a portion of a fiscal year, the 187
assessment for the state fiscal year shall be adjusted by 188
multiplying the assessment by a fraction, the numerator of which 189
is the number of days in the year during which the hospital 190
operates, and the denominator of which is three hundred sixty-five 191
(365). Immediately upon ceasing to operate, the hospital shall 192
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pay the assessment for the year as so adjusted (to the extent not 193
previously paid). 194
(iii) The division shall determine the tax for new 195
hospitals and hospitals that undergo a change of ownership in 196
accordance with this section, using the best available 197
information, as determined by the division. 198
(f) Applicability. 199
The hospital assessment imposed by this subsection shall not 200
take effect and/or shall cease to be imposed if: 201
(i) The assessment is determined to be an 202
impermissible tax under Title XIX of the Social Security Act; or 203
(ii) CMS revokes its approval of the division's 204
2009 Medicaid State Plan Amendment for the methodology for DSH 205
payments to hospitals under Section 43-13-117(A)(18). 206
(5) Each health care facility that is subject to the 207
provisions of this section shall keep and preserve such suitable 208
books and records as may be necessary to determine the amount of 209
assessment for which it is liable under this section. The books 210
and records shall be kept and preserved for a period of not less 211
than five (5) years, during which time those books and records 212
shall be open for examination during business hours by the 213
division, the Department of Revenue, the Office of the Attorney 214
General and the State Department of Health. 215
(6) [Deleted] 216
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(7) All assessments collected under this section shall be 217
deposited in the Medical Care Fund created by Section 43-13-143. 218
(8) The assessment levied under this section shall be in 219
addition to any other assessments, taxes or fees levied by law, 220
and the assessment shall constitute a debt due the State of 221
Mississippi from the time the assessment is due until it is paid. 222
(9) (a) If a health care facility that is liable for 223
payment of an assessment levied by the division does not pay the 224
assessment when it is due, the division shall give written notice 225
to the health care facility demanding payment of the assessment 226
within ten (10) days from the date of delivery of the notice. If 227
the health care facility fails or refuses to pay the assessment 228
after receiving the notice and demand from the division, the 229
division shall withhold from any Medicaid reimbursement payments 230
that are due to the health care facility the amount of the unpaid 231
assessment and a penalty of ten percent (10%) of the amount of the 232
assessment, plus the legal rate of interest until the assessment 233
is paid in full. If the health care facility does not participate 234
in the Medicaid program, the division shall turn over to the 235
Office of the Attorney General the collection of the unpaid 236
assessment by civil action. In any such civil action, the Office 237
of the Attorney General shall collect the amount of the unpaid 238
assessment and a penalty of ten percent (10%) of the amount of the 239
assessment, plus the legal rate of interest until the assessment 240
is paid in full. 241
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(b) As an additional or alternative method for 242
collecting unpaid assessments levied by the division, if a health 243
care facility fails or refuses to pay the assessment after 244
receiving notice and demand from the division, the division may 245
file a notice of a tax lien with the chancery clerk of the county 246
in which the health care facility is located, for the amount of 247
the unpaid assessment and a penalty of ten percent (10%) of the 248
amount of the assessment, plus the legal rate of interest until 249
the assessment is paid in full. Immediately upon receipt of 250
notice of the tax lien for the assessment, the chancery clerk 251
shall forward the notice to the circuit clerk who shall enter the 252
notice of the tax lien as a judgment upon the judgment roll and 253
show in the appropriate columns the name of the health care 254
facility as judgment debtor, the name of the division as judgment 255
creditor, the amount of the unpaid assessment, and the date and 256
time of enrollment. The judgment shall be valid as against 257
mortgagees, pledgees, entrusters, purchasers, judgment creditors 258
and other persons from the time of filing with the clerk. The 259
amount of the judgment shall be a debt due the State of 260
Mississippi and remain a lien upon the tangible property of the 261
health care facility until the judgment is satisfied. The 262
judgment shall be the equivalent of any enrolled judgment of a 263
court of record and shall serve as authority for the issuance of 264
writs of execution, writs of attachment or other remedial writs. 265
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(10) (a) To further the provisions of Section 266
43-13-117(A)(18), the Division of Medicaid shall submit to the 267
Centers for Medicare and Medicaid Services (CMS) any documents 268
regarding the hospital assessment established under subsection (4) 269
of this section. In addition to defining the assessment 270
established in subsection (4) of this section if necessary, the 271
documents shall describe any supplement payment programs and/or 272
payment methodologies as authorized in Section 43-13-117(A)(18) if 273
necessary. 274
(b) All hospitals satisfying the minimum federal DSH 275
eligibility requirements (Section 1923(d) of the Social Security 276
Act) may, subject to OBRA 1993 payment limitations, receive a DSH 277
payment. This DSH payment shall expend the balance of the federal 278
DSH allotment and associated state share not utilized in DSH 279
payments to state-owned institutions for treatment of mental 280
diseases. The payment to each hospital shall be calculated by 281
applying a uniform percentage to the uninsured costs of each 282
eligible hospital, excluding state-owned institutions for 283
treatment of mental diseases; however, that percentage for a 284
state-owned teaching hospital located in Hinds County shall be 285
multiplied by a factor of two (2). 286
(11) The division shall implement DSH and supplemental 287
payment calculation methodologies that result in the maximization 288
of available federal funds. 289
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(12) The DSH payments shall be paid on or before December 290
31, March 31, and June 30 of each fiscal year, in increments of 291
one-third (1/3) of the total calculated DSH amounts. Supplemental 292
payments developed pursuant to Section 43-13-117(A)(18) shall be 293
paid monthly. 294
(13) Payment. 295
(a) The hospital assessment as described in subsection 296
(4) for the nonfederal share necessary to maximize the Medicare 297
Upper Payments Limits (UPL) Program payments and hospital access 298
payments and such other supplemental payments as may be developed 299
pursuant to Section 43-3-117(A)(18) shall be assessed and 300
collected monthly no later than the fifteenth calendar day of each 301
month. 302
(b) The hospital assessment as described in subsection 303
(4) for the nonfederal share necessary to maximize the 304
Disproportionate Share Hospital (DSH) payments shall be assessed 305
and collected on December 15, March 15 and June 15. 306
(c) The annual hospital assessment and any additional 307
hospital assessment as described in subsection (4) shall be 308
assessed and collected on September 15 and on the 15th of each 309
month from December through June. 310
(14) If for any reason any part of the plan for annual DSH 311
and supplemental payment programs to hospitals provided under 312
subsection (10) of this section and/or developed pursuant to 313
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ST: Medicaid; exempt Medicare-certified long-
term acute hospitals from hospital assessment.
Section 43-13-117(A)(18) is not approved by CMS, the remainder of 314
the plan shall remain in full force and effect. 315
(15) Nothing in this section shall prevent the Division of 316
Medicaid from facilitating participation in Medicaid supplemental 317
hospital payment programs by a hospital located in a county 318
contiguous to the State of Mississippi that is also authorized by 319
federal law to submit intergovernmental transfers (IGTs) to the 320
State of Mississippi to fund the state share of the hospital's 321
supplemental and/or MHAP payments. 322
(16) This section shall stand repealed on July 1, 2028. 323
SECTION 2. This act shall take effect and be in force from 324
and after July 1, 2026. 325