Division of Medicaid; apply for waivers to eliminate waiting period for certain services.

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To: Medicaid; Appropriations
A
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representative Scott

HOUSE BILL NO. 234

AN ACT TO AMEND SECTION 43-13-121, MISSISSIPPI CODE OF 1972, 1
TO DIRECT THE DIVISION OF MEDICAID TO APPLY FOR NECESSARY WAIVERS 2
AND EXPEND FUNDS APPROPRIATED AS NECESSARY TO PROVIDE HOME- AND 3
COMMUNITY-BASED SERVICES TO PERSONS WHO ARE AGED/DISABLED, 4
PHYSICALLY DISABLED OR RECIPIENTS WITH TRAUMATIC BRAIN 5
INJURY/SPINAL CORD INJURY, TO ELIMINATE ANY WAITING PERIOD FOR 6
SERVICES; AND FOR RELATED PURPOSES. 7
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 8
SECTION 1. Section 43-13-121, Mississippi Code of 1972, is 9
amended as follows: 10
43-13-121. (1) The division shall administer the Medicaid 11
program under the provisions of this article, and may do the 12
following: 13
(a) Adopt and promulgate reasonable rules, regulations 14
and standards, with approval of the Governor, and in accordance 15
with the Administrative Procedures Law, Section 25-43-1.101 et 16
seq.: 17
(i) Establishing methods and procedures as may be 18
necessary for the proper and efficient administration of this 19
article; 20
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(ii) Providing Medicaid to all qualified 21
recipients under the provisions of this article as the division 22
may determine and within the limits of appropriated funds; 23
(iii) Establishing reasonable fees, charges and 24
rates for medical services and drugs; in doing so, the division 25
shall fix all of those fees, charges and rates at the minimum 26
levels absolutely necessary to provide the medical assistance 27
authorized by this article, and shall not change any of those 28
fees, charges or rates except as may be authorized in Section 29
43-13-117; 30
(iv) Providing for fair and impartial hearings; 31
(v) Providing safeguards for preserving the 32
confidentiality of records; and 33
(vi) For detecting and processing fraudulent 34
practices and abuses of the program; 35
(b) Receive and expend state, federal and other funds 36
in accordance with court judgments or settlements and agreements 37
between the State of Mississippi and the federal government, the 38
rules and regulations promulgated by the division, with the 39
approval of the Governor, and within the limitations and 40
restrictions of this article and within the limits of funds 41
available for that purpose; 42
(c) Subject to the limits imposed by this article and 43
subject to the provisions of subsection (8) of this section, to 44
submit a Medicaid plan to the United States Department of Health 45
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and Human Services for approval under the provisions of the 46
federal Social Security Act, to act for the state in making 47
negotiations relative to the submission and approval of that plan, 48
to make such arrangements, not inconsistent with the law, as may 49
be required by or under federal law to obtain and retain that 50
approval and to secure for the state the benefits of the 51
provisions of that law. 52
No agreements, specifically including the general plan for 53
the operation of the Medicaid program in this state, shall be made 54
by and between the division and the United States Department of 55
Health and Human Services unless the Attorney General of the State 56
of Mississippi has reviewed the agreements, specifically including 57
the operational plan, and has certified in writing to the Governor 58
and to the executive director of the division that the agreements, 59
including the plan of operation, have been drawn strictly in 60
accordance with the terms and requirements of this article; 61
(d) In accordance with the purposes and intent of this 62
article and in compliance with its provisions, provide for aged 63
persons otherwise eligible for the benefits provided under Title 64
XVIII of the federal Social Security Act by expenditure of funds 65
available for those purposes; 66
(e) To make reports to the United States Department of 67
Health and Human Services as from time to time may be required by 68
that federal department and to the Mississippi Legislature as 69
provided in this section; 70
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(f) Define and determine the scope, duration and amount 71
of Medicaid that may be provided in accordance with this article 72
and establish priorities therefor in conformity with this article; 73
(g) Cooperate and contract with other state agencies 74
for the purpose of coordinating Medicaid provided under this 75
article and eliminating duplication and inefficiency in the 76
Medicaid program; 77
(h) Adopt and use an official seal of the division; 78
(i) Sue in its own name on behalf of the State of 79
Mississippi and employ legal counsel on a contingency basis with 80
the approval of the Attorney General; 81
(j) To recover any and all payments incorrectly made by 82
the division to a recipient or provider from the recipient or 83
provider receiving the payments. The division shall be authorized 84
to collect any overpayments to providers sixty (60) days after the 85
conclusion of any administrative appeal unless the matter is 86
appealed to a court of proper jurisdiction and bond is posted. 87
Any appeal filed after July 1, 2015, shall be to the Chancery 88
Court of the First Judicial District of Hinds County, Mississippi, 89
within sixty (60) days after the date that the division has 90
notified the provider by certified mail sent to the proper address 91
of the provider on file with the division and the provider has 92
signed for the certified mail notice, or sixty (60) days after the 93
date of the final decision if the provider does not sign for the 94
certified mail notice. To recover those payments, the division 95
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may use the following methods, in addition to any other methods 96
available to the division: 97
(i) The division shall report to the Department of 98
Revenue the name of any current or former Medicaid recipient who 99
has received medical services rendered during a period of 100
established Medicaid ineligibility and who has not reimbursed the 101
division for the related medical service payment(s). The 102
Department of Revenue shall withhold from the state tax refund of 103
the individual, and pay to the division, the amount of the 104
payment(s) for medical services rendered to the ineligible 105
individual that have not been reimbursed to the division for the 106
related medical service payment(s). 107
(ii) The division shall report to the Department 108
of Revenue the name of any Medicaid provider to whom payments were 109
incorrectly made that the division has not been able to recover by 110
other methods available to the division. The Department of 111
Revenue shall withhold from the state tax refund of the provider, 112
and pay to the division, the amount of the payments that were 113
incorrectly made to the provider that have not been recovered by 114
other available methods; 115
(k) To recover any and all payments by the division 116
fraudulently obtained by a recipient or provider. Additionally, 117
if recovery of any payments fraudulently obtained by a recipient 118
or provider is made in any court, then, upon motion of the 119
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Governor, the judge of the court may award twice the payments 120
recovered as damages; 121
(l) Have full, complete and plenary power and authority 122
to conduct such investigations as it may deem necessary and 123
requisite of alleged or suspected violations or abuses of the 124
provisions of this article or of the regulations adopted under 125
this article, including, but not limited to, fraudulent or 126
unlawful act or deed by applicants for Medicaid or other benefits, 127
or payments made to any person, firm or corporation under the 128
terms, conditions and authority of this article, to suspend or 129
disqualify any provider of services, applicant or recipient for 130
gross abuse, fraudulent or unlawful acts for such periods, 131
including permanently, and under such conditions as the division 132
deems proper and just, including the imposition of a legal rate of 133
interest on the amount improperly or incorrectly paid. Recipients 134
who are found to have misused or abused Medicaid benefits may be 135
locked into one (1) physician and/or one (1) pharmacy of the 136
recipient's choice for a reasonable amount of time in order to 137
educate and promote appropriate use of medical services, in 138
accordance with federal regulations. If an administrative hearing 139
becomes necessary, the division may, if the provider does not 140
succeed in his or her defense, tax the costs of the administrative 141
hearing, including the costs of the court reporter or stenographer 142
and transcript, to the provider. The convictions of a recipient 143
or a provider in a state or federal court for abuse, fraudulent or 144
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unlawful acts under this chapter shall constitute an automatic 145
disqualification of the recipient or automatic disqualification of 146
the provider from participation under the Medicaid program. 147
A conviction, for the purposes of this chapter, shall include 148
a judgment entered on a plea of nolo contendere or a 149
nonadjudicated guilty plea and shall have the same force as a 150
judgment entered pursuant to a guilty plea or a conviction 151
following trial. A certified copy of the judgment of the court of 152
competent jurisdiction of the conviction shall constitute prima 153
facie evidence of the conviction for disqualification purposes; 154
(m) Establish and provide such methods of 155
administration as may be necessary for the proper and efficient 156
operation of the Medicaid program, fully utilizing computer 157
equipment as may be necessary to oversee and control all current 158
expenditures for purposes of this article, and to closely monitor 159
and supervise all recipient payments and vendors rendering 160
services under this article. Notwithstanding any other provision 161
of state law, the division is authorized to enter into a ten-year 162
contract(s) with a vendor(s) to provide services described in this 163
paragraph (m). Notwithstanding any provision of law to the 164
contrary, the division is authorized to extend its Medicaid 165
Management Information System, including all related components 166
and services, and Decision Support System, including all related 167
components and services, contracts in effect on June 30, 2020, for 168
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a period not to exceed two (2) years without complying with state 169
procurement regulations; 170
(n) To cooperate and contract with the federal 171
government for the purpose of providing Medicaid to Vietnamese and 172
Cambodian refugees, under the provisions of Public Law 94-23 and 173
Public Law 94-24, including any amendments to those laws, only to 174
the extent that the Medicaid assistance and the administrative 175
cost related thereto are one hundred percent (100%) reimbursable 176
by the federal government. For the purposes of Section 43-13-117, 177
persons receiving Medicaid under Public Law 94-23 and Public Law 178
94-24, including any amendments to those laws, shall not be 179
considered a new group or category of recipient; and 180
(o) The division shall impose penalties upon Medicaid 181
only, Title XIX participating long-term care facilities found to 182
be in noncompliance with division and certification standards in 183
accordance with federal and state regulations, including interest 184
at the same rate calculated by the United States Department of 185
Health and Human Services and/or the Centers for Medicare and 186
Medicaid Services (CMS) under federal regulations. 187
(2) The division also shall exercise such additional powers 188
and perform such other duties as may be conferred upon the 189
division by act of the Legislature. 190
(3) The division, and the State Department of Health as the 191
agency for licensure of health care facilities and certification 192
and inspection for the Medicaid and/or Medicare programs, shall 193
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contract for or otherwise provide for the consolidation of on-site 194
inspections of health care facilities that are necessitated by the 195
respective programs and functions of the division and the 196
department. 197
(4) The division and its hearing officers shall have power 198
to preserve and enforce order during hearings; to issue subpoenas 199
for, to administer oaths to and to compel the attendance and 200
testimony of witnesses, or the production of books, papers, 201
documents and other evidence, or the taking of depositions before 202
any designated individual competent to administer oaths; to 203
examine witnesses; and to do all things conformable to law that 204
may be necessary to enable them effectively to discharge the 205
duties of their office. In compelling the attendance and 206
testimony of witnesses, or the production of books, papers, 207
documents and other evidence, or the taking of depositions, as 208
authorized by this section, the division or its hearing officers 209
may designate an individual employed by the division or some other 210
suitable person to execute and return that process, whose action 211
in executing and returning that process shall be as lawful as if 212
done by the sheriff or some other proper officer authorized to 213
execute and return process in the county where the witness may 214
reside. In carrying out the investigatory powers under the 215
provisions of this article, the executive director or other 216
designated person or persons may examine, obtain, copy or 217
reproduce the books, papers, documents, medical charts, 218
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prescriptions and other records relating to medical care and 219
services furnished by the provider to a recipient or designated 220
recipients of Medicaid services under investigation. In the 221
absence of the voluntary submission of the books, papers, 222
documents, medical charts, prescriptions and other records, the 223
Governor, the executive director, or other designated person may 224
issue and serve subpoenas instantly upon the provider, his or her 225
agent, servant or employee for the production of the books, 226
papers, documents, medical charts, prescriptions or other records 227
during an audit or investigation of the provider. If any provider 228
or his or her agent, servant or employee refuses to produce the 229
records after being duly subpoenaed, the executive director may 230
certify those facts and institute contempt proceedings in the 231
manner, time and place as authorized by law for administrative 232
proceedings. As an additional remedy, the division may recover 233
all amounts paid to the provider covering the period of the audit 234
or investigation, inclusive of a legal rate of interest and a 235
reasonable attorney's fee and costs of court if suit becomes 236
necessary. Division staff shall have immediate access to the 237
provider's physical location, facilities, records, documents, 238
books, and any other records relating to medical care and services 239
rendered to recipients during regular business hours. 240
(5) If any person in proceedings before the division 241
disobeys or resists any lawful order or process, or misbehaves 242
during a hearing or so near the place thereof as to obstruct the 243
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hearing, or neglects to produce, after having been ordered to do 244
so, any pertinent book, paper or document, or refuses to appear 245
after having been subpoenaed, or upon appearing refuses to take 246
the oath as a witness, or after having taken the oath refuses to 247
be examined according to law, the executive director shall certify 248
the facts to any court having jurisdiction in the place in which 249
it is sitting, and the court shall thereupon, in a summary manner, 250
hear the evidence as to the acts complained of, and if the 251
evidence so warrants, punish that person in the same manner and to 252
the same extent as for a contempt committed before the court, or 253
commit that person upon the same condition as if the doing of the 254
forbidden act had occurred with reference to the process of, or in 255
the presence of, the court. 256
(6) In suspending or terminating any provider from 257
participation in the Medicaid program, the division shall preclude 258
the provider from submitting claims for payment, either personally 259
or through any clinic, group, corporation or other association to 260
the division or its fiscal agents for any services or supplies 261
provided under the Medicaid program except for those services or 262
supplies provided before the suspension or termination. No 263
clinic, group, corporation or other association that is a provider 264
of services shall submit claims for payment to the division or its 265
fiscal agents for any services or supplies provided by a person 266
within that organization who has been suspended or terminated from 267
participation in the Medicaid program except for those services or 268
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supplies provided before the suspension or termination. When this 269
provision is violated by a provider of services that is a clinic, 270
group, corporation or other association, the division may suspend 271
or terminate that organization from participation. Suspension may 272
be applied by the division to all known affiliates of a provider, 273
provided that each decision to include an affiliate is made on a 274
case-by-case basis after giving due regard to all relevant facts 275
and circumstances. The violation, failure or inadequacy of 276
performance may be imputed to a person with whom the provider is 277
affiliated where that conduct was accomplished within the course 278
of his or her official duty or was effectuated by him or her with 279
the knowledge or approval of that person. 280
(7) The division may deny or revoke enrollment in the 281
Medicaid program to a provider if any of the following are found 282
to be applicable to the provider, his or her agent, a managing 283
employee or any person having an ownership interest equal to five 284
percent (5%) or greater in the provider: 285
(a) Failure to truthfully or fully disclose any and all 286
information required, or the concealment of any and all 287
information required, on a claim, a provider application or a 288
provider agreement, or the making of a false or misleading 289
statement to the division relative to the Medicaid program. 290
(b) Previous or current exclusion, suspension, 291
termination from or the involuntary withdrawing from participation 292
in the Medicaid program, any other state's Medicaid program, 293
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Medicare or any other public or private health or health insurance 294
program. If the division ascertains that a provider has been 295
convicted of a felony under federal or state law for an offense 296
that the division determines is detrimental to the best interest 297
of the program or of Medicaid beneficiaries, the division may 298
refuse to enter into an agreement with that provider, or may 299
terminate or refuse to renew an existing agreement. 300
(c) Conviction under federal or state law of a criminal 301
offense relating to the delivery of any goods, services or 302
supplies, including the performance of management or 303
administrative services relating to the delivery of the goods, 304
services or supplies, under the Medicaid program, any other 305
state's Medicaid program, Medicare or any other public or private 306
health or health insurance program. 307
(d) Conviction under federal or state law of a criminal 308
offense relating to the neglect or abuse of a patient in 309
connection with the delivery of any goods, services or supplies. 310
(e) Conviction under federal or state law of a criminal 311
offense relating to the unlawful manufacture, distribution, 312
prescription or dispensing of a controlled substance. 313
(f) Conviction under federal or state law of a criminal 314
offense relating to fraud, theft, embezzlement, breach of 315
fiduciary responsibility or other financial misconduct. 316
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(g) Conviction under federal or state law of a criminal 317
offense punishable by imprisonment of a year or more that involves 318
moral turpitude, or acts against the elderly, children or infirm. 319
(h) Conviction under federal or state law of a criminal 320
offense in connection with the interference or obstruction of any 321
investigation into any criminal offense listed in paragraphs (c) 322
through (i) of this subsection. 323
(i) Sanction for a violation of federal or state laws 324
or rules relative to the Medicaid program, any other state's 325
Medicaid program, Medicare or any other public health care or 326
health insurance program. 327
(j) Revocation of license or certification. 328
(k) Failure to pay recovery properly assessed or 329
pursuant to an approved repayment schedule under the Medicaid 330
program. 331
(l) Failure to meet any condition of enrollment. 332
(8) (a) As used in this subsection (8), the following terms 333
shall be defined as provided in this paragraph, except as 334
otherwise provided in this subsection: 335
(i) "Committees" means the Medicaid Committees of 336
the House of Representatives and the Senate, and "committee" means 337
either one of those committees. 338
(ii) "State Plan" means the agreement between the 339
State of Mississippi and the federal government regarding the 340
nature and scope of Mississippi's Medicaid Program. 341
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(iii) "State Plan Amendment" means a change to the 342
State Plan, which must be approved by the Centers for Medicare and 343
Medicaid Services (CMS) before its implementation. 344
(b) Whenever the Division of Medicaid proposes a State 345
Plan Amendment, the division shall give notice to the chairmen of 346
the committees at least thirty (30) calendar days before the 347
proposed State Plan Amendment is filed with CMS. The division 348
shall furnish the chairmen with a concise summary of each proposed 349
State Plan Amendment along with the notice, and shall furnish the 350
chairmen with a copy of any proposed State Plan Amendment upon 351
request. The division also shall provide a summary and copy of 352
any proposed State Plan Amendment to any other member of the 353
Legislature upon request. 354
(c) If the chairman of either committee or both 355
chairmen jointly object to the proposed State Plan Amendment or 356
any part thereof, the chairman or chairmen shall notify the 357
division and provide the reasons for their objection in writing 358
not later than seven (7) calendar days after receipt of the notice 359
from the division. The chairman or chairmen may make written 360
recommendations to the division for changes to be made to a 361
proposed State Plan Amendment. 362
(d) (i) The chairman of either committee or both 363
chairmen jointly may hold a committee meeting to review a proposed 364
State Plan Amendment. If either chairman or both chairmen decide 365
to hold a meeting, they shall notify the division of their 366
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intention in writing within seven (7) calendar days after receipt 367
of the notice from the division, and shall set the date and time 368
for the meeting in their notice to the division, which shall not 369
be later than fourteen (14) calendar days after receipt of the 370
notice from the division. 371
(ii) After the committee meeting, the committee or 372
committees may object to the proposed State Plan Amendment or any 373
part thereof. The committee or committees shall notify the 374
division and the reasons for their objection in writing not later 375
than seven (7) calendar days after the meeting. The committee or 376
committees may make written recommendations to the division for 377
changes to be made to a proposed State Plan Amendment. 378
(e) If both chairmen notify the division in writing 379
within seven (7) calendar days after receipt of the notice from 380
the division that they do not object to the proposed State Plan 381
Amendment and will not be holding a meeting to review the proposed 382
State Plan Amendment, the division may proceed to file the 383
proposed State Plan Amendment with CMS. 384
(f) (i) If there are any objections to a proposed rate 385
change or any part thereof from either or both of the chairmen or 386
the committees, the division may withdraw the proposed State Plan 387
Amendment, make any of the recommended changes to the proposed 388
State Plan Amendment, or not make any changes to the proposed 389
State Plan Amendment. 390
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(ii) If the division does not make any changes to 391
the proposed State Plan Amendment, it shall notify the chairmen of 392
that fact in writing, and may proceed to file the State Plan 393
Amendment with CMS. 394
(iii) If the division makes any changes to the 395
proposed State Plan Amendment, the division shall notify the 396
chairmen of its actions in writing, and may proceed to file the 397
State Plan Amendment with CMS. 398
(g) Nothing in this subsection (8) shall be construed 399
as giving the chairmen or the committees any authority to veto, 400
nullify or revise any State Plan Amendment proposed by the 401
division. The authority of the chairmen or the committees under 402
this subsection shall be limited to reviewing, making objections 403
to and making recommendations for changes to State Plan Amendments 404
proposed by the division. 405
(i) If the division does not make any changes to 406
the proposed State Plan Amendment, it shall notify the chairmen of 407
that fact in writing, and may proceed to file the proposed State 408
Plan Amendment with CMS. 409
(ii) If the division makes any changes to the 410
proposed State Plan Amendment, the division shall notify the 411
chairmen of the changes in writing, and may proceed to file the 412
proposed State Plan Amendment with CMS. 413
(h) Nothing in this subsection (8) shall be construed 414
as giving the chairmen of the committees any authority to veto, 415
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ST: Division of Medicaid; apply for waivers to
eliminate waiting period for certain services.
nullify or revise any State Plan Amendment proposed by the 416
division. The authority of the chairmen of the committees under 417
this subsection shall be limited to reviewing, making objections 418
to and making recommendations for suggested changes to State Plan 419
Amendments proposed by the division. 420
(9) The Division of Medicaid shall apply for necessary 421
waivers and expend funds appropriated as necessary to provide 422
home- and community-based services through any CMS approved state 423
plan or home- and community-based services waiver to individuals 424
who qualify for those services and who are aged/disabled, are 425
physically disabled or are recipients with traumatic brain 426
injury/spinal cord injury, to eliminate any waiting period for 427
receiving services, or to transition a recipient from an 428
institution to any home- and community-based setting. The cost of 429
providing such home- and community-based services shall not exceed 430
the cost of nursing facility services, as determined by the 431
division. 432
SECTION 2. This act shall take effect and be in force from 433
and after July 1, 2026. 434