Creating Logic for Efficiency and Accountability Reform (CLEAR) Act; create.

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To: Accountability,
Efficiency, Transparency
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representatives Felsher, Ford (54th)

HOUSE BILL NO. 925
(As Sent to Governor)

AN ACT TO BE KNOWN AS THE CREATING LOGIC FOR EFFICIENCY AND 1
ACCOUNTABILITY REFORM (CLEAR) ACT; TO CREATE NEW SECTION 5-3-77, 2
MISSISSIPPI CODE OF 1972, TO AUTHORIZE THE PEER COMMITTEE TO 3
ESTABLISH A PROGRAM OF REVIEWING SELECTED NEWLY ADOPTED STATE 4
AGENCY ADMINISTRATIVE RULES; TO PROVIDE THAT SUCH REVIEWS SHALL 5
PRODUCE A REPORT TO THE LEGISLATURE ON NEWLY ADOPTED STATE AGENCY 6
ADMINISTRATIVE RULES; TO AMEND SECTION 43-13-117, MISSISSIPPI CODE 7
OF 1972, AS AMENDED BY HOUSE BILL NO. 565, 2026 REGULAR SESSION, 8
TO PROVIDE THAT THE PEER COMMITTEE SHALL CONDUCT A PERFORMANCE 9
EVALUATION OF THE MEDICAID NONEMERGENCY TRANSPORTATION PROGRAM 10
ONCE EVERY THREE YEARS TO EVALUATE THE ADMINISTRATION OF THE 11
PROGRAM AND THE PROVIDERS OF TRANSPORTATION SERVICES TO DETERMINE 12
THE MOST COST-EFFECTIVE WAYS OF PROVIDING NONEMERGENCY 13
TRANSPORTATION SERVICES TO THE PATIENTS SERVED UNDER THE PROGRAM; 14
TO CREATE THE STATE BOARD OF HEALTH PROFESSIONS; TO PROVIDE THAT 15
THE MEMBERS OF THE BOARD SHALL BE ONE MEMBER FROM THE BOARDS OF 16
MEDICAL LICENSURE, PHARMACY, NURSING, CHIROPRACTIC EXAMINERS, 17
DENTAL EXAMINERS AND OPTOMETRY, AND FIVE ADDITIONAL MEMBERS; TO 18
PROVIDE THAT THE BOARD SHALL EVALUATE THE NEED FOR COORDINATION 19
AMONG THE HEALTH REGULATORY BOARDS AND THEIR STAFFS, EVALUATE ALL 20
HEALTH CARE PROFESSIONS AND OCCUPATIONS IN THE STATE AND CONSIDER 21
WHETHER EACH SUCH PROFESSION OR OCCUPATION SHOULD BE REGULATED AND 22
THE DEGREE OF REGULATION TO BE IMPOSED, SERVE AS A FORUM FOR 23
RESOLVING CONFLICTS AMONG THE HEALTH REGULATORY BOARDS, ADVISE THE 24
GOVERNOR AND THE LEGISLATURE ON MATTERS RELATING TO THE REGULATION 25
OR DEREGULATION OF HEALTH CARE PROFESSIONS AND OCCUPATIONS, AND 26
EXAMINE SCOPE OF PRACTICE CONFLICTS INVOLVING REGULATED AND 27
UNREGULATED HEALTH CARE PROFESSIONS AND OCCUPATIONS AND ADVISE THE 28
HEALTH REGULATORY BOARDS AND THE LEGISLATURE OF THE NATURE AND 29
DEGREE OF SUCH CONFLICTS; TO PROVIDE THAT THE STATE DEPARTMENT OF 30
HEALTH SHALL ANNUALLY REQUEST A BUDGET FOR THE STATE BOARD OF 31
HEALTH PROFESSIONS AND SHALL PROVIDE A MEETING SPACE AND 32
ADMINISTRATIVE SUPPORT FOR THE BOARD'S OPERATIONS; TO AMEND 33
SECTION 47-5-579, MISSISSIPPI CODE OF 1972, TO CLARIFY THAT ALL 34
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PROGRAM WITHHOLDINGS FROM PARTICIPANTS OF THE PRISON INDUSTRIES 35
CORPORATION'S WORK INITIATIVE PROGRAM SHALL BE CALCULATED BASED 36
UPON PARTICIPANT WAGES AFTER MANDATORY DEDUCTIONS; TO REQUIRE 37
ACCOUNTING OF ANY DEPENDENT SUPPORT PAYMENTS, FINES, RESTITUTIONS, 38
FEES OR COSTS, AS ORDERED BY THE COURT, BE REPORTED FOR EACH WORK 39
INITIATIVE PARTICIPANT; TO REQUIRE THAT THE REMAINING SENTENCE 40
LENGTH OF SUCH PARTICIPANT BE COLLECTED, MAINTAINED AND REPORTED; 41
TO REQUIRE THAT A FINANCIAL ACCOUNT CREATION DATE BE COLLECTED, 42
MAINTAINED AND REPORTED FOR EACH PARTICIPANT; AND FOR RELATED 43
PURPOSES. 44
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 45
SECTION 1. The provisions of this act may be known and cited 46
as the "Creating Logic for Efficiency and Accountability Reform 47
(CLEAR) Act". 48
SECTION 2. The following shall be codified as Section 49
5-3-77, Mississippi Code of 1972: 50
5-3-77. (1) In addition to other duties and 51
responsibilities set out in this chapter, the PEER Committee is 52
authorized to establish a program of reviewing selected newly 53
adopted state agency administrative rules. Such reviews shall 54
produce a report to the Legislature on newly adopted state agency 55
administrative rules. Such reports shall also contain a 56
recommendation for legislative action in cases where the committee 57
believes that such is appropriate. 58
(2) From and after July 1, 2026, the committee may choose to 59
select fifteen (15) rules adopted during the previous fiscal year 60
for review. Reports on those rules shall be made to the 61
Legislature no later than December 15, 2026. Thereafter, the 62
committee may review up to thirty (30) newly adopted rules per 63
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year, with reports on those rules being made to the Legislature no 64
later than December 15 of each year. 65
SECTION 3. Section 43-13-117, Mississippi Code of 1972, as 66
amended by House Bill No. 565, 2026 Regular Session, is amended as 67
follows: 68
43-13-117. (A) Medicaid as authorized by this article shall 69
include payment of part or all of the costs, at the discretion of 70
the division, with approval of the Governor and the Centers for 71
Medicare and Medicaid Services, of the following types of care and 72
services rendered to eligible applicants who have been determined 73
to be eligible for that care and services, within the limits of 74
state appropriations and federal matching funds: 75
(1) Inpatient hospital services. 76
(a) The division is authorized to implement an All 77
Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement 78
methodology for inpatient hospital services. 79
(b) No service benefits or reimbursement 80
limitations in this subsection (A)(1) shall apply to payments 81
under an APR-DRG or Ambulatory Payment Classification (APC) model 82
or a managed care program or similar model described in subsection 83
(H) of this section unless specifically authorized by the 84
division. 85
(2) Outpatient hospital services. 86
(a) Emergency services. 87
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(b) Other outpatient hospital services. The 88
division shall allow benefits for other medically necessary 89
outpatient hospital services (such as chemotherapy, radiation, 90
surgery and therapy), including outpatient services in a clinic or 91
other facility that is not located inside the hospital, but that 92
has been designated as an outpatient facility by the hospital, and 93
that was in operation or under construction on July 1, 2009, 94
provided that the costs and charges associated with the operation 95
of the hospital clinic are included in the hospital's cost report. 96
In addition, the Medicare thirty-five-mile rule will apply to 97
those hospital clinics not located inside the hospital that are 98
constructed after July 1, 2009. Where the same services are 99
reimbursed as clinic services, the division may revise the rate or 100
methodology of outpatient reimbursement to maintain consistency, 101
efficiency, economy and quality of care. 102
(c) The division is authorized to implement an 103
Ambulatory Payment Classification (APC) methodology for outpatient 104
hospital services. The division shall give rural hospitals that 105
have fifty (50) or fewer licensed beds the option to not be 106
reimbursed for outpatient hospital services using the APC 107
methodology, but reimbursement for outpatient hospital services 108
provided by those hospitals shall be based on one hundred one 109
percent (101%) of the rate established under Medicare for 110
outpatient hospital services. Those hospitals choosing to not be 111
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reimbursed under the APC methodology shall remain under cost-based 112
reimbursement for a two-year period. 113
(d) No service benefits or reimbursement 114
limitations in this subsection (A)(2) shall apply to payments 115
under an APR-DRG or APC model or a managed care program or similar 116
model described in subsection (H) of this section unless 117
specifically authorized by the division. 118
(3) Laboratory and x-ray services. 119
(4) Nursing facility services. 120
(a) The division shall make full payment to 121
nursing facilities for each day, not exceeding forty-two (42) days 122
per year, that a patient is absent from the facility on home 123
leave. Payment may be made for the following home leave days in 124
addition to the forty-two-day limitation: Christmas, the day 125
before Christmas, the day after Christmas, Thanksgiving, the day 126
before Thanksgiving and the day after Thanksgiving. 127
(b) From and after July 1, 1997, the division 128
shall implement the integrated case-mix payment and quality 129
monitoring system, which includes the fair rental system for 130
property costs and in which recapture of depreciation is 131
eliminated. The division may reduce the payment for hospital 132
leave and therapeutic home leave days to the lower of the case-mix 133
category as computed for the resident on leave using the 134
assessment being utilized for payment at that point in time, or a 135
case-mix score of 1.000 for nursing facilities, and shall compute 136
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case-mix scores of residents so that only services provided at the 137
nursing facility are considered in calculating a facility's per 138
diem. 139
(c) From and after July 1, 1997, all state-owned 140
nursing facilities shall be reimbursed on a full reasonable cost 141
basis. 142
(d) On or after January 1, 2015, the division 143
shall update the case-mix payment system resource utilization 144
grouper and classifications and fair rental reimbursement system. 145
The division shall develop and implement a payment add-on to 146
reimburse nursing facilities for ventilator-dependent resident 147
services. 148
(e) The division shall develop and implement, not 149
later than January 1, 2001, a case-mix payment add-on determined 150
by time studies and other valid statistical data that will 151
reimburse a nursing facility for the additional cost of caring for 152
a resident who has a diagnosis of Alzheimer's or other related 153
dementia and exhibits symptoms that require special care. Any 154
such case-mix add-on payment shall be supported by a determination 155
of additional cost. The division shall also develop and implement 156
as part of the fair rental reimbursement system for nursing 157
facility beds, an Alzheimer's resident bed depreciation enhanced 158
reimbursement system that will provide an incentive to encourage 159
nursing facilities to convert or construct beds for residents with 160
Alzheimer's or other related dementia. 161
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(f) The division shall develop and implement an 162
assessment process for long-term care services. The division may 163
provide the assessment and related functions directly or through 164
contract with the area agencies on aging. 165
The division shall apply for necessary federal waivers to 166
assure that additional services providing alternatives to nursing 167
facility care are made available to applicants for nursing 168
facility care. 169
(5) Periodic screening and diagnostic services for 170
individuals under age twenty-one (21) years as are needed to 171
identify physical and mental defects and to provide health care 172
treatment and other measures designed to correct or ameliorate 173
defects and physical and mental illness and conditions discovered 174
by the screening services, regardless of whether these services 175
are included in the state plan. The division may include in its 176
periodic screening and diagnostic program those discretionary 177
services authorized under the federal regulations adopted to 178
implement Title XIX of the federal Social Security Act, as 179
amended. The division, in obtaining physical therapy services, 180
occupational therapy services, and services for individuals with 181
speech, hearing and language disorders, may enter into a 182
cooperative agreement with the State Department of Education for 183
the provision of those services to handicapped students by public 184
school districts using state funds that are provided from the 185
appropriation to the Department of Education to obtain federal 186
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matching funds through the division. The division, in obtaining 187
medical and mental health assessments, treatment, care and 188
services for children who are in, or at risk of being put in, the 189
custody of the Mississippi Department of Human Services may enter 190
into a cooperative agreement with the Mississippi Department of 191
Human Services for the provision of those services using state 192
funds that are provided from the appropriation to the Department 193
of Human Services to obtain federal matching funds through the 194
division. 195
(6) Physician services. Fees for physician's services 196
that are covered only by Medicaid shall be reimbursed at ninety 197
percent (90%) of the rate established on January 1, 2018, and as 198
may be adjusted each July thereafter, under Medicare. The 199
division may provide for a reimbursement rate for physician's 200
services of up to one hundred percent (100%) of the rate 201
established under Medicare for physician's services that are 202
provided after the normal working hours of the physician, as 203
determined in accordance with regulations of the division. The 204
division may reimburse eligible providers, as determined by the 205
division, for certain primary care services at one hundred percent 206
(100%) of the rate established under Medicare. The division shall 207
reimburse obstetricians and gynecologists for certain primary care 208
services as defined by the division at one hundred percent (100%) 209
of the rate established under Medicare. 210
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(7) (a) Home health services for eligible persons, not 211
to exceed in cost the prevailing cost of nursing facility 212
services. All home health visits must be precertified as required 213
by the division. In addition to physicians, certified registered 214
nurse practitioners, physician assistants and clinical nurse 215
specialists are authorized to prescribe or order home health 216
services and plans of care, sign home health plans of care, 217
certify and recertify eligibility for home health services and 218
conduct the required initial face-to-face visit with the recipient 219
of the services. 220
(b) [Repealed] 221
(8) Emergency medical transportation services as 222
determined by the division. 223
(9) Prescription drugs and other covered drugs and 224
services as determined by the division. 225
The division shall establish a mandatory preferred drug list. 226
Drugs not on the mandatory preferred drug list shall be made 227
available by utilizing prior authorization procedures established 228
by the division. 229
The division may seek to establish relationships with other 230
states in order to lower acquisition costs of prescription drugs 231
to include single-source and innovator multiple-source drugs or 232
generic drugs. In addition, if allowed by federal law or 233
regulation, the division may seek to establish relationships with 234
and negotiate with other countries to facilitate the acquisition 235
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of prescription drugs to include single-source and innovator 236
multiple-source drugs or generic drugs, if that will lower the 237
acquisition costs of those prescription drugs. 238
The division may allow for a combination of prescriptions for 239
single-source and innovator multiple-source drugs and generic 240
drugs to meet the needs of the beneficiaries. 241
The executive director may approve specific maintenance drugs 242
for beneficiaries with certain medical conditions, which may be 243
prescribed and dispensed in three-month supply increments. 244
Drugs prescribed for a resident of a psychiatric residential 245
treatment facility must be provided in true unit doses when 246
available. The division may require that drugs not covered by 247
Medicare Part D for a resident of a long-term care facility be 248
provided in true unit doses when available. Those drugs that were 249
originally billed to the division but are not used by a resident 250
in any of those facilities shall be returned to the billing 251
pharmacy for credit to the division, in accordance with the 252
guidelines of the State Board of Pharmacy and any requirements of 253
federal law and regulation. Drugs shall be dispensed to a 254
recipient and only one (1) dispensing fee per month may be 255
charged. The division shall develop a methodology for reimbursing 256
for restocked drugs, which shall include a restock fee as 257
determined by the division not exceeding Seven Dollars and 258
Eighty-two Cents ($7.82). 259
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Except for those specific maintenance drugs approved by the 260
executive director, the division shall not reimburse for any 261
portion of a prescription that exceeds a thirty-one-day supply of 262
the drug based on the daily dosage. 263
The division is authorized to develop and implement a program 264
of payment for additional pharmacist services as determined by the 265
division. 266
All claims for drugs for dually eligible Medicare/Medicaid 267
beneficiaries that are paid for by Medicare must be submitted to 268
Medicare for payment before they may be processed by the 269
division's online payment system. 270
The division shall develop a pharmacy policy in which drugs 271
in tamper-resistant packaging that are prescribed for a resident 272
of a nursing facility but are not dispensed to the resident shall 273
be returned to the pharmacy and not billed to Medicaid, in 274
accordance with guidelines of the State Board of Pharmacy. 275
The division shall develop and implement a method or methods 276
by which the division will provide on a regular basis to Medicaid 277
providers who are authorized to prescribe drugs, information about 278
the costs to the Medicaid program of single-source drugs and 279
innovator multiple-source drugs, and information about other drugs 280
that may be prescribed as alternatives to those single-source 281
drugs and innovator multiple-source drugs and the costs to the 282
Medicaid program of those alternative drugs. 283
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Notwithstanding any law or regulation, information obtained 284
or maintained by the division regarding the prescription drug 285
program, including trade secrets and manufacturer or labeler 286
pricing, is confidential and not subject to disclosure except to 287
other state agencies. 288
The dispensing fee for each new or refill prescription, 289
including nonlegend or over-the-counter drugs covered by the 290
division, shall be not less than Three Dollars and Ninety-one 291
Cents ($3.91), as determined by the division. 292
The division shall not reimburse for single-source or 293
innovator multiple-source drugs if there are equally effective 294
generic equivalents available and if the generic equivalents are 295
the least expensive. 296
It is the intent of the Legislature that the pharmacists 297
providers be reimbursed for the reasonable costs of filling and 298
dispensing prescriptions for Medicaid beneficiaries. 299
The division shall allow certain drugs, including 300
physician-administered drugs, and implantable drug system devices, 301
and medical supplies, with limited distribution or limited access 302
for beneficiaries and administered in an appropriate clinical 303
setting, to be reimbursed as either a medical claim or pharmacy 304
claim, as determined by the division. 305
It is the intent of the Legislature that the division and any 306
managed care entity described in subsection (H) of this section 307
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encourage the use of Alpha-Hydroxyprogesterone Caproate (17P) to 308
prevent recurrent preterm birth. 309
(10) Dental and orthodontic services to be determined 310
by the division. 311
The division shall increase the amount of the reimbursement 312
rate for diagnostic and preventative dental services for each of 313
the fiscal years 2022, 2023 and 2024 by five percent (5%) above 314
the amount of the reimbursement rate for the previous fiscal year. 315
The division shall increase the amount of the reimbursement rate 316
for restorative dental services for each of the fiscal years 2023, 317
2024 and 2025 by five percent (5%) above the amount of the 318
reimbursement rate for the previous fiscal year. It is the intent 319
of the Legislature that the reimbursement rate revision for 320
preventative dental services will be an incentive to increase the 321
number of dentists who actively provide Medicaid services. This 322
dental services reimbursement rate revision shall be known as the 323
"James Russell Dumas Medicaid Dental Services Incentive Program." 324
The Medical Care Advisory Committee, assisted by the Division 325
of Medicaid, shall annually determine the effect of this incentive 326
by evaluating the number of dentists who are Medicaid providers, 327
the number who and the degree to which they are actively billing 328
Medicaid, the geographic trends of where dentists are offering 329
what types of Medicaid services and other statistics pertinent to 330
the goals of this legislative intent. This data shall annually be 331
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presented to the Chair of the Senate Medicaid Committee and the 332
Chair of the House Medicaid Committee. 333
The division shall include dental services as a necessary 334
component of overall health services provided to children who are 335
eligible for services. 336
(11) Eyeglasses for all Medicaid beneficiaries who have 337
(a) had surgery on the eyeball or ocular muscle that results in a 338
vision change for which eyeglasses or a change in eyeglasses is 339
medically indicated within six (6) months of the surgery and is in 340
accordance with policies established by the division, or (b) one 341
(1) pair every five (5) years and in accordance with policies 342
established by the division. In either instance, the eyeglasses 343
must be prescribed by a physician skilled in diseases of the eye 344
or an optometrist, whichever the beneficiary may select. 345
(12) Intermediate care facility services. 346
(a) The division shall make full payment to all 347
intermediate care facilities for individuals with intellectual 348
disabilities for each day, not exceeding sixty-three (63) days per 349
year, that a patient is absent from the facility on home leave. 350
Payment may be made for the following home leave days in addition 351
to the sixty-three-day limitation: Christmas, the day before 352
Christmas, the day after Christmas, Thanksgiving, the day before 353
Thanksgiving and the day after Thanksgiving. 354
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(b) All state-owned intermediate care facilities 355
for individuals with intellectual disabilities shall be reimbursed 356
on a full reasonable cost basis. 357
(c) Effective January 1, 2015, the division shall 358
update the fair rental reimbursement system for intermediate care 359
facilities for individuals with intellectual disabilities. 360
(13) Family planning services, including drugs, 361
supplies and devices, when those services are under the 362
supervision of a physician or nurse practitioner. 363
(14) Clinic services. Preventive, diagnostic, 364
therapeutic, rehabilitative or palliative services that are 365
furnished by a facility that is not part of a hospital but is 366
organized and operated to provide medical care to outpatients. 367
Clinic services include, but are not limited to: 368
(a) Services provided by ambulatory surgical 369
centers (ASCs) as defined in Section 41-75-1(a); and 370
(b) Dialysis center services. 371
(15) Home- and community-based services for the elderly 372
and disabled, as provided under Title XIX of the federal Social 373
Security Act, as amended, under waivers, subject to the 374
availability of funds specifically appropriated for that purpose 375
by the Legislature. 376
(16) Mental health services. Certain services provided 377
by a psychiatrist shall be reimbursed at up to one hundred percent 378
(100%) of the Medicare rate. Approved therapeutic and case 379
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management services (a) provided by an approved regional mental 380
health/intellectual disability center established under Sections 381
41-19-31 through 41-19-39, or by another community mental health 382
service provider meeting the requirements of the Department of 383
Mental Health to be an approved mental health/intellectual 384
disability center if determined necessary by the Department of 385
Mental Health, using state funds that are provided in the 386
appropriation to the division to match federal funds, or (b) 387
provided by a facility that is certified by the State Department 388
of Mental Health to provide therapeutic and case management 389
services, to be reimbursed on a fee for service basis, or (c) 390
provided in the community by a facility or program operated by the 391
Department of Mental Health. Any such services provided by a 392
facility described in subparagraph (b) must have the prior 393
approval of the division to be reimbursable under this section. 394
(17) Durable medical equipment services and medical 395
supplies. Precertification of durable medical equipment and 396
medical supplies must be obtained as required by the division. 397
The Division of Medicaid may require durable medical equipment 398
providers to obtain a surety bond in the amount and to the 399
specifications as established by the Balanced Budget Act of 1997. 400
A maximum dollar amount of reimbursement for noninvasive 401
ventilators or ventilation treatments properly ordered and being 402
used in an appropriate care setting shall not be set by any health 403
maintenance organization, coordinated care organization, 404
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provider-sponsored health plan, or other organization paid for 405
services on a capitated basis by the division under any managed 406
care program or coordinated care program implemented by the 407
division under this section. Reimbursement by these organizations 408
to durable medical equipment suppliers for home use of noninvasive 409
and invasive ventilators shall be on a continuous monthly payment 410
basis for the duration of medical need throughout a patient's 411
valid prescription period. 412
(18) (a) Notwithstanding any other provision of this 413
section to the contrary, as provided in the Medicaid state plan 414
amendment or amendments as defined in Section 43-13-145(10), the 415
division shall make additional reimbursement to hospitals that 416
serve a disproportionate share of low-income patients and that 417
meet the federal requirements for those payments as provided in 418
Section 1923 of the federal Social Security Act and any applicable 419
regulations. It is the intent of the Legislature that the 420
division shall draw down all available federal funds allotted to 421
the state for disproportionate share hospitals. However, from and 422
after January 1, 1999, public hospitals participating in the 423
Medicaid disproportionate share program may be required to 424
participate in an intergovernmental transfer program as provided 425
in Section 1903 of the federal Social Security Act and any 426
applicable regulations. 427
(b) (i) 1. The division may establish a Medicare 428
Upper Payment Limits Program, as defined in Section 1902(a)(30) of 429
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the federal Social Security Act and any applicable federal 430
regulations, or an allowable delivery system or provider payment 431
initiative authorized under 42 CFR 438.6(c), for hospitals, 432
nursing facilities and physicians employed or contracted by 433
hospitals. 434
2. The division shall establish a 435
Medicaid Supplemental Payment Program, as permitted by the federal 436
Social Security Act and a comparable allowable delivery system or 437
provider payment initiative authorized under 42 CFR 438.6(c), for 438
emergency ambulance transportation providers in accordance with 439
this subsection (A)(18)(b). 440
(ii) The division shall assess each hospital, 441
nursing facility, and emergency ambulance transportation provider 442
for the sole purpose of financing the state portion of the 443
Medicare Upper Payment Limits Program or other program(s) 444
authorized under this subsection (A)(18)(b). The hospital 445
assessment shall be as provided in Section 43-13-145(4)(a), and 446
the nursing facility and the emergency ambulance transportation 447
assessments, if established, shall be based on Medicaid 448
utilization or other appropriate method, as determined by the 449
division, consistent with federal regulations. The assessments 450
will remain in effect as long as the state participates in the 451
Medicare Upper Payment Limits Program or other program(s) 452
authorized under this subsection (A)(18)(b). In addition to the 453
hospital assessment provided in Section 43-13-145(4)(a), hospitals 454
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with physicians participating in the Medicare Upper Payment Limits 455
Program or other program(s) authorized under this subsection 456
(A)(18)(b) shall be required to participate in an 457
intergovernmental transfer or assessment, as determined by the 458
division, for the purpose of financing the state portion of the 459
physician UPL payments or other payment(s) authorized under this 460
subsection (A)(18)(b). 461
(iii) Subject to approval by the Centers for 462
Medicare and Medicaid Services (CMS) and the provisions of this 463
subsection (A)(18)(b), the division shall make additional 464
reimbursement to hospitals, nursing facilities, and emergency 465
ambulance transportation providers for the Medicare Upper Payment 466
Limits Program or other program(s) authorized under this 467
subsection (A)(18)(b), and, if the program is established for 468
physicians, shall make additional reimbursement for physicians, as 469
defined in Section 1902(a)(30) of the federal Social Security Act 470
and any applicable federal regulations, provided the assessment in 471
this subsection (A)(18)(b) is in effect. 472
(iv) Notwithstanding any other provision of 473
this article to the contrary, effective upon implementation of the 474
Mississippi Hospital Access Program (MHAP) provided in 475
subparagraph (c)(i) below, the hospital portion of the inpatient 476
Upper Payment Limits Program shall transition into and be replaced 477
by the MHAP program. However, the division is authorized to 478
develop and implement an alternative fee-for-service Upper Payment 479
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Limits model in accordance with federal laws and regulations if 480
necessary to preserve supplemental funding. Further, the 481
division, in consultation with the hospital industry shall develop 482
alternative models for distribution of medical claims and 483
supplemental payments for inpatient and outpatient hospital 484
services, and such models may include, but shall not be limited to 485
the following: increasing rates for inpatient and outpatient 486
services; creating a low-income utilization pool of funds to 487
reimburse hospitals for the costs of uncompensated care, charity 488
care and bad debts as permitted and approved pursuant to federal 489
regulations and the Centers for Medicare and Medicaid Services; 490
supplemental payments based upon Medicaid utilization, quality, 491
service lines and/or costs of providing such services to Medicaid 492
beneficiaries and to uninsured patients. The goals of such 493
payment models shall be to ensure access to inpatient and 494
outpatient care and to maximize any federal funds that are 495
available to reimburse hospitals for services provided. Any such 496
documents required to achieve the goals described in this 497
paragraph shall be submitted to the Centers for Medicare and 498
Medicaid Services, with a proposed effective date of July 1, 2019, 499
to the extent possible, but in no event shall the effective date 500
of such payment models be later than July 1, 2020. The Chairmen 501
of the Senate and House Medicaid Committees shall be provided a 502
copy of the proposed payment model(s) prior to submission. 503
Effective July 1, 2018, and until such time as any payment 504
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model(s) as described above become effective, the division, in 505
consultation with the hospital industry, is authorized to 506
implement a transitional program for inpatient and outpatient 507
payments and/or supplemental payments (including, but not limited 508
to, MHAP and directed payments), to redistribute available 509
supplemental funds among hospital providers, provided that when 510
compared to a hospital's prior year supplemental payments, 511
supplemental payments made pursuant to any such transitional 512
program shall not result in a decrease of more than five percent 513
(5%) and shall not increase by more than the amount needed to 514
maximize the distribution of the available funds. 515
(v) 1. To preserve and improve access to 516
ambulance transportation provider services, the division shall 517
seek CMS approval to make ambulance service access payments as set 518
forth in this subsection (A)(18)(b) for all covered emergency 519
ambulance services rendered on or after July 1, 2022, and shall 520
make such ambulance service access payments for all covered 521
services rendered on or after the effective date of CMS approval. 522
2. The division shall calculate the 523
ambulance service access payment amount as the balance of the 524
portion of the Medical Care Fund related to ambulance 525
transportation service provider assessments plus any federal 526
matching funds earned on the balance, up to, but not to exceed, 527
the upper payment limit gap for all emergency ambulance service 528
providers. 529
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3. a. Except for ambulance services 530
exempt from the assessment provided in this paragraph (18)(b), all 531
ambulance transportation service providers shall be eligible for 532
ambulance service access payments each state fiscal year as set 533
forth in this paragraph (18)(b). 534
b. In addition to any other funds 535
paid to ambulance transportation service providers for emergency 536
medical services provided to Medicaid beneficiaries, each eligible 537
ambulance transportation service provider shall receive ambulance 538
service access payments each state fiscal year equal to the 539
ambulance transportation service provider's upper payment limit 540
gap. Subject to approval by the Centers for Medicare and Medicaid 541
Services, ambulance service access payments shall be made no less 542
than on a quarterly basis. 543
c. As used in this paragraph 544
(18)(b)(v), the term "upper payment limit gap" means the 545
difference between the total amount that the ambulance 546
transportation service provider received from Medicaid and the 547
average amount that the ambulance transportation service provider 548
would have received from commercial insurers for those services 549
reimbursed by Medicaid. 550
4. An ambulance service access payment 551
shall not be used to offset any other payment by the division for 552
emergency or nonemergency services to Medicaid beneficiaries. 553
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(c) (i) Not later than December l, 2015, the 554
division shall, subject to approval by the Centers for Medicare 555
and Medicaid Services (CMS), establish, implement and operate a 556
Mississippi Hospital Access Program (MHAP) for the purpose of 557
protecting patient access to hospital care through hospital 558
inpatient reimbursement programs provided in this section designed 559
to maintain total hospital reimbursement for inpatient services 560
rendered by in-state hospitals and the out-of-state hospital that 561
is authorized by federal law to submit intergovernmental transfers 562
(IGTs) to the State of Mississippi and is classified as Level I 563
trauma center located in a county contiguous to the state line at 564
the maximum levels permissible under applicable federal statutes 565
and regulations, at which time the current inpatient Medicare 566
Upper Payment Limits (UPL) Program for hospital inpatient services 567
shall transition to the MHAP. 568
(ii) Subject to approval by the Centers for 569
Medicare and Medicaid Services (CMS), the MHAP shall provide 570
increased inpatient capitation (PMPM) payments to managed care 571
entities contracting with the division pursuant to subsection (H) 572
of this section to support availability of hospital services or 573
such other payments permissible under federal law necessary to 574
accomplish the intent of this subsection. 575
(iii) The intent of this subparagraph (c) is 576
that effective for all inpatient hospital Medicaid services during 577
state fiscal year 2016, and so long as this provision shall remain 578
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in effect hereafter, the division shall to the fullest extent 579
feasible replace the additional reimbursement for hospital 580
inpatient services under the inpatient Medicare Upper Payment 581
Limits (UPL) Program with additional reimbursement under the MHAP 582
and other payment programs for inpatient and/or outpatient 583
payments which may be developed under the authority of this 584
paragraph. 585
(iv) The division shall assess each hospital 586
as provided in Section 43-13-145(4)(a) for the purpose of 587
financing the state portion of the MHAP, supplemental payments and 588
such other purposes as specified in Section 43-13-145. The 589
assessment will remain in effect as long as the MHAP and 590
supplemental payments are in effect. 591
(19) (a) Perinatal risk management services. The 592
division shall promulgate regulations to be effective from and 593
after October 1, 1988, to establish a comprehensive perinatal 594
system for risk assessment of all pregnant and infant Medicaid 595
recipients and for management, education and follow-up for those 596
who are determined to be at risk. Services to be performed 597
include case management, nutrition assessment/counseling, 598
psychosocial assessment/counseling and health education. The 599
division shall contract with the State Department of Health to 600
provide services within this paragraph (Perinatal High Risk 601
Management/Infant Services System (PHRM/ISS)). The State 602
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Department of Health shall be reimbursed on a full reasonable cost 603
basis for services provided under this subparagraph (a). 604
(b) Early intervention system services. The 605
division shall cooperate with the State Department of Health, 606
acting as lead agency, in the development and implementation of a 607
statewide system of delivery of early intervention services, under 608
Part C of the Individuals with Disabilities Education Act (IDEA). 609
The State Department of Health shall certify annually in writing 610
to the executive director of the division the dollar amount of 611
state early intervention funds available that will be utilized as 612
a certified match for Medicaid matching funds. Those funds then 613
shall be used to provide expanded targeted case management 614
services for Medicaid eligible children with special needs who are 615
eligible for the state's early intervention system. 616
Qualifications for persons providing service coordination shall be 617
determined by the State Department of Health and the Division of 618
Medicaid. 619
(20) Home- and community-based services for physically 620
disabled approved services as allowed by a waiver from the United 621
States Department of Health and Human Services for home- and 622
community-based services for physically disabled people using 623
state funds that are provided from the appropriation to the State 624
Department of Rehabilitation Services and used to match federal 625
funds under a cooperative agreement between the division and the 626
department, provided that funds for these services are 627
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specifically appropriated to the Department of Rehabilitation 628
Services. 629
(21) Nurse practitioner services. Services furnished 630
by a registered nurse who is licensed and certified by the 631
Mississippi Board of Nursing as a nurse practitioner, including, 632
but not limited to, nurse anesthetists, nurse midwives, family 633
nurse practitioners, family planning nurse practitioners, 634
pediatric nurse practitioners, obstetrics-gynecology nurse 635
practitioners and neonatal nurse practitioners, under regulations 636
adopted by the division. Reimbursement for those services shall 637
not exceed ninety percent (90%) of the reimbursement rate for 638
comparable services rendered by a physician. The division may 639
provide for a reimbursement rate for nurse practitioner services 640
of up to one hundred percent (100%) of the reimbursement rate for 641
comparable services rendered by a physician for nurse practitioner 642
services that are provided after the normal working hours of the 643
nurse practitioner, as determined in accordance with regulations 644
of the division. 645
(22) Ambulatory services delivered in federally 646
qualified health centers, rural health centers and clinics of the 647
local health departments of the State Department of Health for 648
individuals eligible for Medicaid under this article based on 649
reasonable costs as determined by the division. Federally 650
qualified health centers shall be reimbursed by the Medicaid 651
prospective payment system as approved by the Centers for Medicare 652
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and Medicaid Services. The division shall recognize federally 653
qualified health centers (FQHCs), rural health clinics (RHCs) and 654
community mental health centers (CMHCs) as both an originating and 655
distant site provider for the purposes of telehealth 656
reimbursement. The division is further authorized and directed to 657
reimburse FQHCs, RHCs and CMHCs for both distant site and 658
originating site services when such services are appropriately 659
provided by the same organization. 660
(23) Inpatient psychiatric services. 661
(a) Inpatient psychiatric services to be 662
determined by the division for recipients under age twenty-one 663
(21) that are provided under the direction of a physician in an 664
inpatient program in a licensed acute care psychiatric facility or 665
in a licensed psychiatric residential treatment facility, before 666
the recipient reaches age twenty-one (21) or, if the recipient was 667
receiving the services immediately before he or she reached age 668
twenty-one (21), before the earlier of the date he or she no 669
longer requires the services or the date he or she reaches age 670
twenty-two (22), as provided by federal regulations. From and 671
after January 1, 2015, the division shall update the fair rental 672
reimbursement system for psychiatric residential treatment 673
facilities. Precertification of inpatient days and residential 674
treatment days must be obtained as required by the division. From 675
and after July 1, 2009, all state-owned and state-operated 676
facilities that provide inpatient psychiatric services to persons 677
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under age twenty-one (21) who are eligible for Medicaid 678
reimbursement shall be reimbursed for those services on a full 679
reasonable cost basis. 680
(b) The division may reimburse for services 681
provided by a licensed freestanding psychiatric hospital to 682
Medicaid recipients over the age of twenty-one (21) in a method 683
and manner consistent with the provisions of Section 43-13-117.5. 684
(24) [Deleted] 685
(25) [Deleted] 686
(26) Hospice care. As used in this paragraph, the term 687
"hospice care" means a coordinated program of active professional 688
medical attention within the home and outpatient and inpatient 689
care that treats the terminally ill patient and family as a unit, 690
employing a medically directed interdisciplinary team. The 691
program provides relief of severe pain or other physical symptoms 692
and supportive care to meet the special needs arising out of 693
physical, psychological, spiritual, social and economic stresses 694
that are experienced during the final stages of illness and during 695
dying and bereavement and meets the Medicare requirements for 696
participation as a hospice as provided in federal regulations. 697
(27) Group health plan premiums and cost-sharing if it 698
is cost-effective as defined by the United States Secretary of 699
Health and Human Services. 700
(28) Other health insurance premiums that are 701
cost-effective as defined by the United States Secretary of Health 702
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and Human Services. Medicare eligible must have Medicare Part B 703
before other insurance premiums can be paid. 704
(29) The Division of Medicaid may apply for a waiver 705
from the United States Department of Health and Human Services for 706
home- and community-based services for developmentally disabled 707
people using state funds that are provided from the appropriation 708
to the State Department of Mental Health and/or funds transferred 709
to the department by a political subdivision or instrumentality of 710
the state and used to match federal funds under a cooperative 711
agreement between the division and the department, provided that 712
funds for these services are specifically appropriated to the 713
Department of Mental Health and/or transferred to the department 714
by a political subdivision or instrumentality of the state. 715
(30) Pediatric skilled nursing services as determined 716
by the division and in a manner consistent with regulations 717
promulgated by the Mississippi State Department of Health. 718
(31) Targeted case management services for children 719
with special needs, under waivers from the United States 720
Department of Health and Human Services, using state funds that 721
are provided from the appropriation to the Mississippi Department 722
of Human Services and used to match federal funds under a 723
cooperative agreement between the division and the department. 724
(32) Care and services provided in Christian Science 725
Sanatoria listed and certified by the Commission for Accreditation 726
of Christian Science Nursing Organizations/Facilities, Inc., 727
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rendered in connection with treatment by prayer or spiritual means 728
to the extent that those services are subject to reimbursement 729
under Section 1903 of the federal Social Security Act. 730
(33) Podiatrist services. 731
(34) Assisted living services as provided through 732
home- and community-based services under Title XIX of the federal 733
Social Security Act, as amended, subject to the availability of 734
funds specifically appropriated for that purpose by the 735
Legislature. 736
(35) Services and activities authorized in Sections 737
43-27-101 and 43-27-103, using state funds that are provided from 738
the appropriation to the Mississippi Department of Human Services 739
and used to match federal funds under a cooperative agreement 740
between the division and the department. 741
(36) Nonemergency transportation services for 742
Medicaid-eligible persons as determined by the division. The PEER 743
Committee shall conduct a performance evaluation of the 744
nonemergency transportation program to evaluate the administration 745
of the program and the providers of transportation services to 746
determine the most cost-effective ways of providing nonemergency 747
transportation services to the patients served under the program. 748
The performance evaluation shall be completed and provided to the 749
members of the Senate Medicaid Committee and the House Medicaid 750
Committee not later than January 1, * * * 2027, and every * * * 751
three (3) years thereafter. 752
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(37) [Deleted] 753
(38) Chiropractic services. A chiropractor's manual 754
manipulation of the spine to correct a subluxation, if x-ray 755
demonstrates that a subluxation exists and if the subluxation has 756
resulted in a neuromusculoskeletal condition for which 757
manipulation is appropriate treatment, and related spinal x-rays 758
performed to document these conditions. Reimbursement for 759
chiropractic services shall not exceed Seven Hundred Dollars 760
($700.00) per year per beneficiary. 761
(39) Dually eligible Medicare/Medicaid beneficiaries. 762
The division shall pay the Medicare deductible and coinsurance 763
amounts for services available under Medicare, as determined by 764
the division. From and after July 1, 2009, the division shall 765
reimburse crossover claims for inpatient hospital services and 766
crossover claims covered under Medicare Part B in the same manner 767
that was in effect on January 1, 2008, unless specifically 768
authorized by the Legislature to change this method. 769
(40) [Deleted] 770
(41) Services provided by the State Department of 771
Rehabilitation Services for the care and rehabilitation of persons 772
with spinal cord injuries or traumatic brain injuries, as allowed 773
under waivers from the United States Department of Health and 774
Human Services, using up to seventy-five percent (75%) of the 775
funds that are appropriated to the Department of Rehabilitation 776
Services from the Spinal Cord and Head Injury Trust Fund 777
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established under Section 37-33-261 and used to match federal 778
funds under a cooperative agreement between the division and the 779
department. 780
(42) [Deleted] 781
(43) The division shall provide reimbursement, 782
according to a payment schedule developed by the division, for 783
smoking cessation medications for pregnant women during their 784
pregnancy and other Medicaid-eligible women who are of 785
child-bearing age. 786
(44) Nursing facility services for the severely 787
disabled. 788
(a) Severe disabilities include, but are not 789
limited to, spinal cord injuries, closed-head injuries and 790
ventilator-dependent patients. 791
(b) Those services must be provided in a long-term 792
care nursing facility dedicated to the care and treatment of 793
persons with severe disabilities. 794
(45) Physician assistant services. Services furnished 795
by a physician assistant who is licensed by the State Board of 796
Medical Licensure and is practicing with physician supervision 797
under regulations adopted by the board, under regulations adopted 798
by the division. Reimbursement for those services shall not 799
exceed ninety percent (90%) of the reimbursement rate for 800
comparable services rendered by a physician. The division may 801
provide for a reimbursement rate for physician assistant services 802
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of up to one hundred percent (100%) or the reimbursement rate for 803
comparable services rendered by a physician for physician 804
assistant services that are provided after the normal working 805
hours of the physician assistant, as determined in accordance with 806
regulations of the division. 807
(46) The division shall make application to the federal 808
Centers for Medicare and Medicaid Services (CMS) for a waiver to 809
develop and provide services for children with serious emotional 810
disturbances as defined in Section 43-14-1(1), which may include 811
home- and community-based services, case management services or 812
managed care services through mental health providers certified by 813
the Department of Mental Health. The division may implement and 814
provide services under this waivered program only if funds for 815
these services are specifically appropriated for this purpose by 816
the Legislature, or if funds are voluntarily provided by affected 817
agencies. 818
(47) (a) The division may develop and implement 819
disease management programs for individuals with high-cost chronic 820
diseases and conditions, including the use of grants, waivers, 821
demonstrations or other projects as necessary. 822
(b) Participation in any disease management 823
program implemented under this paragraph (47) is optional with the 824
individual. An individual must affirmatively elect to participate 825
in the disease management program in order to participate, and may 826
elect to discontinue participation in the program at any time. 827
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(48) Pediatric long-term acute care hospital services. 828
(a) Pediatric long-term acute care hospital 829
services means services provided to eligible persons under 830
twenty-one (21) years of age by a freestanding Medicare-certified 831
hospital that has an average length of inpatient stay greater than 832
twenty-five (25) days and that is primarily engaged in providing 833
chronic or long-term medical care to persons under twenty-one (21) 834
years of age. 835
(b) The services under this paragraph (48) shall 836
be reimbursed as a separate category of hospital services. 837
(49) The division may establish copayments and/or 838
coinsurance for any Medicaid services for which copayments and/or 839
coinsurance are allowable under federal law or regulation. 840
(50) Services provided by the State Department of 841
Rehabilitation Services for the care and rehabilitation of persons 842
who are deaf and blind, as allowed under waivers from the United 843
States Department of Health and Human Services to provide home- 844
and community-based services using state funds that are provided 845
from the appropriation to the State Department of Rehabilitation 846
Services or if funds are voluntarily provided by another agency. 847
(51) Upon determination of Medicaid eligibility and in 848
association with annual redetermination of Medicaid eligibility, 849
beneficiaries shall be encouraged to undertake a physical 850
examination that will establish a base-line level of health and 851
identification of a usual and customary source of care (a medical 852
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home) to aid utilization of disease management tools. This 853
physical examination and utilization of these disease management 854
tools shall be consistent with current United States Preventive 855
Services Task Force or other recognized authority recommendations. 856
For persons who are determined ineligible for Medicaid, the 857
division will provide information and direction for accessing 858
medical care and services in the area of their residence. 859
(52) Notwithstanding any provisions of this article, 860
the division may pay enhanced reimbursement fees related to trauma 861
care, as determined by the division in conjunction with the State 862
Department of Health, using funds appropriated to the State 863
Department of Health for trauma care and services and used to 864
match federal funds under a cooperative agreement between the 865
division and the State Department of Health. The division, in 866
conjunction with the State Department of Health, may use grants, 867
waivers, demonstrations, enhanced reimbursements, Upper Payment 868
Limits Programs, supplemental payments, or other projects as 869
necessary in the development and implementation of this 870
reimbursement program. 871
(53) Targeted case management services for high-cost 872
beneficiaries may be developed by the division for all services 873
under this section. 874
(54) [Deleted] 875
(55) Therapy services. The plan of care for therapy 876
services may be developed to cover a period of treatment for up to 877
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six (6) months, but in no event shall the plan of care exceed a 878
six-month period of treatment. The projected period of treatment 879
must be indicated on the initial plan of care and must be updated 880
with each subsequent revised plan of care. Based on medical 881
necessity, the division shall approve certification periods for 882
less than or up to six (6) months, but in no event shall the 883
certification period exceed the period of treatment indicated on 884
the plan of care. The appeal process for any reduction in therapy 885
services shall be consistent with the appeal process in federal 886
regulations. 887
(56) Prescribed pediatric extended care centers 888
services for medically dependent or technologically dependent 889
children with complex medical conditions that require continual 890
care as prescribed by the child's attending physician, as 891
determined by the division. 892
(57) No Medicaid benefit shall restrict coverage for 893
medically appropriate treatment prescribed by a physician and 894
agreed to by a fully informed individual, or if the individual 895
lacks legal capacity to consent by a person who has legal 896
authority to consent on his or her behalf, based on an 897
individual's diagnosis with a terminal condition. As used in this 898
paragraph (57), "terminal condition" means any aggressive 899
malignancy, chronic end-stage cardiovascular or cerebral vascular 900
disease, or any other disease, illness or condition which a 901
physician diagnoses as terminal. 902
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(58) Treatment services for persons with opioid 903
dependency or other highly addictive substance use disorders. The 904
division is authorized to reimburse eligible providers for 905
treatment of opioid dependency and other highly addictive 906
substance use disorders, as determined by the division. Treatment 907
related to these conditions shall not count against any physician 908
visit limit imposed under this section. 909
(59) The division shall allow beneficiaries between the 910
ages of ten (10) and eighteen (18) years to receive vaccines 911
through a pharmacy venue. The division and the State Department 912
of Health shall coordinate and notify OB-GYN providers that the 913
Vaccines for Children program is available to providers free of 914
charge. 915
(60) Border city university-affiliated pediatric 916
teaching hospital. 917
(a) Payments may only be made to a border city 918
university-affiliated pediatric teaching hospital if the Centers 919
for Medicare and Medicaid Services (CMS) approve an increase in 920
the annual request for the provider payment initiative authorized 921
under 42 CFR Section 438.6(c) in an amount equal to or greater 922
than the estimated annual payment to be made to the border city 923
university-affiliated pediatric teaching hospital. The estimate 924
shall be based on the hospital's prior year Mississippi managed 925
care utilization. 926
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(b) As used in this paragraph (60), the term 927
"border city university-affiliated pediatric teaching hospital" 928
means an out-of-state hospital located within a city bordering the 929
eastern bank of the Mississippi River and the State of Mississippi 930
that submits to the division a copy of a current and effective 931
affiliation agreement with an accredited university and other 932
documentation establishing that the hospital is 933
university-affiliated, is licensed and designated as a pediatric 934
hospital or pediatric primary hospital within its home state, 935
maintains at least five (5) different pediatric specialty training 936
programs, and maintains at least one hundred (100) operated beds 937
dedicated exclusively for the treatment of patients under the age 938
of twenty-one (21) years. 939
(c) The cost of providing services to Mississippi 940
Medicaid beneficiaries under the age of twenty-one (21) years who 941
are treated by a border city university-affiliated pediatric 942
teaching hospital shall not exceed the cost of providing the same 943
services to individuals in hospitals in the state. 944
(d) It is the intent of the Legislature that 945
payments shall not result in any in-state hospital receiving 946
payments lower than they would otherwise receive if not for the 947
payments made to any border city university-affiliated pediatric 948
teaching hospital. 949
(e) This paragraph (60) shall stand repealed on 950
July 1, 2024. 951
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(61) Services described in Section 41-140-3 that are 952
provided by certified community health workers employed and 953
supervised by a Medicaid provider. Reimbursement for these 954
services shall be provided only if the division has received 955
approval from the Centers for Medicare and Medicaid Services for a 956
state plan amendment, waiver or alternative payment model for 957
services delivered by certified community health workers. 958
(62) Biomarker testing in accordance with the 959
provisions of Sections 2 and 3 of House Bill No. 565, 2026 Regular 960
Session. With respect to biomarker testing, the division shall, 961
within sixty (60) days after July 1, 2026, update the fee schedule 962
for Medicaid services to include the appropriate current 963
procedural terminology (CPT) and proprietary laboratory analysis 964
(PLA) codes for all biomarker tests coverage that is mandated 965
under Sections 2 and 3 of House Bill No. 565, 2026 Regular 966
Session. 967
(B) Planning and development districts participating in the 968
home- and community-based services program for the elderly and 969
disabled as case management providers shall be reimbursed for case 970
management services at the maximum rate approved by the Centers 971
for Medicare and Medicaid Services (CMS). 972
(C) The division may pay to those providers who participate 973
in and accept patient referrals from the division's emergency room 974
redirection program a percentage, as determined by the division, 975
of savings achieved according to the performance measures and 976
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reduction of costs required of that program. Federally qualified 977
health centers may participate in the emergency room redirection 978
program, and the division may pay those centers a percentage of 979
any savings to the Medicaid program achieved by the centers' 980
accepting patient referrals through the program, as provided in 981
this subsection (C). 982
(D) (1) As used in this subsection (D), the following terms 983
shall be defined as provided in this paragraph, except as 984
otherwise provided in this subsection: 985
(a) "Committees" means the Medicaid Committees of 986
the House of Representatives and the Senate, and "committee" means 987
either one of those committees. 988
(b) "Rate change" means an increase, decrease or 989
other change in the payments or rates of reimbursement, or a 990
change in any payment methodology that results in an increase, 991
decrease or other change in the payments or rates of 992
reimbursement, to any Medicaid provider that renders any services 993
authorized to be provided to Medicaid recipients under this 994
article. 995
(2) Whenever the Division of Medicaid proposes a rate 996
change, the division shall give notice to the chairmen of the 997
committees at least thirty (30) calendar days before the proposed 998
rate change is scheduled to take effect. The division shall 999
furnish the chairmen with a concise summary of each proposed rate 1000
change along with the notice, and shall furnish the chairmen with 1001
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a copy of any proposed rate change upon request. The division 1002
also shall provide a summary and copy of any proposed rate change 1003
to any other member of the Legislature upon request. 1004
(3) If the chairman of either committee or both 1005
chairmen jointly object to the proposed rate change or any part 1006
thereof, the chairman or chairmen shall notify the division and 1007
provide the reasons for their objection in writing not later than 1008
seven (7) calendar days after receipt of the notice from the 1009
division. The chairman or chairmen may make written 1010
recommendations to the division for changes to be made to a 1011
proposed rate change. 1012
(4) (a) The chairman of either committee or both 1013
chairmen jointly may hold a committee meeting to review a proposed 1014
rate change. If either chairman or both chairmen decide to hold a 1015
meeting, they shall notify the division of their intention in 1016
writing within seven (7) calendar days after receipt of the notice 1017
from the division, and shall set the date and time for the meeting 1018
in their notice to the division, which shall not be later than 1019
fourteen (14) calendar days after receipt of the notice from the 1020
division. 1021
(b) After the committee meeting, the committee or 1022
committees may object to the proposed rate change or any part 1023
thereof. The committee or committees shall notify the division 1024
and the reasons for their objection in writing not later than 1025
seven (7) calendar days after the meeting. The committee or 1026
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committees may make written recommendations to the division for 1027
changes to be made to a proposed rate change. 1028
(5) If both chairmen notify the division in writing 1029
within seven (7) calendar days after receipt of the notice from 1030
the division that they do not object to the proposed rate change 1031
and will not be holding a meeting to review the proposed rate 1032
change, the proposed rate change will take effect on the original 1033
date as scheduled by the division or on such other date as 1034
specified by the division. 1035
(6) (a) If there are any objections to a proposed rate 1036
change or any part thereof from either or both of the chairmen or 1037
the committees, the division may withdraw the proposed rate 1038
change, make any of the recommended changes to the proposed rate 1039
change, or not make any changes to the proposed rate change. 1040
(b) If the division does not make any changes to 1041
the proposed rate change, it shall notify the chairmen of that 1042
fact in writing, and the proposed rate change shall take effect on 1043
the original date as scheduled by the division or on such other 1044
date as specified by the division. 1045
(c) If the division makes any changes to the 1046
proposed rate change, the division shall notify the chairmen of 1047
its actions in writing, and the revised proposed rate change shall 1048
take effect on the date as specified by the division. 1049
(7) Nothing in this subsection (D) shall be construed 1050
as giving the chairmen or the committees any authority to veto, 1051
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nullify or revise any rate change proposed by the division. The 1052
authority of the chairmen or the committees under this subsection 1053
shall be limited to reviewing, making objections to and making 1054
recommendations for changes to rate changes proposed by the 1055
division. 1056
(E) Notwithstanding any provision of this article, no new 1057
groups or categories of recipients and new types of care and 1058
services may be added without enabling legislation from the 1059
Mississippi Legislature, except that the division may authorize 1060
those changes without enabling legislation when the addition of 1061
recipients or services is ordered by a court of proper authority. 1062
(F) The executive director shall keep the Governor advised 1063
on a timely basis of the funds available for expenditure and the 1064
projected expenditures. Notwithstanding any other provisions of 1065
this article, if current or projected expenditures of the division 1066
are reasonably anticipated to exceed the amount of funds 1067
appropriated to the division for any fiscal year, the Governor, 1068
after consultation with the executive director, shall take all 1069
appropriate measures to reduce costs, which may include, but are 1070
not limited to: 1071
(1) Reducing or discontinuing any or all services that 1072
are deemed to be optional under Title XIX of the Social Security 1073
Act; 1074
(2) Reducing reimbursement rates for any or all service 1075
types; 1076
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(3) Imposing additional assessments on health care 1077
providers; or 1078
(4) Any additional cost-containment measures deemed 1079
appropriate by the Governor. 1080
To the extent allowed under federal law, any reduction to 1081
services or reimbursement rates under this subsection (F) shall be 1082
accompanied by a reduction, to the fullest allowable amount, to 1083
the profit margin and administrative fee portions of capitated 1084
payments to organizations described in paragraph (1) of subsection 1085
(H). 1086
Beginning in fiscal year 2010 and in fiscal years thereafter, 1087
when Medicaid expenditures are projected to exceed funds available 1088
for the fiscal year, the division shall submit the expected 1089
shortfall information to the PEER Committee not later than 1090
December 1 of the year in which the shortfall is projected to 1091
occur. PEER shall review the computations of the division and 1092
report its findings to the Legislative Budget Office not later 1093
than January 7 in any year. 1094
(G) Notwithstanding any other provision of this article, it 1095
shall be the duty of each provider participating in the Medicaid 1096
program to keep and maintain books, documents and other records as 1097
prescribed by the Division of Medicaid in accordance with federal 1098
laws and regulations. 1099
(H) (1) Notwithstanding any other provision of this 1100
article, the division is authorized to implement (a) a managed 1101
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care program, (b) a coordinated care program, (c) a coordinated 1102
care organization program, (d) a health maintenance organization 1103
program, (e) a patient-centered medical home program, (f) an 1104
accountable care organization program, (g) provider-sponsored 1105
health plan, or (h) any combination of the above programs. As a 1106
condition for the approval of any program under this subsection 1107
(H)(1), the division shall require that no managed care program, 1108
coordinated care program, coordinated care organization program, 1109
health maintenance organization program, or provider-sponsored 1110
health plan may: 1111
(a) Pay providers at a rate that is less than the 1112
Medicaid All Patient Refined Diagnosis Related Groups (APR-DRG) 1113
reimbursement rate; 1114
(b) Override the medical decisions of hospital 1115
physicians or staff regarding patients admitted to a hospital for 1116
an emergency medical condition as defined by 42 US Code Section 1117
1395dd. This restriction (b) does not prohibit the retrospective 1118
review of the appropriateness of the determination that an 1119
emergency medical condition exists by chart review or coding 1120
algorithm, nor does it prohibit prior authorization for 1121
nonemergency hospital admissions; 1122
(c) Pay providers at a rate that is less than the 1123
normal Medicaid reimbursement rate. It is the intent of the 1124
Legislature that all managed care entities described in this 1125
subsection (H), in collaboration with the division, develop and 1126
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implement innovative payment models that incentivize improvements 1127
in health care quality, outcomes, or value, as determined by the 1128
division. Participation in the provider network of any managed 1129
care, coordinated care, provider-sponsored health plan, or similar 1130
contractor shall not be conditioned on the provider's agreement to 1131
accept such alternative payment models; 1132
(d) Implement a prior authorization and 1133
utilization review program for medical services, transportation 1134
services and prescription drugs that is more stringent than the 1135
prior authorization processes used by the division in its 1136
administration of the Medicaid program. Not later than December 1137
2, 2021, the contractors that are receiving capitated payments 1138
under a managed care delivery system established under this 1139
subsection (H) shall submit a report to the Chairmen of the House 1140
and Senate Medicaid Committees on the status of the prior 1141
authorization and utilization review program for medical services, 1142
transportation services and prescription drugs that is required to 1143
be implemented under this subparagraph (d); 1144
(e) [Deleted] 1145
(f) Implement a preferred drug list that is more 1146
stringent than the mandatory preferred drug list established by 1147
the division under subsection (A)(9) of this section; 1148
(g) Implement a policy which denies beneficiaries 1149
with hemophilia access to the federally funded hemophilia 1150
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treatment centers as part of the Medicaid Managed Care network of 1151
providers. 1152
Each health maintenance organization, coordinated care 1153
organization, provider-sponsored health plan, or other 1154
organization paid for services on a capitated basis by the 1155
division under any managed care program or coordinated care 1156
program implemented by the division under this section shall use a 1157
clear set of level of care guidelines in the determination of 1158
medical necessity and in all utilization management practices, 1159
including the prior authorization process, concurrent reviews, 1160
retrospective reviews and payments, that are consistent with 1161
widely accepted professional standards of care. Organizations 1162
participating in a managed care program or coordinated care 1163
program implemented by the division may not use any additional 1164
criteria that would result in denial of care that would be 1165
determined appropriate and, therefore, medically necessary under 1166
those levels of care guidelines. 1167
(2) Notwithstanding any provision of this section, the 1168
recipients eligible for enrollment into a Medicaid Managed Care 1169
Program authorized under this subsection (H) may include only 1170
those categories of recipients eligible for participation in the 1171
Medicaid Managed Care Program as of January 1, 2021, the 1172
Children's Health Insurance Program (CHIP), and the CMS-approved 1173
Section 1115 demonstration waivers in operation as of January 1, 1174
2021. No expansion of Medicaid Managed Care Program contracts may 1175
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be implemented by the division without enabling legislation from 1176
the Mississippi Legislature. 1177
(3) (a) Any contractors receiving capitated payments 1178
under a managed care delivery system established in this section 1179
shall provide to the Legislature and the division statistical data 1180
to be shared with provider groups in order to improve patient 1181
access, appropriate utilization, cost savings and health outcomes 1182
not later than October 1 of each year. Additionally, each 1183
contractor shall disclose to the Chairmen of the Senate and House 1184
Medicaid Committees the administrative expenses costs for the 1185
prior calendar year, and the number of full-equivalent employees 1186
located in the State of Mississippi dedicated to the Medicaid and 1187
CHIP lines of business as of June 30 of the current year. 1188
(b) The division and the contractors participating 1189
in the managed care program, a coordinated care program or a 1190
provider-sponsored health plan shall be subject to annual program 1191
reviews or audits performed by the Office of the State Auditor, 1192
the PEER Committee, the Department of Insurance and/or independent 1193
third parties. 1194
(c) Those reviews shall include, but not be 1195
limited to, at least two (2) of the following items: 1196
(i) The financial benefit to the State of 1197
Mississippi of the managed care program, 1198
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(ii) The difference between the premiums paid 1199
to the managed care contractors and the payments made by those 1200
contractors to health care providers, 1201
(iii) Compliance with performance measures 1202
required under the contracts, 1203
(iv) Administrative expense allocation 1204
methodologies, 1205
(v) Whether nonprovider payments assigned as 1206
medical expenses are appropriate, 1207
(vi) Capitated arrangements with related 1208
party subcontractors, 1209
(vii) Reasonableness of corporate 1210
allocations, 1211
(viii) Value-added benefits and the extent to 1212
which they are used, 1213
(ix) The effectiveness of subcontractor 1214
oversight, including subcontractor review, 1215
(x) Whether health care outcomes have been 1216
improved, and 1217
(xi) The most common claim denial codes to 1218
determine the reasons for the denials. 1219
The audit reports shall be considered public documents and 1220
shall be posted in their entirety on the division's website. 1221
(4) All health maintenance organizations, coordinated 1222
care organizations, provider-sponsored health plans, or other 1223
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organizations paid for services on a capitated basis by the 1224
division under any managed care program or coordinated care 1225
program implemented by the division under this section shall 1226
reimburse all providers in those organizations at rates no lower 1227
than those provided under this section for beneficiaries who are 1228
not participating in those programs. 1229
(5) No health maintenance organization, coordinated 1230
care organization, provider-sponsored health plan, or other 1231
organization paid for services on a capitated basis by the 1232
division under any managed care program or coordinated care 1233
program implemented by the division under this section shall 1234
require its providers or beneficiaries to use any pharmacy that 1235
ships, mails or delivers prescription drugs or legend drugs or 1236
devices. 1237
(6) (a) Not later than December 1, 2021, the 1238
contractors who are receiving capitated payments under a managed 1239
care delivery system established under this subsection (H) shall 1240
develop and implement a uniform credentialing process for 1241
providers. Under that uniform credentialing process, a provider 1242
who meets the criteria for credentialing will be credentialed with 1243
all of those contractors and no such provider will have to be 1244
separately credentialed by any individual contractor in order to 1245
receive reimbursement from the contractor. Not later than 1246
December 2, 2021, those contractors shall submit a report to the 1247
Chairmen of the House and Senate Medicaid Committees on the status 1248
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of the uniform credentialing process for providers that is 1249
required under this subparagraph (a). 1250
(b) If those contractors have not implemented a 1251
uniform credentialing process as described in subparagraph (a) by 1252
December 1, 2021, the division shall develop and implement, not 1253
later than July 1, 2022, a single, consolidated credentialing 1254
process by which all providers will be credentialed. Under the 1255
division's single, consolidated credentialing process, no such 1256
contractor shall require its providers to be separately 1257
credentialed by the contractor in order to receive reimbursement 1258
from the contractor, but those contractors shall recognize the 1259
credentialing of the providers by the division's credentialing 1260
process. 1261
(c) The division shall require a uniform provider 1262
credentialing application that shall be used in the credentialing 1263
process that is established under subparagraph (a) or (b). If the 1264
contractor or division, as applicable, has not approved or denied 1265
the provider credentialing application within sixty (60) days of 1266
receipt of the completed application that includes all required 1267
information necessary for credentialing, then the contractor or 1268
division, upon receipt of a written request from the applicant and 1269
within five (5) business days of its receipt, shall issue a 1270
temporary provider credential/enrollment to the applicant if the 1271
applicant has a valid Mississippi professional or occupational 1272
license to provide the health care services to which the 1273
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credential/enrollment would apply. The contractor or the division 1274
shall not issue a temporary credential/enrollment if the applicant 1275
has reported on the application a history of medical or other 1276
professional or occupational malpractice claims, a history of 1277
substance abuse or mental health issues, a criminal record, or a 1278
history of medical or other licensing board, state or federal 1279
disciplinary action, including any suspension from participation 1280
in a federal or state program. The temporary 1281
credential/enrollment shall be effective upon issuance and shall 1282
remain in effect until the provider's credentialing/enrollment 1283
application is approved or denied by the contractor or division. 1284
The contractor or division shall render a final decision regarding 1285
credentialing/enrollment of the provider within sixty (60) days 1286
from the date that the temporary provider credential/enrollment is 1287
issued to the applicant. 1288
(d) If the contractor or division does not render 1289
a final decision regarding credentialing/enrollment of the 1290
provider within the time required in subparagraph (c), the 1291
provider shall be deemed to be credentialed by and enrolled with 1292
all of the contractors and eligible to receive reimbursement from 1293
the contractors. 1294
(7) (a) Each contractor that is receiving capitated 1295
payments under a managed care delivery system established under 1296
this subsection (H) shall provide to each provider for whom the 1297
contractor has denied the coverage of a procedure that was ordered 1298
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or requested by the provider for or on behalf of a patient, a 1299
letter that provides a detailed explanation of the reasons for the 1300
denial of coverage of the procedure and the name and the 1301
credentials of the person who denied the coverage. The letter 1302
shall be sent to the provider in electronic format. 1303
(b) After a contractor that is receiving capitated 1304
payments under a managed care delivery system established under 1305
this subsection (H) has denied coverage for a claim submitted by a 1306
provider, the contractor shall issue to the provider within sixty 1307
(60) days a final ruling of denial of the claim that allows the 1308
provider to have a state fair hearing and/or agency appeal with 1309
the division. If a contractor does not issue a final ruling of 1310
denial within sixty (60) days as required by this subparagraph 1311
(b), the provider's claim shall be deemed to be automatically 1312
approved and the contractor shall pay the amount of the claim to 1313
the provider. 1314
(c) After a contractor has issued a final ruling 1315
of denial of a claim submitted by a provider, the division shall 1316
conduct a state fair hearing and/or agency appeal on the matter of 1317
the disputed claim between the contractor and the provider within 1318
sixty (60) days, and shall render a decision on the matter within 1319
thirty (30) days after the date of the hearing and/or appeal. 1320
(8) It is the intention of the Legislature that the 1321
division evaluate the feasibility of using a single vendor to 1322
administer pharmacy benefits provided under a managed care 1323
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delivery system established under this subsection (H). Providers 1324
of pharmacy benefits shall cooperate with the division in any 1325
transition to a carve-out of pharmacy benefits under managed care. 1326
(9) The division shall evaluate the feasibility of 1327
using a single vendor to administer dental benefits provided under 1328
a managed care delivery system established in this subsection (H). 1329
Providers of dental benefits shall cooperate with the division in 1330
any transition to a carve-out of dental benefits under managed 1331
care. 1332
(10) It is the intent of the Legislature that any 1333
contractor receiving capitated payments under a managed care 1334
delivery system established in this section shall implement 1335
innovative programs to improve the health and well-being of 1336
members diagnosed with prediabetes and diabetes. 1337
(11) It is the intent of the Legislature that any 1338
contractors receiving capitated payments under a managed care 1339
delivery system established under this subsection (H) shall work 1340
with providers of Medicaid services to improve the utilization of 1341
long-acting reversible contraceptives (LARCs). Not later than 1342
December 1, 2021, any contractors receiving capitated payments 1343
under a managed care delivery system established under this 1344
subsection (H) shall provide to the Chairmen of the House and 1345
Senate Medicaid Committees and House and Senate Public Health 1346
Committees a report of LARC utilization for State Fiscal Years 1347
2018 through 2020 as well as any programs, initiatives, or efforts 1348
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made by the contractors and providers to increase LARC 1349
utilization. This report shall be updated annually to include 1350
information for subsequent state fiscal years. 1351
(12) The division is authorized to make not more than 1352
one (1) emergency extension of the contracts that are in effect on 1353
July 1, 2021, with contractors who are receiving capitated 1354
payments under a managed care delivery system established under 1355
this subsection (H), as provided in this paragraph (12). The 1356
maximum period of any such extension shall be one (1) year, and 1357
under any such extensions, the contractors shall be subject to all 1358
of the provisions of this subsection (H). The extended contracts 1359
shall be revised to incorporate any provisions of this subsection 1360
(H). 1361
(I) [Deleted] 1362
(J) There shall be no cuts in inpatient and outpatient 1363
hospital payments, or allowable days or volumes, as long as the 1364
hospital assessment provided in Section 43-13-145 is in effect. 1365
This subsection (J) shall not apply to decreases in payments that 1366
are a result of: reduced hospital admissions, audits or payments 1367
under the APR-DRG or APC models, or a managed care program or 1368
similar model described in subsection (H) of this section. 1369
(K) In the negotiation and execution of such contracts 1370
involving services performed by actuarial firms, the Executive 1371
Director of the Division of Medicaid may negotiate a limitation on 1372
liability to the state of prospective contractors. 1373
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(L) The Division of Medicaid shall reimburse for services 1374
provided to eligible Medicaid beneficiaries by a licensed birthing 1375
center in a method and manner to be determined by the division in 1376
accordance with federal laws and federal regulations. The 1377
division shall seek any necessary waivers, make any required 1378
amendments to its State Plan or revise any contracts authorized 1379
under subsection (H) of this section as necessary to provide the 1380
services authorized under this subsection. As used in this 1381
subsection, the term "birthing centers" shall have the meaning as 1382
defined in Section 41-77-1(a), which is a publicly or privately 1383
owned facility, place or institution constructed, renovated, 1384
leased or otherwise established where nonemergency births are 1385
planned to occur away from the mother's usual residence following 1386
a documented period of prenatal care for a normal uncomplicated 1387
pregnancy which has been determined to be low risk through a 1388
formal risk-scoring examination. 1389
SECTION 4. The Legislature finds that: 1390
(a) There is a growing complexity in health professions 1391
that can lead to the overlapping of existing licensed professions; 1392
(b) The Legislature is often called upon to make 1393
decisions about issues related to the scope of professional 1394
practice for multiple regulated health professions; and 1395
(c) A source of sound policy guidance could provide the 1396
Legislature with meaningful assistance in addressing these issues. 1397
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SECTION 5. (1) There is created the State Board of Health 1398
Professions, which shall consist of one (1) member from each of 1399
the following health regulatory boards: 1400
(a) The State Board of Medical Licensure; 1401
(b) The State Board of Pharmacy; 1402
(c) The Mississippi Board of Nursing; 1403
(d) The State Board of Chiropractic Examiners; 1404
(e) The State Board of Dental Examiners; and 1405
(f) The State Board of Optometry. 1406
(2) The members described in subsection (1) of this section 1407
shall be appointed by the Governor for terms of four (4) years and 1408
until their successor is duly qualified. Terms shall begin on 1409
July 1 and end on June 30. 1410
(3) In addition to the members provided for in subsection 1411
(1) of this section, there shall be five (5) members to be 1412
appointed by the Governor from the state at large, with the advice 1413
and consent of the Senate. The term for members appointed under 1414
this subsection (3) shall be for four (4) years and until their 1415
successor is duly qualified. Terms shall begin on July 1 and end 1416
on June 30. These members shall not hold a license to practice 1417
any of the professions regulated by the boards listed in 1418
subsection (1) of this section. 1419
(4) No member of the State Board of Health Professions who 1420
represents a health regulatory board shall continue serving as a 1421
member of the State Board of Health Professions after he or she 1422
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ceases to be a member of the health regulatory board from which he 1423
or she was appointed. 1424
SECTION 6. The chairman of the State Board of Health 1425
Professions shall be elected by the board from its members. The 1426
board shall meet at least annually and may hold additional 1427
meetings as necessary to perform its duties. Six (6) members of 1428
the board shall constitute a quorum for the conduct of business. 1429
Members of the board shall be entitled to actual travel expenses 1430
including mileage as provided in Section 25-3-41 and a per diem 1431
for attending meetings of the board in the amount provided in 1432
Section 25-3-69. 1433
SECTION 7. The State Board of Health Professions shall have 1434
the following powers and duties: 1435
(a) To evaluate the need for coordination among the 1436
health regulatory boards and their staffs and report its findings 1437
and recommendations to the boards; 1438
(b) To evaluate all health care professions and 1439
occupations in the state, including those regulated and those not 1440
regulated by other provisions of Title 73, Mississippi Code of 1441
1972, and to consider whether each such profession or occupation 1442
should be regulated and the degree of regulation to be imposed. 1443
Whenever the board determines that the public interest requires 1444
that a health care profession or occupation that is not regulated 1445
by law should be regulated, the board shall recommend to the 1446
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Legislature a regulatory system to establish the appropriate 1447
degree of regulation; 1448
(c) To serve as a forum for resolving conflicts among 1449
the health regulatory boards; 1450
(d) To advise the Governor and the Legislature on 1451
matters relating to the regulation or deregulation of health care 1452
professions and occupations; 1453
(e) To make bylaws for the governing of the board and 1454
the proper fulfillment of its duties under this chapter; 1455
(f) To promote the development of standards to evaluate 1456
the competency of the professions and occupations represented on 1457
the board; 1458
(g) To review periodically the investigatory, 1459
disciplinary and enforcement processes of the individual health 1460
regulatory boards to ensure the protection of the public and the 1461
fair and equitable treatment of health professionals; and 1462
(h) To examine scope of practice conflicts involving 1463
regulated and unregulated health care professions and occupations 1464
and advise the health regulatory boards and the Legislature of the 1465
nature and degree of such conflicts. 1466
SECTION 8. The State Department of Health shall annually 1467
request a budget for the State Board of Health Professions and 1468
shall provide a meeting space and administrative support for the 1469
board's operations. 1470
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SECTION 9. Sections 4 through 8 of this act shall be 1471
codified as a new Chapter 44 in Title 73, Mississippi Code of 1472
1972. 1473
SECTION 10. Section 47-5-579, Mississippi Code of 1972, is 1474
amended as follows: 1475
47-5-579. (1) (a) The corporation shall operate a work 1476
initiative at the Central Mississippi Correctional Facility, South 1477
Mississippi Correctional Institution, Mississippi State 1478
Penitentiary and the Mississippi Correctional Institute for Women, 1479
and is authorized, in its discretion, to create a work initiative 1480
at any other correctional facility listed in Section 47-5-539(d). 1481
In lieu of a work initiative created by the corporation, the 1482
warden or superintendent or sheriff at any regional and private 1483
facility listed in Section 47-5-539 is authorized to create a work 1484
initiative at their respective facility consistent with the 1485
provisions and requirements of this section. Each initiative 1486
shall be limited to no more than twenty-five (25) inmates in the 1487
state, regional or private facility at any given time. 1488
(b) The department, with regard to a work initiative in 1489
an MDOC facility, shall: 1490
(i) Have the ultimate authority for oversight of 1491
the administration of the initiative; 1492
(ii) Delegate the administration of the initiative 1493
to the corporation; and 1494
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(iii) Oversee the selection of inmates for 1495
admission to the initiative. 1496
(c) The sheriff, with regard to a work initiative at a 1497
regional facility, shall: 1498
(i) Have the ultimate authority for oversight of 1499
the administration of the initiative; 1500
(ii) Oversee the selection of inmates for 1501
admission to the initiative; and 1502
(iii) Work with the department and the corporation 1503
to establish guidelines for the initiative and develop a report 1504
thereon. 1505
(2) (a) An inmate is eligible for participation in the 1506
initiative if the inmate has: 1507
(i) No more than two (2) years remaining on the 1508
inmate's sentence; 1509
(ii) Not been convicted under Section 97-9-49 1510
within the last five (5) years; and 1511
(iii) Not been sentenced for a sex offense as 1512
defined in Section 45-33-23(h). 1513
(b) Any inmate who meets the eligibility requirements 1514
of paragraph (a) may request assignment to a work initiative 1515
established under this section. 1516
(3) (a) The commissioner, in the case of MDOC facilities, 1517
or the warden, superintendent, sheriff or similar leader in the 1518
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case of regional and private facilities, shall select inmates for 1519
admission to the program. 1520
(b) An inmate currently participating in vocational 1521
training or a soft skills training program at a facility 1522
authorized to operate a work initiative shall have priority in 1523
admission to the program. 1524
(4) (a) The chief executive officer, in the case of MDOC 1525
facilities, or the warden, superintendent, sheriff or similar 1526
leader in the case of regional and private facilities, may 1527
authorize the inmate to participate in educational or other 1528
rehabilitative programs designed to supplement his work initiative 1529
employment or to prepare the person for successful reentry. 1530
(b) Before accepting any participants to the program, 1531
the corporation, in consultation with the department, shall adopt 1532
and publish rules and regulations to effectuate this section no 1533
later than six (6) months after the effective date of this 1534
section. These rules and regulations shall include all protection 1535
requirements for work release programs established pursuant to 1536
Sections 47-5-451 through 47-5-471. 1537
(5) Participating employers shall pay no less than the 1538
prevailing wage for the position and shall under no circumstance 1539
pay less than the federal minimum wage. 1540
(6) Any inmate assigned to the initiative who, without 1541
proper authority or just cause, leaves the area to which he has 1542
been assigned to work or attend educational or other 1543
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rehabilitative programs, or leaves the vehicle or route of travel 1544
involved in his or her going to or returning from such place, will 1545
be guilty of escape as provided in Section 97-9-49. An offender 1546
who is convicted under Section 97-9-49 shall be ineligible for 1547
further participation in the work initiative during his or her 1548
current term of confinement. 1549
(7) (a) The inmate shall maintain an account through a 1550
local financial institution and shall provide a copy of a check 1551
stub to the chief executive officer, the warden, the 1552
superintendent or the sheriff at a regional facility, as the case 1553
may be. 1554
(b) The inmate shall be required: 1555
(i) To pay twenty-five percent (25%) of the 1556
inmate's wages after mandatory deductions for the following 1557
purposes: 1558
1. To pay support of dependents or to the 1559
Mississippi Department of Human Services on behalf of dependents 1560
as may be ordered by a judge of competent jurisdiction; and 1561
2. To pay any fines, restitution, or costs as 1562
ordered by the court to include any fines and fees associated with 1563
obtaining a valid driver's license upon release. 1564
(ii) To pay fifteen percent (15%) of the inmate's 1565
wages to the corporation for administrative expenses to include 1566
transportation costs to be remitted to the state, regional or 1567
private facility where the inmate is housed. In the case of state 1568
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facilities, the administrative expense reimbursement shall be paid 1569
to the corporation; in the case of regional facilities, the 1570
administrative expense reimbursement shall be paid to the 1571
sheriff's department; in the case of private facilities the 1572
administrative expense reimbursement shall be paid to the 1573
contractor overseeing the facility. 1574
(iii) To save fifty percent (50%) of the inmate's 1575
wages after mandatory reductions in the account required under 1576
paragraph (a) of this subsection. Monies under this subparagraph 1577
shall be made available to the inmate upon parole or release. 1578
(c) The inmate shall have access to the remaining ten 1579
percent (10%) of the monies in the inmate's account to purchase 1580
incidental expenses. 1581
(d) Any monies remaining under paragraph (a) of this 1582
subsection after all mandatory deductions are paid, shall be 1583
deposited in the inmate's account established under this 1584
subsection. Any monies remaining upon release in paragraph (c) of 1585
this subsection shall be released to the inmate. 1586
(8) The chief executive officer of the corporation shall 1587
collect and maintain data which shall be shared semiannually with 1588
the Joint Legislative Committee on Performance Evaluation and 1589
Expenditure Review (PEER) and the Corrections and Criminal Justice 1590
Oversight Task Force in sortable electronic format. The first 1591
report shall be made on January 15, 2023, and in six-month 1592
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intervals thereafter unless PEER establishes a different schedule. 1593
The data shall include: 1594
(a) Total number of participants at the end of each 1595
month by race, gender, and offenses charged; 1596
(b) Total number of participants who began the program 1597
in each month by race, gender, and offenses charged; 1598
(c) Total number of participants who successfully 1599
completed the program in each month by race, gender, and offenses 1600
charged; 1601
(d) Total number of participants who left the program 1602
in each month and reason for leaving by race, gender, and offenses 1603
charged; 1604
(e) Total number of participants who were arrested for 1605
a new criminal offense while in the program in each month by race, 1606
gender and offenses charged; 1607
(f) Total number of participants who were convicted of 1608
a new crime while in the program in each month by race, gender and 1609
offenses charged; 1610
(g) Total number of participants who completed the 1611
program and were convicted of a new crime within three (3) years 1612
of completing the program; 1613
(h) Total amount earned by participants and how the 1614
earnings were distributed in each month; 1615
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(i) Results of any initial risk and needs assessments 1616
conducted on each participant by race, gender, and offenses 1617
charged; 1618
(j) List of participating employers; 1619
(k) List of jobs acquired by participants; 1620
(l) List of the hourly wage paid to each participant; 1621
(m) Accounting of the manner and use of the * * * 1622
fifteen percent (15%) of the wages paid to the corporation by the 1623
inmate for administrative expenses; 1624
(n) Total costs associated with program operations; 1625
(o) List of participating financial institutions; 1626
(p) * * * Participating financial institutions, which 1627
must collect, maintain and report the create date for financial 1628
accounts opened by work initiative participants; 1629
(q) The average hourly wage earned in the 1630
program; * * * 1631
(r) The accounting of any dependent support payments, 1632
fines, restitutions, fees or costs as ordered by the court for 1633
each work initiative participant; 1634
(s) The collection, maintenance and reporting of the 1635
remaining sentence length of work initiative participants; and 1636
( * * *t) Any other data or information as requested by 1637
the task force. 1638
(9) The Joint Legislative Committee on Performance 1639
Evaluation and Expenditure Review (PEER) shall conduct a review of 1640
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ST: Creating Logic for Efficiency and
Accountability Reform (CLEAR) Act; create.
the initiative, including any expansion of the initiative 1641
authorized under this section, and produce an annual report to the 1642
Legislature on their effectiveness by January 1 of each year. The 1643
PEER Committee shall seek the assistance of the Corrections and 1644
Criminal Justice Task Force and may seek assistance from any other 1645
criminal justice experts it deems necessary during its review. 1646
SECTION 11. This act shall take effect and be in force from 1647
and after July 1, 2026. 1648