Medicaid; division shall allow provider to repay incorrect payments made to provider under an installment repayment plan.

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To: Medicaid
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representatives McGee, Scott

HOUSE BILL NO. 737
(As Passed the House)

AN ACT TO AMEND SECTION 43-13-121, MISSISSIPPI CODE OF 1972, 1
TO PROVIDE THAT IF THE DIVISION OF MEDICAID HAS INCORRECTLY MADE 2
PAYMENTS TO A MEDICAID PROVIDER THAT ARE NOT AS A RESULT OF FRAUD 3
OR ABUSE BY THE PROVIDER AND THE PROVIDER IS UNABLE TO IMMEDIATELY 4
REPAY ALL OF THE INCORRECT PAYMENTS, OR IF IMMEDIATE REPAYMENT OF 5
THE INCORRECT PAYMENTS WOULD CONSTITUTE A SUBSTANTIAL FINANCIAL 6
HARDSHIP ON THE PROVIDER, THE DIVISION SHALL ALLOW THE PROVIDER TO 7
REPAY THE INCORRECT PAYMENTS UNDER AN INSTALLMENT REPAYMENT PLAN, 8
WITH FULL REPAYMENT BEING REQUIRED NOT MORE THAN TWELVE MONTHS 9
AFTER NOTIFICATION BY THE DIVISION OR SUCH LONGER PERIOD OF TIME 10
AS MAY BE ALLOWED UNDER FEDERAL LAW OR REGULATION; AND FOR RELATED 11
PURPOSES. 12
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 13
SECTION 1. Section 43-13-121, Mississippi Code of 1972, is 14
amended as follows: 15
43-13-121. (1) The division shall administer the Medicaid 16
program under the provisions of this article, and may do the 17
following: 18
(a) Adopt and promulgate reasonable rules, regulations 19
and standards, with approval of the Governor, and in accordance 20
with the Administrative Procedures Law, Section 25-43-1.101 et 21
seq.: 22
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(i) Establishing methods and procedures as may be 23
necessary for the proper and efficient administration of this 24
article; 25
(ii) Providing Medicaid to all qualified 26
recipients under the provisions of this article as the division 27
may determine and within the limits of appropriated funds; 28
(iii) Establishing reasonable fees, charges and 29
rates for medical services and drugs; in doing so, the division 30
shall fix all of those fees, charges and rates at the minimum 31
levels absolutely necessary to provide the medical assistance 32
authorized by this article, and shall not change any of those 33
fees, charges or rates except as may be authorized in Section 34
43-13-117; 35
(iv) Providing for fair and impartial hearings; 36
(v) Providing safeguards for preserving the 37
confidentiality of records; and 38
(vi) For detecting and processing fraudulent 39
practices and abuses of the program; 40
(b) Receive and expend state, federal and other funds 41
in accordance with court judgments or settlements and agreements 42
between the State of Mississippi and the federal government, the 43
rules and regulations promulgated by the division, with the 44
approval of the Governor, and within the limitations and 45
restrictions of this article and within the limits of funds 46
available for that purpose; 47
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(c) Subject to the limits imposed by this article and 48
subject to the provisions of subsection (8) of this section, to 49
submit a Medicaid plan to the United States Department of Health 50
and Human Services for approval under the provisions of the 51
federal Social Security Act, to act for the state in making 52
negotiations relative to the submission and approval of that plan, 53
to make such arrangements, not inconsistent with the law, as may 54
be required by or under federal law to obtain and retain that 55
approval and to secure for the state the benefits of the 56
provisions of that law. 57
No agreements, specifically including the general plan for 58
the operation of the Medicaid program in this state, shall be made 59
by and between the division and the United States Department of 60
Health and Human Services unless the Attorney General of the State 61
of Mississippi has reviewed the agreements, specifically including 62
the operational plan, and has certified in writing to the Governor 63
and to the executive director of the division that the agreements, 64
including the plan of operation, have been drawn strictly in 65
accordance with the terms and requirements of this article; 66
(d) In accordance with the purposes and intent of this 67
article and in compliance with its provisions, provide for aged 68
persons otherwise eligible for the benefits provided under Title 69
XVIII of the federal Social Security Act by expenditure of funds 70
available for those purposes; 71
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(e) To make reports to the United States Department of 72
Health and Human Services as from time to time may be required by 73
that federal department and to the Mississippi Legislature as 74
provided in this section; 75
(f) Define and determine the scope, duration and amount 76
of Medicaid that may be provided in accordance with this article 77
and establish priorities therefor in conformity with this article; 78
(g) Cooperate and contract with other state agencies 79
for the purpose of coordinating Medicaid provided under this 80
article and eliminating duplication and inefficiency in the 81
Medicaid program; 82
(h) Adopt and use an official seal of the division; 83
(i) Sue in its own name on behalf of the State of 84
Mississippi and employ legal counsel on a contingency basis with 85
the approval of the Attorney General; 86
(j) To recover any and all payments incorrectly made by 87
the division to a recipient or provider from the recipient or 88
provider receiving the payments. The division shall be authorized 89
to collect any overpayments to providers sixty (60) days after the 90
conclusion of any administrative appeal unless the matter is 91
appealed to a court of proper jurisdiction and bond is posted. 92
Any appeal filed after July 1, 2015, shall be to the Chancery 93
Court of the First Judicial District of Hinds County, Mississippi, 94
within sixty (60) days after the date that the division has 95
notified the provider by certified mail sent to the proper address 96
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of the provider on file with the division and the provider has 97
signed for the certified mail notice, or sixty (60) days after the 98
date of the final decision if the provider does not sign for the 99
certified mail notice. To recover those payments, the division 100
may use the following methods, in addition to any other methods 101
available to the division: 102
(i) The division shall report to the Department of 103
Revenue the name of any current or former Medicaid recipient who 104
has received medical services rendered during a period of 105
established Medicaid ineligibility and who has not reimbursed the 106
division for the related medical service payment(s). The 107
Department of Revenue shall withhold from the state tax refund of 108
the individual, and pay to the division, the amount of the 109
payment(s) for medical services rendered to the ineligible 110
individual that have not been reimbursed to the division for the 111
related medical service payment(s). 112
(ii) The division shall report to the Department 113
of Revenue the name of any Medicaid provider to whom payments were 114
incorrectly made that the division has not been able to recover by 115
other methods available to the division. The Department of 116
Revenue shall withhold from the state tax refund of the provider, 117
and pay to the division, the amount of the payments that were 118
incorrectly made to the provider that have not been recovered by 119
other available methods. 120
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If a provider is unable to immediately repay all of the 121
payments incorrectly made to the provider by the division that are 122
not as a result of fraud or abuse by the provider or if immediate 123
repayment of the full amount of the incorrect payments would 124
constitute a substantial financial hardship on the provider as 125
demonstrated by the provider, the division shall allow the 126
provider to repay the full amount of the incorrect payments under 127
an installment repayment plan negotiated between the provider and 128
the division, with full repayment being required not more than 129
twelve (12) months after notification by the division or such 130
longer period of time as may be allowed under federal law or 131
regulation; 132
(k) To recover any and all payments by the division 133
fraudulently obtained by a recipient or provider. Additionally, 134
if recovery of any payments fraudulently obtained by a recipient 135
or provider is made in any court, then, upon motion of the 136
Governor, the judge of the court may award twice the payments 137
recovered as damages; 138
(l) Have full, complete and plenary power and authority 139
to conduct such investigations as it may deem necessary and 140
requisite of alleged or suspected violations or abuses of the 141
provisions of this article or of the regulations adopted under 142
this article, including, but not limited to, fraudulent or 143
unlawful act or deed by applicants for Medicaid or other benefits, 144
or payments made to any person, firm or corporation under the 145
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terms, conditions and authority of this article, to suspend or 146
disqualify any provider of services, applicant or recipient for 147
gross abuse, fraudulent or unlawful acts for such periods, 148
including permanently, and under such conditions as the division 149
deems proper and just, including the imposition of a legal rate of 150
interest on the amount improperly or incorrectly paid. Recipients 151
who are found to have misused or abused Medicaid benefits may be 152
locked into one (1) physician and/or one (1) pharmacy of the 153
recipient's choice for a reasonable amount of time in order to 154
educate and promote appropriate use of medical services, in 155
accordance with federal regulations. If an administrative hearing 156
becomes necessary, the division may, if the provider does not 157
succeed in his or her defense, tax the costs of the administrative 158
hearing, including the costs of the court reporter or stenographer 159
and transcript, to the provider. The convictions of a recipient 160
or a provider in a state or federal court for abuse, fraudulent or 161
unlawful acts under this chapter shall constitute an automatic 162
disqualification of the recipient or automatic disqualification of 163
the provider from participation under the Medicaid program. 164
A conviction, for the purposes of this chapter, shall include 165
a judgment entered on a plea of nolo contendere or a 166
nonadjudicated guilty plea and shall have the same force as a 167
judgment entered pursuant to a guilty plea or a conviction 168
following trial. A certified copy of the judgment of the court of 169
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competent jurisdiction of the conviction shall constitute prima 170
facie evidence of the conviction for disqualification purposes; 171
(m) Establish and provide such methods of 172
administration as may be necessary for the proper and efficient 173
operation of the Medicaid program, fully utilizing computer 174
equipment as may be necessary to oversee and control all current 175
expenditures for purposes of this article, and to closely monitor 176
and supervise all recipient payments and vendors rendering 177
services under this article. Notwithstanding any other provision 178
of state law, the division is authorized to enter into a ten-year 179
contract(s) with a vendor(s) to provide services described in this 180
paragraph (m). Notwithstanding any provision of law to the 181
contrary, the division is authorized to extend its Medicaid 182
Management Information System, including all related components 183
and services, and Decision Support System, including all related 184
components and services, contracts in effect on June 30, 2020, for 185
a period not to exceed two (2) years without complying with state 186
procurement regulations; 187
(n) To cooperate and contract with the federal 188
government for the purpose of providing Medicaid to Vietnamese and 189
Cambodian refugees, under the provisions of Public Law 94-23 and 190
Public Law 94-24, including any amendments to those laws, only to 191
the extent that the Medicaid assistance and the administrative 192
cost related thereto are one hundred percent (100%) reimbursable 193
by the federal government. For the purposes of Section 43-13-117, 194
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persons receiving Medicaid under Public Law 94-23 and Public Law 195
94-24, including any amendments to those laws, shall not be 196
considered a new group or category of recipient; and 197
(o) The division shall impose penalties upon Medicaid 198
only, Title XIX participating long-term care facilities found to 199
be in noncompliance with division and certification standards in 200
accordance with federal and state regulations, including interest 201
at the same rate calculated by the United States Department of 202
Health and Human Services and/or the Centers for Medicare and 203
Medicaid Services (CMS) under federal regulations. 204
(2) The division also shall exercise such additional powers 205
and perform such other duties as may be conferred upon the 206
division by act of the Legislature. 207
(3) The division, and the State Department of Health as the 208
agency for licensure of health care facilities and certification 209
and inspection for the Medicaid and/or Medicare programs, shall 210
contract for or otherwise provide for the consolidation of on-site 211
inspections of health care facilities that are necessitated by the 212
respective programs and functions of the division and the 213
department. 214
(4) The division and its hearing officers shall have power 215
to preserve and enforce order during hearings; to issue subpoenas 216
for, to administer oaths to and to compel the attendance and 217
testimony of witnesses, or the production of books, papers, 218
documents and other evidence, or the taking of depositions before 219
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any designated individual competent to administer oaths; to 220
examine witnesses; and to do all things conformable to law that 221
may be necessary to enable them effectively to discharge the 222
duties of their office. In compelling the attendance and 223
testimony of witnesses, or the production of books, papers, 224
documents and other evidence, or the taking of depositions, as 225
authorized by this section, the division or its hearing officers 226
may designate an individual employed by the division or some other 227
suitable person to execute and return that process, whose action 228
in executing and returning that process shall be as lawful as if 229
done by the sheriff or some other proper officer authorized to 230
execute and return process in the county where the witness may 231
reside. In carrying out the investigatory powers under the 232
provisions of this article, the executive director or other 233
designated person or persons may examine, obtain, copy or 234
reproduce the books, papers, documents, medical charts, 235
prescriptions and other records relating to medical care and 236
services furnished by the provider to a recipient or designated 237
recipients of Medicaid services under investigation. In the 238
absence of the voluntary submission of the books, papers, 239
documents, medical charts, prescriptions and other records, the 240
Governor, the executive director, or other designated person may 241
issue and serve subpoenas instantly upon the provider, his or her 242
agent, servant or employee for the production of the books, 243
papers, documents, medical charts, prescriptions or other records 244
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during an audit or investigation of the provider. If any provider 245
or his or her agent, servant or employee refuses to produce the 246
records after being duly subpoenaed, the executive director may 247
certify those facts and institute contempt proceedings in the 248
manner, time and place as authorized by law for administrative 249
proceedings. As an additional remedy, the division may recover 250
all amounts paid to the provider covering the period of the audit 251
or investigation, inclusive of a legal rate of interest and a 252
reasonable attorney's fee and costs of court if suit becomes 253
necessary. Division staff shall have immediate access to the 254
provider's physical location, facilities, records, documents, 255
books, and any other records relating to medical care and services 256
rendered to recipients during regular business hours. 257
(5) If any person in proceedings before the division 258
disobeys or resists any lawful order or process, or misbehaves 259
during a hearing or so near the place thereof as to obstruct the 260
hearing, or neglects to produce, after having been ordered to do 261
so, any pertinent book, paper or document, or refuses to appear 262
after having been subpoenaed, or upon appearing refuses to take 263
the oath as a witness, or after having taken the oath refuses to 264
be examined according to law, the executive director shall certify 265
the facts to any court having jurisdiction in the place in which 266
it is sitting, and the court shall thereupon, in a summary manner, 267
hear the evidence as to the acts complained of, and if the 268
evidence so warrants, punish that person in the same manner and to 269
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the same extent as for a contempt committed before the court, or 270
commit that person upon the same condition as if the doing of the 271
forbidden act had occurred with reference to the process of, or in 272
the presence of, the court. 273
(6) In suspending or terminating any provider from 274
participation in the Medicaid program, the division shall preclude 275
the provider from submitting claims for payment, either personally 276
or through any clinic, group, corporation or other association to 277
the division or its fiscal agents for any services or supplies 278
provided under the Medicaid program except for those services or 279
supplies provided before the suspension or termination. No 280
clinic, group, corporation or other association that is a provider 281
of services shall submit claims for payment to the division or its 282
fiscal agents for any services or supplies provided by a person 283
within that organization who has been suspended or terminated from 284
participation in the Medicaid program except for those services or 285
supplies provided before the suspension or termination. When this 286
provision is violated by a provider of services that is a clinic, 287
group, corporation or other association, the division may suspend 288
or terminate that organization from participation. Suspension may 289
be applied by the division to all known affiliates of a provider, 290
provided that each decision to include an affiliate is made on a 291
case-by-case basis after giving due regard to all relevant facts 292
and circumstances. The violation, failure or inadequacy of 293
performance may be imputed to a person with whom the provider is 294
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affiliated where that conduct was accomplished within the course 295
of his or her official duty or was effectuated by him or her with 296
the knowledge or approval of that person. 297
(7) The division may deny or revoke enrollment in the 298
Medicaid program to a provider if any of the following are found 299
to be applicable to the provider, his or her agent, a managing 300
employee or any person having an ownership interest equal to five 301
percent (5%) or greater in the provider: 302
(a) Failure to truthfully or fully disclose any and all 303
information required, or the concealment of any and all 304
information required, on a claim, a provider application or a 305
provider agreement, or the making of a false or misleading 306
statement to the division relative to the Medicaid program. 307
(b) Previous or current exclusion, suspension, 308
termination from or the involuntary withdrawing from participation 309
in the Medicaid program, any other state's Medicaid program, 310
Medicare or any other public or private health or health insurance 311
program. If the division ascertains that a provider has been 312
convicted of a felony under federal or state law for an offense 313
that the division determines is detrimental to the best interest 314
of the program or of Medicaid beneficiaries, the division may 315
refuse to enter into an agreement with that provider, or may 316
terminate or refuse to renew an existing agreement. 317
(c) Conviction under federal or state law of a criminal 318
offense relating to the delivery of any goods, services or 319
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supplies, including the performance of management or 320
administrative services relating to the delivery of the goods, 321
services or supplies, under the Medicaid program, any other 322
state's Medicaid program, Medicare or any other public or private 323
health or health insurance program. 324
(d) Conviction under federal or state law of a criminal 325
offense relating to the neglect or abuse of a patient in 326
connection with the delivery of any goods, services or supplies. 327
(e) Conviction under federal or state law of a criminal 328
offense relating to the unlawful manufacture, distribution, 329
prescription or dispensing of a controlled substance. 330
(f) Conviction under federal or state law of a criminal 331
offense relating to fraud, theft, embezzlement, breach of 332
fiduciary responsibility or other financial misconduct. 333
(g) Conviction under federal or state law of a criminal 334
offense punishable by imprisonment of a year or more that involves 335
moral turpitude, or acts against the elderly, children or infirm. 336
(h) Conviction under federal or state law of a criminal 337
offense in connection with the interference or obstruction of any 338
investigation into any criminal offense listed in paragraphs (c) 339
through (i) of this subsection. 340
(i) Sanction for a violation of federal or state laws 341
or rules relative to the Medicaid program, any other state's 342
Medicaid program, Medicare or any other public health care or 343
health insurance program. 344
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(j) Revocation of license or certification. 345
(k) Failure to pay recovery properly assessed or 346
pursuant to an approved repayment schedule under the Medicaid 347
program. 348
(l) Failure to meet any condition of enrollment. 349
(8) (a) As used in this subsection (8), the following terms 350
shall be defined as provided in this paragraph, except as 351
otherwise provided in this subsection: 352
(i) "Committees" means the Medicaid Committees of 353
the House of Representatives and the Senate, and "committee" means 354
either one of those committees. 355
(ii) "State Plan" means the agreement between the 356
State of Mississippi and the federal government regarding the 357
nature and scope of Mississippi's Medicaid Program. 358
(iii) "State Plan Amendment" means a change to the 359
State Plan, which must be approved by the Centers for Medicare and 360
Medicaid Services (CMS) before its implementation. 361
(b) Whenever the Division of Medicaid proposes a State 362
Plan Amendment, the division shall give notice to the chairmen of 363
the committees at least thirty (30) calendar days before the 364
proposed State Plan Amendment is filed with CMS. The division 365
shall furnish the chairmen with a concise summary of each proposed 366
State Plan Amendment along with the notice, and shall furnish the 367
chairmen with a copy of any proposed State Plan Amendment upon 368
request. The division also shall provide a summary and copy of 369
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any proposed State Plan Amendment to any other member of the 370
Legislature upon request. 371
(c) If the chairman of either committee or both 372
chairmen jointly object to the proposed State Plan Amendment or 373
any part thereof, the chairman or chairmen shall notify the 374
division and provide the reasons for their objection in writing 375
not later than seven (7) calendar days after receipt of the notice 376
from the division. The chairman or chairmen may make written 377
recommendations to the division for changes to be made to a 378
proposed State Plan Amendment. 379
(d) (i) The chairman of either committee or both 380
chairmen jointly may hold a committee meeting to review a proposed 381
State Plan Amendment. If either chairman or both chairmen decide 382
to hold a meeting, they shall notify the division of their 383
intention in writing within seven (7) calendar days after receipt 384
of the notice from the division, and shall set the date and time 385
for the meeting in their notice to the division, which shall not 386
be later than fourteen (14) calendar days after receipt of the 387
notice from the division. 388
(ii) After the committee meeting, the committee or 389
committees may object to the proposed State Plan Amendment or any 390
part thereof. The committee or committees shall notify the 391
division and the reasons for their objection in writing not later 392
than seven (7) calendar days after the meeting. The committee or 393
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committees may make written recommendations to the division for 394
changes to be made to a proposed State Plan Amendment. 395
(e) If both chairmen notify the division in writing 396
within seven (7) calendar days after receipt of the notice from 397
the division that they do not object to the proposed State Plan 398
Amendment and will not be holding a meeting to review the proposed 399
State Plan Amendment, the division may proceed to file the 400
proposed State Plan Amendment with CMS. 401
(f) (i) If there are any objections to a proposed rate 402
change or any part thereof from either or both of the chairmen or 403
the committees, the division may withdraw the proposed State Plan 404
Amendment, make any of the recommended changes to the proposed 405
State Plan Amendment, or not make any changes to the proposed 406
State Plan Amendment. 407
(ii) If the division does not make any changes to 408
the proposed State Plan Amendment, it shall notify the chairmen of 409
that fact in writing, and may proceed to file the State Plan 410
Amendment with CMS. 411
(iii) If the division makes any changes to the 412
proposed State Plan Amendment, the division shall notify the 413
chairmen of its actions in writing, and may proceed to file the 414
State Plan Amendment with CMS. 415
(g) Nothing in this subsection (8) shall be construed 416
as giving the chairmen or the committees any authority to veto, 417
nullify or revise any State Plan Amendment proposed by the 418
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ST: Medicaid; division shall allow provider to
repay incorrect payments made to provider under
an installment repayment plan.
division. The authority of the chairmen or the committees under 419
this subsection shall be limited to reviewing, making objections 420
to and making recommendations for changes to State Plan Amendments 421
proposed by the division. 422
(i) If the division does not make any changes to 423
the proposed State Plan Amendment, it shall notify the chairmen of 424
that fact in writing, and may proceed to file the proposed State 425
Plan Amendment with CMS. 426
(ii) If the division makes any changes to the 427
proposed State Plan Amendment, the division shall notify the 428
chairmen of the changes in writing, and may proceed to file the 429
proposed State Plan Amendment with CMS. 430
(h) Nothing in this subsection (8) shall be construed 431
as giving the chairmen of the committees any authority to veto, 432
nullify or revise any State Plan Amendment proposed by the 433
division. The authority of the chairmen of the committees under 434
this subsection shall be limited to reviewing, making objections 435
to and making recommendations for suggested changes to State Plan 436
Amendments proposed by the division. 437
SECTION 2. This act shall take effect and be in force from 438
and after its passage. 439