Postpartum depression; create new laws and revise existing provisions related to.

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To: Medicaid
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Senator(s) Boyd, Brumfield, Gillespie
Isom

SENATE BILL NO. 2708
(As Passed the Senate)

AN ACT TO REQUIRE HEALTH CARE PROFESSIONALS TO SCREEN BIRTH 1
MOTHERS FOR DEPRESSION AT THE TIME OF BIRTH; TO REQUIRE HEALTH 2
INSURANCE ISSUERS TO COVER SUCH SCREENING; TO PROVIDE EXEMPTIONS 3
TO HEALTH INSURANCE ISSUERS THAT ARE REQUIRED TO COVER SUCH 4
SCREENING; TO AMEND SECTION 43-13-117, MISSISSIPPI CODE OF 1972, 5
TO REQUIRE COVERAGE AND REIMBURSEMENT FOR POSTPARTUM DEPRESSION 6
SCREENING; TO CREATE NEW SECTION 41-140-1, MISSISSIPPI CODE OF 7
1972, TO DEFINE TERMS; TO CREATE NEW SECTION 41-140-3, MISSISSIPPI 8
CODE OF 1972, TO REQUIRE THE STATE DEPARTMENT OF HEALTH TO DEVELOP 9
AND PROMULGATE WRITTEN EDUCATIONAL MATERIALS AND INFORMATION FOR 10
HEALTH CARE PROFESSIONALS AND PATIENTS ABOUT MATERNAL MENTAL 11
HEALTH CONDITIONS; TO REQUIRE HOSPITALS PROVIDING BIRTH SERVICES 12
TO PROVIDE SUCH EDUCATIONAL MATERIALS TO NEW PARENTS AND, AS 13
APPROPRIATE, OTHER FAMILY MEMBERS; TO REQUIRE SUCH MATERIALS BE 14
PROVIDED TO ANY WOMAN WHO PRESENTS WITH SIGNS OF A MATERNAL MENTAL 15
HEALTH DISORDER; TO CREATE NEW SECTION 41-140-5, MISSISSIPPI CODE 16
OF 1972, TO REQUIRE ANY HEALTH CARE PROVIDER OR NURSE MIDWIFE WHO 17
RENDERS POSTNATAL CARE OR PEDIATRIC INFANT CARE TO ENSURE THAT THE 18
POSTNATAL CARE PATIENT OR BIRTHING MOTHER OF THE PEDIATRIC INFANT 19
CARE PATIENT, AS APPLICABLE, IS OFFERED SCREENING FOR POSTPARTUM 20
DEPRESSION AND TO PROVIDE APPROPRIATE REFERRALS IF SUCH PATIENT OR 21
MOTHER IS DEEMED LIKELY TO BE SUFFERING FROM POSTPARTUM 22
DEPRESSION; TO CREATE NEW SECTION 83-9-48, MISSISSIPPI CODE OF 23
1972, TO DEFINE "INSURER" AND REQUIRE INSURERS TO PROVIDE COVERAGE 24
FOR POSTPARTUM DEPRESSION SCREENING; AND FOR RELATED PURPOSES. 25
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 26
SECTION 1. For purposes of this act, the following terms 27
shall have the meanings ascribed herein: 28
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(a) "Birth mother" means the biological mother of a 29
child. 30
(b) "Depression" means a mental illness classified as a 31
mood disorder that causes a persistent feeling of sadness and a 32
loss of interest. 33
(c) "Health benefit plan" means: 34
(i) Services consisting of medical care, provided 35
directly, through insurance or reimbursement, or otherwise, and 36
including items and services paid for as medical care under any 37
hospital or medical service policy or certificate, hospital or 38
medical service plan contract, preferred provider organization, or 39
health maintenance organization contract offered by a health 40
insurance issuer; and 41
(ii) The Medicaid fee-for-service program and any 42
managed care program, coordinated care program, coordinated care 43
organization program or health maintenance organization program 44
implemented by the Division of Medicaid. 45
A health benefit plan does not include the following: 46
disability income plans, credit insurance plans, insurance 47
coverage issued as a supplement to liability insurance, a medical 48
payment under automobile or homeowner's insurance plans, health 49
care provided pursuant to the Mississippi Workers' Compensation 50
Act, a plan that provides only indemnity for hospital confinement, 51
an accident-only plan, a long-term care-only plan, a dental-only 52
plan or a vision-only plan. 53
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(d) "Health insurance issuer" means any entity that 54
offers health insurance coverage through a health benefit plan, 55
policy or certificate of insurance subject to state law that 56
regulates the business of insurance. "Health insurance issuer" 57
also includes a health maintenance organization, as defined and 58
regulated under Section 83-41-301 et seq., and includes the 59
Division of Medicaid for the services provided by fee-for-service 60
and through any managed care program, coordinated care program, 61
coordinated care organization program or health maintenance 62
organization program implemented by the division. 63
(e) "Health care professional" means a person who is 64
licensed, certified or otherwise authorized by the laws of this 65
state to administer health care in the ordinary course of the 66
practice of his or her profession. 67
SECTION 2. (1) A physician or health care provider who is 68
attending a birth in this state or a licensed health care provider 69
who is attending or providing medical treatment to a birth mother 70
in this state shall facilitate a health care provider to screen 71
the birth mother for depression within the first six (6) weeks of 72
birth. 73
(2) If the birth mother declines to be screened for 74
depression within the first six (6) weeks of having given birth, 75
the physician or health care provider shall record in the 76
patient's medical records that the birth mother was not screened 77
for depression based upon the refusal of the patient. The record 78
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of a patient refusal relieves the physician and the health care 79
provider of liability under this section. 80
(3) Records, reports, data or other information collected or 81
maintained under this section that identifies or could be used to 82
identify an individual patient, health care provider or 83
institution shall be confidential and considered protected health 84
information and be subject to all state confidentiality standards 85
and the Health Insurance Portability and Accountability Act 86
(HIPAA). 87
SECTION 3. (1) A health care insurer that offers, issues or 88
renews a health benefit plan in this state shall provide coverage 89
for screening for depression of the birth mother by a healthcare 90
professional within the first six (6) weeks of the birth mother's 91
having given birth on or after January 1, 2027. 92
(2) The coverage for screening for depression of the birth 93
mother under this section (a) is not subject to policy deductibles 94
or copayment requirements; and (b) does not diminish or limit 95
benefits otherwise allowable under a health benefit plan. 96
SECTION 4. Section 43-13-117, Mississippi Code of 1972, is 97
amended as follows: 98
43-13-117. (A) Medicaid as authorized by this article shall 99
include payment of part or all of the costs, at the discretion of 100
the division, with approval of the Governor and the Centers for 101
Medicare and Medicaid Services, of the following types of care and 102
services rendered to eligible applicants who have been determined 103
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to be eligible for that care and services, within the limits of 104
state appropriations and federal matching funds: 105
(1) Inpatient hospital services. 106
(a) The division is authorized to implement an All 107
Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement 108
methodology for inpatient hospital services. 109
(b) No service benefits or reimbursement 110
limitations in this subsection (A)(1) shall apply to payments 111
under an APR-DRG or Ambulatory Payment Classification (APC) model 112
or a managed care program or similar model described in subsection 113
(H) of this section unless specifically authorized by the 114
division. 115
(2) Outpatient hospital services. 116
(a) Emergency services. 117
(b) Other outpatient hospital services. The 118
division shall allow benefits for other medically necessary 119
outpatient hospital services (such as chemotherapy, radiation, 120
surgery and therapy), including outpatient services in a clinic or 121
other facility that is not located inside the hospital, but that 122
has been designated as an outpatient facility by the hospital, and 123
that was in operation or under construction on July 1, 2009, 124
provided that the costs and charges associated with the operation 125
of the hospital clinic are included in the hospital's cost report. 126
In addition, the Medicare thirty-five-mile rule will apply to 127
those hospital clinics not located inside the hospital that are 128
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constructed after July 1, 2009. Where the same services are 129
reimbursed as clinic services, the division may revise the rate or 130
methodology of outpatient reimbursement to maintain consistency, 131
efficiency, economy and quality of care. 132
(c) The division is authorized to implement an 133
Ambulatory Payment Classification (APC) methodology for outpatient 134
hospital services. The division shall give rural hospitals that 135
have fifty (50) or fewer licensed beds the option to not be 136
reimbursed for outpatient hospital services using the APC 137
methodology, but reimbursement for outpatient hospital services 138
provided by those hospitals shall be based on one hundred one 139
percent (101%) of the rate established under Medicare for 140
outpatient hospital services. Those hospitals choosing to not be 141
reimbursed under the APC methodology shall remain under cost-based 142
reimbursement for a two-year period. 143
(d) No service benefits or reimbursement 144
limitations in this subsection (A)(2) shall apply to payments 145
under an APR-DRG or APC model or a managed care program or similar 146
model described in subsection (H) of this section unless 147
specifically authorized by the division. 148
(3) Laboratory and x-ray services. 149
(4) Nursing facility services. 150
(a) The division shall make full payment to 151
nursing facilities for each day, not exceeding forty-two (42) days 152
per year, that a patient is absent from the facility on home 153
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leave. Payment may be made for the following home leave days in 154
addition to the forty-two-day limitation: Christmas, the day 155
before Christmas, the day after Christmas, Thanksgiving, the day 156
before Thanksgiving and the day after Thanksgiving. 157
(b) From and after July 1, 1997, the division 158
shall implement the integrated case-mix payment and quality 159
monitoring system, which includes the fair rental system for 160
property costs and in which recapture of depreciation is 161
eliminated. The division may reduce the payment for hospital 162
leave and therapeutic home leave days to the lower of the case-mix 163
category as computed for the resident on leave using the 164
assessment being utilized for payment at that point in time, or a 165
case-mix score of 1.000 for nursing facilities, and shall compute 166
case-mix scores of residents so that only services provided at the 167
nursing facility are considered in calculating a facility's per 168
diem. 169
(c) From and after July 1, 1997, all state-owned 170
nursing facilities shall be reimbursed on a full reasonable cost 171
basis. 172
(d) On or after January 1, 2015, the division 173
shall update the case-mix payment system resource utilization 174
grouper and classifications and fair rental reimbursement system. 175
The division shall develop and implement a payment add-on to 176
reimburse nursing facilities for ventilator-dependent resident 177
services. 178
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(e) The division shall develop and implement, not 179
later than January 1, 2001, a case-mix payment add-on determined 180
by time studies and other valid statistical data that will 181
reimburse a nursing facility for the additional cost of caring for 182
a resident who has a diagnosis of Alzheimer's or other related 183
dementia and exhibits symptoms that require special care. Any 184
such case-mix add-on payment shall be supported by a determination 185
of additional cost. The division shall also develop and implement 186
as part of the fair rental reimbursement system for nursing 187
facility beds, an Alzheimer's resident bed depreciation enhanced 188
reimbursement system that will provide an incentive to encourage 189
nursing facilities to convert or construct beds for residents with 190
Alzheimer's or other related dementia. 191
(f) The division shall develop and implement an 192
assessment process for long-term care services. The division may 193
provide the assessment and related functions directly or through 194
contract with the area agencies on aging. 195
The division shall apply for necessary federal waivers to 196
assure that additional services providing alternatives to nursing 197
facility care are made available to applicants for nursing 198
facility care. 199
(5) Periodic screening and diagnostic services for 200
individuals under age twenty-one (21) years as are needed to 201
identify physical and mental defects and to provide health care 202
treatment and other measures designed to correct or ameliorate 203
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defects and physical and mental illness and conditions discovered 204
by the screening services, regardless of whether these services 205
are included in the state plan. The division may include in its 206
periodic screening and diagnostic program those discretionary 207
services authorized under the federal regulations adopted to 208
implement Title XIX of the federal Social Security Act, as 209
amended. The division, in obtaining physical therapy services, 210
occupational therapy services, and services for individuals with 211
speech, hearing and language disorders, may enter into a 212
cooperative agreement with the State Department of Education for 213
the provision of those services to handicapped students by public 214
school districts using state funds that are provided from the 215
appropriation to the Department of Education to obtain federal 216
matching funds through the division. The division, in obtaining 217
medical and mental health assessments, treatment, care and 218
services for children who are in, or at risk of being put in, the 219
custody of the Mississippi Department of Human Services may enter 220
into a cooperative agreement with the Mississippi Department of 221
Human Services for the provision of those services using state 222
funds that are provided from the appropriation to the Department 223
of Human Services to obtain federal matching funds through the 224
division. 225
(6) Physician services. Fees for physician's services 226
that are covered only by Medicaid shall be reimbursed at ninety 227
percent (90%) of the rate established on January 1, 2018, and as 228
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may be adjusted each July thereafter, under Medicare. The 229
division may provide for a reimbursement rate for physician's 230
services of up to one hundred percent (100%) of the rate 231
established under Medicare for physician's services that are 232
provided after the normal working hours of the physician, as 233
determined in accordance with regulations of the division. The 234
division may reimburse eligible providers, as determined by the 235
division, for certain primary care services at one hundred percent 236
(100%) of the rate established under Medicare. The division shall 237
reimburse obstetricians and gynecologists for certain primary care 238
services as defined by the division at one hundred percent (100%) 239
of the rate established under Medicare. 240
(7) (a) Home health services for eligible persons, not 241
to exceed in cost the prevailing cost of nursing facility 242
services. All home health visits must be precertified as required 243
by the division. In addition to physicians, certified registered 244
nurse practitioners, physician assistants and clinical nurse 245
specialists are authorized to prescribe or order home health 246
services and plans of care, sign home health plans of care, 247
certify and recertify eligibility for home health services and 248
conduct the required initial face-to-face visit with the recipient 249
of the services. 250
(b) [Repealed] 251
(8) Emergency medical transportation services as 252
determined by the division. 253
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(9) Prescription drugs and other covered drugs and 254
services as determined by the division. 255
The division shall establish a mandatory preferred drug list. 256
Drugs not on the mandatory preferred drug list shall be made 257
available by utilizing prior authorization procedures established 258
by the division. 259
The division may seek to establish relationships with other 260
states in order to lower acquisition costs of prescription drugs 261
to include single-source and innovator multiple-source drugs or 262
generic drugs. In addition, if allowed by federal law or 263
regulation, the division may seek to establish relationships with 264
and negotiate with other countries to facilitate the acquisition 265
of prescription drugs to include single-source and innovator 266
multiple-source drugs or generic drugs, if that will lower the 267
acquisition costs of those prescription drugs. 268
The division may allow for a combination of prescriptions for 269
single-source and innovator multiple-source drugs and generic 270
drugs to meet the needs of the beneficiaries. 271
The executive director may approve specific maintenance drugs 272
for beneficiaries with certain medical conditions, which may be 273
prescribed and dispensed in three-month supply increments. 274
Drugs prescribed for a resident of a psychiatric residential 275
treatment facility must be provided in true unit doses when 276
available. The division may require that drugs not covered by 277
Medicare Part D for a resident of a long-term care facility be 278
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provided in true unit doses when available. Those drugs that were 279
originally billed to the division but are not used by a resident 280
in any of those facilities shall be returned to the billing 281
pharmacy for credit to the division, in accordance with the 282
guidelines of the State Board of Pharmacy and any requirements of 283
federal law and regulation. Drugs shall be dispensed to a 284
recipient and only one (1) dispensing fee per month may be 285
charged. The division shall develop a methodology for reimbursing 286
for restocked drugs, which shall include a restock fee as 287
determined by the division not exceeding Seven Dollars and 288
Eighty-two Cents ($7.82). 289
Except for those specific maintenance drugs approved by the 290
executive director, the division shall not reimburse for any 291
portion of a prescription that exceeds a thirty-one-day supply of 292
the drug based on the daily dosage. 293
The division is authorized to develop and implement a program 294
of payment for additional pharmacist services as determined by the 295
division. 296
All claims for drugs for dually eligible Medicare/Medicaid 297
beneficiaries that are paid for by Medicare must be submitted to 298
Medicare for payment before they may be processed by the 299
division's online payment system. 300
The division shall develop a pharmacy policy in which drugs 301
in tamper-resistant packaging that are prescribed for a resident 302
of a nursing facility but are not dispensed to the resident shall 303
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be returned to the pharmacy and not billed to Medicaid, in 304
accordance with guidelines of the State Board of Pharmacy. 305
The division shall develop and implement a method or methods 306
by which the division will provide on a regular basis to Medicaid 307
providers who are authorized to prescribe drugs, information about 308
the costs to the Medicaid program of single-source drugs and 309
innovator multiple-source drugs, and information about other drugs 310
that may be prescribed as alternatives to those single-source 311
drugs and innovator multiple-source drugs and the costs to the 312
Medicaid program of those alternative drugs. 313
Notwithstanding any law or regulation, information obtained 314
or maintained by the division regarding the prescription drug 315
program, including trade secrets and manufacturer or labeler 316
pricing, is confidential and not subject to disclosure except to 317
other state agencies. 318
The dispensing fee for each new or refill prescription, 319
including nonlegend or over-the-counter drugs covered by the 320
division, shall be not less than Three Dollars and Ninety-one 321
Cents ($3.91), as determined by the division. 322
The division shall not reimburse for single-source or 323
innovator multiple-source drugs if there are equally effective 324
generic equivalents available and if the generic equivalents are 325
the least expensive. 326
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It is the intent of the Legislature that the pharmacists 327
providers be reimbursed for the reasonable costs of filling and 328
dispensing prescriptions for Medicaid beneficiaries. 329
The division shall allow certain drugs, including 330
physician-administered drugs, and implantable drug system devices, 331
and medical supplies, with limited distribution or limited access 332
for beneficiaries and administered in an appropriate clinical 333
setting, to be reimbursed as either a medical claim or pharmacy 334
claim, as determined by the division. 335
It is the intent of the Legislature that the division and any 336
managed care entity described in subsection (H) of this section 337
encourage the use of Alpha-Hydroxyprogesterone Caproate (17P) to 338
prevent recurrent preterm birth. 339
(10) Dental and orthodontic services to be determined 340
by the division. 341
The division shall increase the amount of the reimbursement 342
rate for diagnostic and preventative dental services for each of 343
the fiscal years 2022, 2023 and 2024 by five percent (5%) above 344
the amount of the reimbursement rate for the previous fiscal year. 345
The division shall increase the amount of the reimbursement rate 346
for restorative dental services for each of the fiscal years 2023, 347
2024 and 2025 by five percent (5%) above the amount of the 348
reimbursement rate for the previous fiscal year. It is the intent 349
of the Legislature that the reimbursement rate revision for 350
preventative dental services will be an incentive to increase the 351
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number of dentists who actively provide Medicaid services. This 352
dental services reimbursement rate revision shall be known as the 353
"James Russell Dumas Medicaid Dental Services Incentive Program." 354
The Medical Care Advisory Committee, assisted by the Division 355
of Medicaid, shall annually determine the effect of this incentive 356
by evaluating the number of dentists who are Medicaid providers, 357
the number who and the degree to which they are actively billing 358
Medicaid, the geographic trends of where dentists are offering 359
what types of Medicaid services and other statistics pertinent to 360
the goals of this legislative intent. This data shall annually be 361
presented to the Chair of the Senate Medicaid Committee and the 362
Chair of the House Medicaid Committee. 363
The division shall include dental services as a necessary 364
component of overall health services provided to children who are 365
eligible for services. 366
(11) Eyeglasses for all Medicaid beneficiaries who have 367
(a) had surgery on the eyeball or ocular muscle that results in a 368
vision change for which eyeglasses or a change in eyeglasses is 369
medically indicated within six (6) months of the surgery and is in 370
accordance with policies established by the division, or (b) one 371
(1) pair every five (5) years and in accordance with policies 372
established by the division. In either instance, the eyeglasses 373
must be prescribed by a physician skilled in diseases of the eye 374
or an optometrist, whichever the beneficiary may select. 375
(12) Intermediate care facility services. 376
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(a) The division shall make full payment to all 377
intermediate care facilities for individuals with intellectual 378
disabilities for each day, not exceeding sixty-three (63) days per 379
year, that a patient is absent from the facility on home leave. 380
Payment may be made for the following home leave days in addition 381
to the sixty-three-day limitation: Christmas, the day before 382
Christmas, the day after Christmas, Thanksgiving, the day before 383
Thanksgiving and the day after Thanksgiving. 384
(b) All state-owned intermediate care facilities 385
for individuals with intellectual disabilities shall be reimbursed 386
on a full reasonable cost basis. 387
(c) Effective January 1, 2015, the division shall 388
update the fair rental reimbursement system for intermediate care 389
facilities for individuals with intellectual disabilities. 390
(13) Family planning services, including drugs, 391
supplies and devices, when those services are under the 392
supervision of a physician or nurse practitioner. 393
(14) Clinic services. Preventive, diagnostic, 394
therapeutic, rehabilitative or palliative services that are 395
furnished by a facility that is not part of a hospital but is 396
organized and operated to provide medical care to outpatients. 397
Clinic services include, but are not limited to: 398
(a) Services provided by ambulatory surgical 399
centers (ASCs) as defined in Section 41-75-1(a); and 400
(b) Dialysis center services. 401
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(15) Home- and community-based services for the elderly 402
and disabled, as provided under Title XIX of the federal Social 403
Security Act, as amended, under waivers, subject to the 404
availability of funds specifically appropriated for that purpose 405
by the Legislature. 406
(16) Mental health services. Certain services provided 407
by a psychiatrist shall be reimbursed at up to one hundred percent 408
(100%) of the Medicare rate. Approved therapeutic and case 409
management services (a) provided by an approved regional mental 410
health/intellectual disability center established under Sections 411
41-19-31 through 41-19-39, or by another community mental health 412
service provider meeting the requirements of the Department of 413
Mental Health to be an approved mental health/intellectual 414
disability center if determined necessary by the Department of 415
Mental Health, using state funds that are provided in the 416
appropriation to the division to match federal funds, or (b) 417
provided by a facility that is certified by the State Department 418
of Mental Health to provide therapeutic and case management 419
services, to be reimbursed on a fee for service basis, or (c) 420
provided in the community by a facility or program operated by the 421
Department of Mental Health. Any such services provided by a 422
facility described in subparagraph (b) must have the prior 423
approval of the division to be reimbursable under this section. 424
(17) Durable medical equipment services and medical 425
supplies. Precertification of durable medical equipment and 426
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medical supplies must be obtained as required by the division. 427
The Division of Medicaid may require durable medical equipment 428
providers to obtain a surety bond in the amount and to the 429
specifications as established by the Balanced Budget Act of 1997. 430
A maximum dollar amount of reimbursement for noninvasive 431
ventilators or ventilation treatments properly ordered and being 432
used in an appropriate care setting shall not be set by any health 433
maintenance organization, coordinated care organization, 434
provider-sponsored health plan, or other organization paid for 435
services on a capitated basis by the division under any managed 436
care program or coordinated care program implemented by the 437
division under this section. Reimbursement by these organizations 438
to durable medical equipment suppliers for home use of noninvasive 439
and invasive ventilators shall be on a continuous monthly payment 440
basis for the duration of medical need throughout a patient's 441
valid prescription period. 442
(18) (a) Notwithstanding any other provision of this 443
section to the contrary, as provided in the Medicaid state plan 444
amendment or amendments as defined in Section 43-13-145(10), the 445
division shall make additional reimbursement to hospitals that 446
serve a disproportionate share of low-income patients and that 447
meet the federal requirements for those payments as provided in 448
Section 1923 of the federal Social Security Act and any applicable 449
regulations. It is the intent of the Legislature that the 450
division shall draw down all available federal funds allotted to 451
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the state for disproportionate share hospitals. However, from and 452
after January 1, 1999, public hospitals participating in the 453
Medicaid disproportionate share program may be required to 454
participate in an intergovernmental transfer program as provided 455
in Section 1903 of the federal Social Security Act and any 456
applicable regulations. 457
(b) (i) 1. The division may establish a Medicare 458
Upper Payment Limits Program, as defined in Section 1902(a)(30) of 459
the federal Social Security Act and any applicable federal 460
regulations, or an allowable delivery system or provider payment 461
initiative authorized under 42 CFR 438.6(c), for hospitals, 462
nursing facilities and physicians employed or contracted by 463
hospitals. 464
2. The division shall establish a 465
Medicaid Supplemental Payment Program, as permitted by the federal 466
Social Security Act and a comparable allowable delivery system or 467
provider payment initiative authorized under 42 CFR 438.6(c), for 468
emergency ambulance transportation providers in accordance with 469
this subsection (A)(18)(b). 470
(ii) The division shall assess each hospital, 471
nursing facility, and emergency ambulance transportation provider 472
for the sole purpose of financing the state portion of the 473
Medicare Upper Payment Limits Program or other program(s) 474
authorized under this subsection (A)(18)(b). The hospital 475
assessment shall be as provided in Section 43-13-145(4)(a), and 476
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the nursing facility and the emergency ambulance transportation 477
assessments, if established, shall be based on Medicaid 478
utilization or other appropriate method, as determined by the 479
division, consistent with federal regulations. The assessments 480
will remain in effect as long as the state participates in the 481
Medicare Upper Payment Limits Program or other program(s) 482
authorized under this subsection (A)(18)(b). In addition to the 483
hospital assessment provided in Section 43-13-145(4)(a), hospitals 484
with physicians participating in the Medicare Upper Payment Limits 485
Program or other program(s) authorized under this subsection 486
(A)(18)(b) shall be required to participate in an 487
intergovernmental transfer or assessment, as determined by the 488
division, for the purpose of financing the state portion of the 489
physician UPL payments or other payment(s) authorized under this 490
subsection (A)(18)(b). 491
(iii) Subject to approval by the Centers for 492
Medicare and Medicaid Services (CMS) and the provisions of this 493
subsection (A)(18)(b), the division shall make additional 494
reimbursement to hospitals, nursing facilities, and emergency 495
ambulance transportation providers for the Medicare Upper Payment 496
Limits Program or other program(s) authorized under this 497
subsection (A)(18)(b), and, if the program is established for 498
physicians, shall make additional reimbursement for physicians, as 499
defined in Section 1902(a)(30) of the federal Social Security Act 500
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and any applicable federal regulations, provided the assessment in 501
this subsection (A)(18)(b) is in effect. 502
(iv) Notwithstanding any other provision of 503
this article to the contrary, effective upon implementation of the 504
Mississippi Hospital Access Program (MHAP) provided in 505
subparagraph (c)(i) below, the hospital portion of the inpatient 506
Upper Payment Limits Program shall transition into and be replaced 507
by the MHAP program. However, the division is authorized to 508
develop and implement an alternative fee-for-service Upper Payment 509
Limits model in accordance with federal laws and regulations if 510
necessary to preserve supplemental funding. Further, the 511
division, in consultation with the hospital industry shall develop 512
alternative models for distribution of medical claims and 513
supplemental payments for inpatient and outpatient hospital 514
services, and such models may include, but shall not be limited to 515
the following: increasing rates for inpatient and outpatient 516
services; creating a low-income utilization pool of funds to 517
reimburse hospitals for the costs of uncompensated care, charity 518
care and bad debts as permitted and approved pursuant to federal 519
regulations and the Centers for Medicare and Medicaid Services; 520
supplemental payments based upon Medicaid utilization, quality, 521
service lines and/or costs of providing such services to Medicaid 522
beneficiaries and to uninsured patients. The goals of such 523
payment models shall be to ensure access to inpatient and 524
outpatient care and to maximize any federal funds that are 525
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available to reimburse hospitals for services provided. Any such 526
documents required to achieve the goals described in this 527
paragraph shall be submitted to the Centers for Medicare and 528
Medicaid Services, with a proposed effective date of July 1, 2019, 529
to the extent possible, but in no event shall the effective date 530
of such payment models be later than July 1, 2020. The Chairmen 531
of the Senate and House Medicaid Committees shall be provided a 532
copy of the proposed payment model(s) prior to submission. 533
Effective July 1, 2018, and until such time as any payment 534
model(s) as described above become effective, the division, in 535
consultation with the hospital industry, is authorized to 536
implement a transitional program for inpatient and outpatient 537
payments and/or supplemental payments (including, but not limited 538
to, MHAP and directed payments), to redistribute available 539
supplemental funds among hospital providers, provided that when 540
compared to a hospital's prior year supplemental payments, 541
supplemental payments made pursuant to any such transitional 542
program shall not result in a decrease of more than five percent 543
(5%) and shall not increase by more than the amount needed to 544
maximize the distribution of the available funds. 545
(v) 1. To preserve and improve access to 546
ambulance transportation provider services, the division shall 547
seek CMS approval to make ambulance service access payments as set 548
forth in this subsection (A)(18)(b) for all covered emergency 549
ambulance services rendered on or after July 1, 2022, and shall 550
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make such ambulance service access payments for all covered 551
services rendered on or after the effective date of CMS approval. 552
2. The division shall calculate the 553
ambulance service access payment amount as the balance of the 554
portion of the Medical Care Fund related to ambulance 555
transportation service provider assessments plus any federal 556
matching funds earned on the balance, up to, but not to exceed, 557
the upper payment limit gap for all emergency ambulance service 558
providers. 559
3. a. Except for ambulance services 560
exempt from the assessment provided in this paragraph (18)(b), all 561
ambulance transportation service providers shall be eligible for 562
ambulance service access payments each state fiscal year as set 563
forth in this paragraph (18)(b). 564
b. In addition to any other funds 565
paid to ambulance transportation service providers for emergency 566
medical services provided to Medicaid beneficiaries, each eligible 567
ambulance transportation service provider shall receive ambulance 568
service access payments each state fiscal year equal to the 569
ambulance transportation service provider's upper payment limit 570
gap. Subject to approval by the Centers for Medicare and Medicaid 571
Services, ambulance service access payments shall be made no less 572
than on a quarterly basis. 573
c. As used in this paragraph 574
(18)(b)(v), the term "upper payment limit gap" means the 575
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difference between the total amount that the ambulance 576
transportation service provider received from Medicaid and the 577
average amount that the ambulance transportation service provider 578
would have received from commercial insurers for those services 579
reimbursed by Medicaid. 580
4. An ambulance service access payment 581
shall not be used to offset any other payment by the division for 582
emergency or nonemergency services to Medicaid beneficiaries. 583
(c) (i) Not later than December l, 2015, the 584
division shall, subject to approval by the Centers for Medicare 585
and Medicaid Services (CMS), establish, implement and operate a 586
Mississippi Hospital Access Program (MHAP) for the purpose of 587
protecting patient access to hospital care through hospital 588
inpatient reimbursement programs provided in this section designed 589
to maintain total hospital reimbursement for inpatient services 590
rendered by in-state hospitals and the out-of-state hospital that 591
is authorized by federal law to submit intergovernmental transfers 592
(IGTs) to the State of Mississippi and is classified as Level I 593
trauma center located in a county contiguous to the state line at 594
the maximum levels permissible under applicable federal statutes 595
and regulations, at which time the current inpatient Medicare 596
Upper Payment Limits (UPL) Program for hospital inpatient services 597
shall transition to the MHAP. 598
(ii) Subject to approval by the Centers for 599
Medicare and Medicaid Services (CMS), the MHAP shall provide 600
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increased inpatient capitation (PMPM) payments to managed care 601
entities contracting with the division pursuant to subsection (H) 602
of this section to support availability of hospital services or 603
such other payments permissible under federal law necessary to 604
accomplish the intent of this subsection. 605
(iii) The intent of this subparagraph (c) is 606
that effective for all inpatient hospital Medicaid services during 607
state fiscal year 2016, and so long as this provision shall remain 608
in effect hereafter, the division shall to the fullest extent 609
feasible replace the additional reimbursement for hospital 610
inpatient services under the inpatient Medicare Upper Payment 611
Limits (UPL) Program with additional reimbursement under the MHAP 612
and other payment programs for inpatient and/or outpatient 613
payments which may be developed under the authority of this 614
paragraph. 615
(iv) The division shall assess each hospital 616
as provided in Section 43-13-145(4)(a) for the purpose of 617
financing the state portion of the MHAP, supplemental payments and 618
such other purposes as specified in Section 43-13-145. The 619
assessment will remain in effect as long as the MHAP and 620
supplemental payments are in effect. 621
(19) (a) Perinatal risk management services. The 622
division shall promulgate regulations to be effective from and 623
after October 1, 1988, to establish a comprehensive perinatal 624
system for risk assessment of all pregnant and infant Medicaid 625
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recipients and for management, education and follow-up for those 626
who are determined to be at risk. Services to be performed 627
include case management, nutrition assessment/counseling, 628
psychosocial assessment/counseling and health education. The 629
division shall contract with the State Department of Health to 630
provide services within this paragraph (Perinatal High Risk 631
Management/Infant Services System (PHRM/ISS)). The State 632
Department of Health shall be reimbursed on a full reasonable cost 633
basis for services provided under this subparagraph (a). 634
(b) Early intervention system services. The 635
division shall cooperate with the State Department of Health, 636
acting as lead agency, in the development and implementation of a 637
statewide system of delivery of early intervention services, under 638
Part C of the Individuals with Disabilities Education Act (IDEA). 639
The State Department of Health shall certify annually in writing 640
to the executive director of the division the dollar amount of 641
state early intervention funds available that will be utilized as 642
a certified match for Medicaid matching funds. Those funds then 643
shall be used to provide expanded targeted case management 644
services for Medicaid eligible children with special needs who are 645
eligible for the state's early intervention system. 646
Qualifications for persons providing service coordination shall be 647
determined by the State Department of Health and the Division of 648
Medicaid. 649
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(20) Home- and community-based services for physically 650
disabled approved services as allowed by a waiver from the United 651
States Department of Health and Human Services for home- and 652
community-based services for physically disabled people using 653
state funds that are provided from the appropriation to the State 654
Department of Rehabilitation Services and used to match federal 655
funds under a cooperative agreement between the division and the 656
department, provided that funds for these services are 657
specifically appropriated to the Department of Rehabilitation 658
Services. 659
(21) Nurse practitioner services. Services furnished 660
by a registered nurse who is licensed and certified by the 661
Mississippi Board of Nursing as a nurse practitioner, including, 662
but not limited to, nurse anesthetists, nurse midwives, family 663
nurse practitioners, family planning nurse practitioners, 664
pediatric nurse practitioners, obstetrics-gynecology nurse 665
practitioners and neonatal nurse practitioners, under regulations 666
adopted by the division. Reimbursement for those services shall 667
not exceed ninety percent (90%) of the reimbursement rate for 668
comparable services rendered by a physician. The division may 669
provide for a reimbursement rate for nurse practitioner services 670
of up to one hundred percent (100%) of the reimbursement rate for 671
comparable services rendered by a physician for nurse practitioner 672
services that are provided after the normal working hours of the 673
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nurse practitioner, as determined in accordance with regulations 674
of the division. 675
(22) Ambulatory services delivered in federally 676
qualified health centers, rural health centers and clinics of the 677
local health departments of the State Department of Health for 678
individuals eligible for Medicaid under this article based on 679
reasonable costs as determined by the division. Federally 680
qualified health centers shall be reimbursed by the Medicaid 681
prospective payment system as approved by the Centers for Medicare 682
and Medicaid Services. The division shall recognize federally 683
qualified health centers (FQHCs), rural health clinics (RHCs) and 684
community mental health centers (CMHCs) as both an originating and 685
distant site provider for the purposes of telehealth 686
reimbursement. The division is further authorized and directed to 687
reimburse FQHCs, RHCs and CMHCs for both distant site and 688
originating site services when such services are appropriately 689
provided by the same organization. 690
(23) Inpatient psychiatric services. 691
(a) Inpatient psychiatric services to be 692
determined by the division for recipients under age twenty-one 693
(21) that are provided under the direction of a physician in an 694
inpatient program in a licensed acute care psychiatric facility or 695
in a licensed psychiatric residential treatment facility, before 696
the recipient reaches age twenty-one (21) or, if the recipient was 697
receiving the services immediately before he or she reached age 698
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twenty-one (21), before the earlier of the date he or she no 699
longer requires the services or the date he or she reaches age 700
twenty-two (22), as provided by federal regulations. From and 701
after January 1, 2015, the division shall update the fair rental 702
reimbursement system for psychiatric residential treatment 703
facilities. Precertification of inpatient days and residential 704
treatment days must be obtained as required by the division. From 705
and after July 1, 2009, all state-owned and state-operated 706
facilities that provide inpatient psychiatric services to persons 707
under age twenty-one (21) who are eligible for Medicaid 708
reimbursement shall be reimbursed for those services on a full 709
reasonable cost basis. 710
(b) The division may reimburse for services 711
provided by a licensed freestanding psychiatric hospital to 712
Medicaid recipients over the age of twenty-one (21) in a method 713
and manner consistent with the provisions of Section 43-13-117.5. 714
(24) [Deleted] 715
(25) [Deleted] 716
(26) Hospice care. As used in this paragraph, the term 717
"hospice care" means a coordinated program of active professional 718
medical attention within the home and outpatient and inpatient 719
care that treats the terminally ill patient and family as a unit, 720
employing a medically directed interdisciplinary team. The 721
program provides relief of severe pain or other physical symptoms 722
and supportive care to meet the special needs arising out of 723
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physical, psychological, spiritual, social and economic stresses 724
that are experienced during the final stages of illness and during 725
dying and bereavement and meets the Medicare requirements for 726
participation as a hospice as provided in federal regulations. 727
(27) Group health plan premiums and cost-sharing if it 728
is cost-effective as defined by the United States Secretary of 729
Health and Human Services. 730
(28) Other health insurance premiums that are 731
cost-effective as defined by the United States Secretary of Health 732
and Human Services. Medicare eligible must have Medicare Part B 733
before other insurance premiums can be paid. 734
(29) The Division of Medicaid may apply for a waiver 735
from the United States Department of Health and Human Services for 736
home- and community-based services for developmentally disabled 737
people using state funds that are provided from the appropriation 738
to the State Department of Mental Health and/or funds transferred 739
to the department by a political subdivision or instrumentality of 740
the state and used to match federal funds under a cooperative 741
agreement between the division and the department, provided that 742
funds for these services are specifically appropriated to the 743
Department of Mental Health and/or transferred to the department 744
by a political subdivision or instrumentality of the state. 745
(30) Pediatric skilled nursing services as determined 746
by the division and in a manner consistent with regulations 747
promulgated by the Mississippi State Department of Health. 748
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(31) Targeted case management services for children 749
with special needs, under waivers from the United States 750
Department of Health and Human Services, using state funds that 751
are provided from the appropriation to the Mississippi Department 752
of Human Services and used to match federal funds under a 753
cooperative agreement between the division and the department. 754
(32) Care and services provided in Christian Science 755
Sanatoria listed and certified by the Commission for Accreditation 756
of Christian Science Nursing Organizations/Facilities, Inc., 757
rendered in connection with treatment by prayer or spiritual means 758
to the extent that those services are subject to reimbursement 759
under Section 1903 of the federal Social Security Act. 760
(33) Podiatrist services. 761
(34) Assisted living services as provided through 762
home- and community-based services under Title XIX of the federal 763
Social Security Act, as amended, subject to the availability of 764
funds specifically appropriated for that purpose by the 765
Legislature. 766
(35) Services and activities authorized in Sections 767
43-27-101 and 43-27-103, using state funds that are provided from 768
the appropriation to the Mississippi Department of Human Services 769
and used to match federal funds under a cooperative agreement 770
between the division and the department. 771
(36) Nonemergency transportation services for 772
Medicaid-eligible persons as determined by the division. The PEER 773
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Committee shall conduct a performance evaluation of the 774
nonemergency transportation program to evaluate the administration 775
of the program and the providers of transportation services to 776
determine the most cost-effective ways of providing nonemergency 777
transportation services to the patients served under the program. 778
The performance evaluation shall be completed and provided to the 779
members of the Senate Medicaid Committee and the House Medicaid 780
Committee not later than January 1, 2019, and every two (2) years 781
thereafter. 782
(37) [Deleted] 783
(38) Chiropractic services. A chiropractor's manual 784
manipulation of the spine to correct a subluxation, if x-ray 785
demonstrates that a subluxation exists and if the subluxation has 786
resulted in a neuromusculoskeletal condition for which 787
manipulation is appropriate treatment, and related spinal x-rays 788
performed to document these conditions. Reimbursement for 789
chiropractic services shall not exceed Seven Hundred Dollars 790
($700.00) per year per beneficiary. 791
(39) Dually eligible Medicare/Medicaid beneficiaries. 792
The division shall pay the Medicare deductible and coinsurance 793
amounts for services available under Medicare, as determined by 794
the division. From and after July 1, 2009, the division shall 795
reimburse crossover claims for inpatient hospital services and 796
crossover claims covered under Medicare Part B in the same manner 797
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that was in effect on January 1, 2008, unless specifically 798
authorized by the Legislature to change this method. 799
(40) [Deleted] 800
(41) Services provided by the State Department of 801
Rehabilitation Services for the care and rehabilitation of persons 802
with spinal cord injuries or traumatic brain injuries, as allowed 803
under waivers from the United States Department of Health and 804
Human Services, using up to seventy-five percent (75%) of the 805
funds that are appropriated to the Department of Rehabilitation 806
Services from the Spinal Cord and Head Injury Trust Fund 807
established under Section 37-33-261 and used to match federal 808
funds under a cooperative agreement between the division and the 809
department. 810
(42) [Deleted] 811
(43) The division shall provide reimbursement, 812
according to a payment schedule developed by the division, for 813
smoking cessation medications for pregnant women during their 814
pregnancy and other Medicaid-eligible women who are of 815
child-bearing age. 816
(44) Nursing facility services for the severely 817
disabled. 818
(a) Severe disabilities include, but are not 819
limited to, spinal cord injuries, closed-head injuries and 820
ventilator-dependent patients. 821
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(b) Those services must be provided in a long-term 822
care nursing facility dedicated to the care and treatment of 823
persons with severe disabilities. 824
(45) Physician assistant services. Services furnished 825
by a physician assistant who is licensed by the State Board of 826
Medical Licensure and is practicing with physician supervision 827
under regulations adopted by the board, under regulations adopted 828
by the division. Reimbursement for those services shall not 829
exceed ninety percent (90%) of the reimbursement rate for 830
comparable services rendered by a physician. The division may 831
provide for a reimbursement rate for physician assistant services 832
of up to one hundred percent (100%) or the reimbursement rate for 833
comparable services rendered by a physician for physician 834
assistant services that are provided after the normal working 835
hours of the physician assistant, as determined in accordance with 836
regulations of the division. 837
(46) The division shall make application to the federal 838
Centers for Medicare and Medicaid Services (CMS) for a waiver to 839
develop and provide services for children with serious emotional 840
disturbances as defined in Section 43-14-1(1), which may include 841
home- and community-based services, case management services or 842
managed care services through mental health providers certified by 843
the Department of Mental Health. The division may implement and 844
provide services under this waivered program only if funds for 845
these services are specifically appropriated for this purpose by 846
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the Legislature, or if funds are voluntarily provided by affected 847
agencies. 848
(47) (a) The division may develop and implement 849
disease management programs for individuals with high-cost chronic 850
diseases and conditions, including the use of grants, waivers, 851
demonstrations or other projects as necessary. 852
(b) Participation in any disease management 853
program implemented under this paragraph (47) is optional with the 854
individual. An individual must affirmatively elect to participate 855
in the disease management program in order to participate, and may 856
elect to discontinue participation in the program at any time. 857
(48) Pediatric long-term acute care hospital services. 858
(a) Pediatric long-term acute care hospital 859
services means services provided to eligible persons under 860
twenty-one (21) years of age by a freestanding Medicare-certified 861
hospital that has an average length of inpatient stay greater than 862
twenty-five (25) days and that is primarily engaged in providing 863
chronic or long-term medical care to persons under twenty-one (21) 864
years of age. 865
(b) The services under this paragraph (48) shall 866
be reimbursed as a separate category of hospital services. 867
(49) The division may establish copayments and/or 868
coinsurance for any Medicaid services for which copayments and/or 869
coinsurance are allowable under federal law or regulation. 870
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(50) Services provided by the State Department of 871
Rehabilitation Services for the care and rehabilitation of persons 872
who are deaf and blind, as allowed under waivers from the United 873
States Department of Health and Human Services to provide home- 874
and community-based services using state funds that are provided 875
from the appropriation to the State Department of Rehabilitation 876
Services or if funds are voluntarily provided by another agency. 877
(51) Upon determination of Medicaid eligibility and in 878
association with annual redetermination of Medicaid eligibility, 879
beneficiaries shall be encouraged to undertake a physical 880
examination that will establish a base-line level of health and 881
identification of a usual and customary source of care (a medical 882
home) to aid utilization of disease management tools. This 883
physical examination and utilization of these disease management 884
tools shall be consistent with current United States Preventive 885
Services Task Force or other recognized authority recommendations. 886
For persons who are determined ineligible for Medicaid, the 887
division will provide information and direction for accessing 888
medical care and services in the area of their residence. 889
(52) Notwithstanding any provisions of this article, 890
the division may pay enhanced reimbursement fees related to trauma 891
care, as determined by the division in conjunction with the State 892
Department of Health, using funds appropriated to the State 893
Department of Health for trauma care and services and used to 894
match federal funds under a cooperative agreement between the 895
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division and the State Department of Health. The division, in 896
conjunction with the State Department of Health, may use grants, 897
waivers, demonstrations, enhanced reimbursements, Upper Payment 898
Limits Programs, supplemental payments, or other projects as 899
necessary in the development and implementation of this 900
reimbursement program. 901
(53) Targeted case management services for high-cost 902
beneficiaries may be developed by the division for all services 903
under this section. 904
(54) [Deleted] 905
(55) Therapy services. The plan of care for therapy 906
services may be developed to cover a period of treatment for up to 907
six (6) months, but in no event shall the plan of care exceed a 908
six-month period of treatment. The projected period of treatment 909
must be indicated on the initial plan of care and must be updated 910
with each subsequent revised plan of care. Based on medical 911
necessity, the division shall approve certification periods for 912
less than or up to six (6) months, but in no event shall the 913
certification period exceed the period of treatment indicated on 914
the plan of care. The appeal process for any reduction in therapy 915
services shall be consistent with the appeal process in federal 916
regulations. 917
(56) Prescribed pediatric extended care centers 918
services for medically dependent or technologically dependent 919
children with complex medical conditions that require continual 920
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care as prescribed by the child's attending physician, as 921
determined by the division. 922
(57) No Medicaid benefit shall restrict coverage for 923
medically appropriate treatment prescribed by a physician and 924
agreed to by a fully informed individual, or if the individual 925
lacks legal capacity to consent by a person who has legal 926
authority to consent on his or her behalf, based on an 927
individual's diagnosis with a terminal condition. As used in this 928
paragraph (57), "terminal condition" means any aggressive 929
malignancy, chronic end-stage cardiovascular or cerebral vascular 930
disease, or any other disease, illness or condition which a 931
physician diagnoses as terminal. 932
(58) Treatment services for persons with opioid 933
dependency or other highly addictive substance use disorders. The 934
division is authorized to reimburse eligible providers for 935
treatment of opioid dependency and other highly addictive 936
substance use disorders, as determined by the division. Treatment 937
related to these conditions shall not count against any physician 938
visit limit imposed under this section. 939
(59) The division shall allow beneficiaries between the 940
ages of ten (10) and eighteen (18) years to receive vaccines 941
through a pharmacy venue. The division and the State Department 942
of Health shall coordinate and notify OB-GYN providers that the 943
Vaccines for Children program is available to providers free of 944
charge. 945
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(60) Border city university-affiliated pediatric 946
teaching hospital. 947
(a) Payments may only be made to a border city 948
university-affiliated pediatric teaching hospital if the Centers 949
for Medicare and Medicaid Services (CMS) approve an increase in 950
the annual request for the provider payment initiative authorized 951
under 42 CFR Section 438.6(c) in an amount equal to or greater 952
than the estimated annual payment to be made to the border city 953
university-affiliated pediatric teaching hospital. The estimate 954
shall be based on the hospital's prior year Mississippi managed 955
care utilization. 956
(b) As used in this paragraph (60), the term 957
"border city university-affiliated pediatric teaching hospital" 958
means an out-of-state hospital located within a city bordering the 959
eastern bank of the Mississippi River and the State of Mississippi 960
that submits to the division a copy of a current and effective 961
affiliation agreement with an accredited university and other 962
documentation establishing that the hospital is 963
university-affiliated, is licensed and designated as a pediatric 964
hospital or pediatric primary hospital within its home state, 965
maintains at least five (5) different pediatric specialty training 966
programs, and maintains at least one hundred (100) operated beds 967
dedicated exclusively for the treatment of patients under the age 968
of twenty-one (21) years. 969
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(c) The cost of providing services to Mississippi 970
Medicaid beneficiaries under the age of twenty-one (21) years who 971
are treated by a border city university-affiliated pediatric 972
teaching hospital shall not exceed the cost of providing the same 973
services to individuals in hospitals in the state. 974
(d) It is the intent of the Legislature that 975
payments shall not result in any in-state hospital receiving 976
payments lower than they would otherwise receive if not for the 977
payments made to any border city university-affiliated pediatric 978
teaching hospital. 979
(e) This paragraph (60) shall stand repealed on 980
July 1, 2024. 981
(61) Services described in Section 41-140-3 that are 982
provided by certified community health workers employed and 983
supervised by a Medicaid provider. Reimbursement for these 984
services shall be provided only if the division has received 985
approval from the Centers for Medicare and Medicaid Services for a 986
state plan amendment, waiver or alternative payment model for 987
services delivered by certified community health workers. 988
(62) Coverage and reimbursement for postpartum 989
depression screening. The division and any managed care entity 990
described in subsection (H) of this section shall provide coverage 991
for postpartum depression screening required pursuant to Section 992
41-140-5. Such coverage shall provide for additional 993
reimbursement for the administration of postpartum depression 994
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screening adequate to compensate the health care provider for the 995
provision of such screening and consistent with ensuring broad 996
access to postpartum depression screening in line with 997
evidence-based guidelines. 998
(B) Planning and development districts participating in the 999
home- and community-based services program for the elderly and 1000
disabled as case management providers shall be reimbursed for case 1001
management services at the maximum rate approved by the Centers 1002
for Medicare and Medicaid Services (CMS). 1003
(C) The division may pay to those providers who participate 1004
in and accept patient referrals from the division's emergency room 1005
redirection program a percentage, as determined by the division, 1006
of savings achieved according to the performance measures and 1007
reduction of costs required of that program. Federally qualified 1008
health centers may participate in the emergency room redirection 1009
program, and the division may pay those centers a percentage of 1010
any savings to the Medicaid program achieved by the centers' 1011
accepting patient referrals through the program, as provided in 1012
this subsection (C). 1013
(D) (1) As used in this subsection (D), the following terms 1014
shall be defined as provided in this paragraph, except as 1015
otherwise provided in this subsection: 1016
(a) "Committees" means the Medicaid Committees of 1017
the House of Representatives and the Senate, and "committee" means 1018
either one of those committees. 1019
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(b) "Rate change" means an increase, decrease or 1020
other change in the payments or rates of reimbursement, or a 1021
change in any payment methodology that results in an increase, 1022
decrease or other change in the payments or rates of 1023
reimbursement, to any Medicaid provider that renders any services 1024
authorized to be provided to Medicaid recipients under this 1025
article. 1026
(2) Whenever the Division of Medicaid proposes a rate 1027
change, the division shall give notice to the chairmen of the 1028
committees at least thirty (30) calendar days before the proposed 1029
rate change is scheduled to take effect. The division shall 1030
furnish the chairmen with a concise summary of each proposed rate 1031
change along with the notice, and shall furnish the chairmen with 1032
a copy of any proposed rate change upon request. The division 1033
also shall provide a summary and copy of any proposed rate change 1034
to any other member of the Legislature upon request. 1035
(3) If the chairman of either committee or both 1036
chairmen jointly object to the proposed rate change or any part 1037
thereof, the chairman or chairmen shall notify the division and 1038
provide the reasons for their objection in writing not later than 1039
seven (7) calendar days after receipt of the notice from the 1040
division. The chairman or chairmen may make written 1041
recommendations to the division for changes to be made to a 1042
proposed rate change. 1043
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(4) (a) The chairman of either committee or both 1044
chairmen jointly may hold a committee meeting to review a proposed 1045
rate change. If either chairman or both chairmen decide to hold a 1046
meeting, they shall notify the division of their intention in 1047
writing within seven (7) calendar days after receipt of the notice 1048
from the division, and shall set the date and time for the meeting 1049
in their notice to the division, which shall not be later than 1050
fourteen (14) calendar days after receipt of the notice from the 1051
division. 1052
(b) After the committee meeting, the committee or 1053
committees may object to the proposed rate change or any part 1054
thereof. The committee or committees shall notify the division 1055
and the reasons for their objection in writing not later than 1056
seven (7) calendar days after the meeting. The committee or 1057
committees may make written recommendations to the division for 1058
changes to be made to a proposed rate change. 1059
(5) If both chairmen notify the division in writing 1060
within seven (7) calendar days after receipt of the notice from 1061
the division that they do not object to the proposed rate change 1062
and will not be holding a meeting to review the proposed rate 1063
change, the proposed rate change will take effect on the original 1064
date as scheduled by the division or on such other date as 1065
specified by the division. 1066
(6) (a) If there are any objections to a proposed rate 1067
change or any part thereof from either or both of the chairmen or 1068
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the committees, the division may withdraw the proposed rate 1069
change, make any of the recommended changes to the proposed rate 1070
change, or not make any changes to the proposed rate change. 1071
(b) If the division does not make any changes to 1072
the proposed rate change, it shall notify the chairmen of that 1073
fact in writing, and the proposed rate change shall take effect on 1074
the original date as scheduled by the division or on such other 1075
date as specified by the division. 1076
(c) If the division makes any changes to the 1077
proposed rate change, the division shall notify the chairmen of 1078
its actions in writing, and the revised proposed rate change shall 1079
take effect on the date as specified by the division. 1080
(7) Nothing in this subsection (D) shall be construed 1081
as giving the chairmen or the committees any authority to veto, 1082
nullify or revise any rate change proposed by the division. The 1083
authority of the chairmen or the committees under this subsection 1084
shall be limited to reviewing, making objections to and making 1085
recommendations for changes to rate changes proposed by the 1086
division. 1087
(E) Notwithstanding any provision of this article, no new 1088
groups or categories of recipients and new types of care and 1089
services may be added without enabling legislation from the 1090
Mississippi Legislature, except that the division may authorize 1091
those changes without enabling legislation when the addition of 1092
recipients or services is ordered by a court of proper authority. 1093
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(F) The executive director shall keep the Governor advised 1094
on a timely basis of the funds available for expenditure and the 1095
projected expenditures. Notwithstanding any other provisions of 1096
this article, if current or projected expenditures of the division 1097
are reasonably anticipated to exceed the amount of funds 1098
appropriated to the division for any fiscal year, the Governor, 1099
after consultation with the executive director, shall take all 1100
appropriate measures to reduce costs, which may include, but are 1101
not limited to: 1102
(1) Reducing or discontinuing any or all services that 1103
are deemed to be optional under Title XIX of the Social Security 1104
Act; 1105
(2) Reducing reimbursement rates for any or all service 1106
types; 1107
(3) Imposing additional assessments on health care 1108
providers; or 1109
(4) Any additional cost-containment measures deemed 1110
appropriate by the Governor. 1111
To the extent allowed under federal law, any reduction to 1112
services or reimbursement rates under this subsection (F) shall be 1113
accompanied by a reduction, to the fullest allowable amount, to 1114
the profit margin and administrative fee portions of capitated 1115
payments to organizations described in paragraph (1) of subsection 1116
(H). 1117
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Beginning in fiscal year 2010 and in fiscal years thereafter, 1118
when Medicaid expenditures are projected to exceed funds available 1119
for the fiscal year, the division shall submit the expected 1120
shortfall information to the PEER Committee not later than 1121
December 1 of the year in which the shortfall is projected to 1122
occur. PEER shall review the computations of the division and 1123
report its findings to the Legislative Budget Office not later 1124
than January 7 in any year. 1125
(G) Notwithstanding any other provision of this article, it 1126
shall be the duty of each provider participating in the Medicaid 1127
program to keep and maintain books, documents and other records as 1128
prescribed by the Division of Medicaid in accordance with federal 1129
laws and regulations. 1130
(H) (1) Notwithstanding any other provision of this 1131
article, the division is authorized to implement (a) a managed 1132
care program, (b) a coordinated care program, (c) a coordinated 1133
care organization program, (d) a health maintenance organization 1134
program, (e) a patient-centered medical home program, (f) an 1135
accountable care organization program, (g) provider-sponsored 1136
health plan, or (h) any combination of the above programs. As a 1137
condition for the approval of any program under this subsection 1138
(H)(1), the division shall require that no managed care program, 1139
coordinated care program, coordinated care organization program, 1140
health maintenance organization program, or provider-sponsored 1141
health plan may: 1142
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(a) Pay providers at a rate that is less than the 1143
Medicaid All Patient Refined Diagnosis Related Groups (APR-DRG) 1144
reimbursement rate; 1145
(b) Override the medical decisions of hospital 1146
physicians or staff regarding patients admitted to a hospital for 1147
an emergency medical condition as defined by 42 US Code Section 1148
1395dd. This restriction (b) does not prohibit the retrospective 1149
review of the appropriateness of the determination that an 1150
emergency medical condition exists by chart review or coding 1151
algorithm, nor does it prohibit prior authorization for 1152
nonemergency hospital admissions; 1153
(c) Pay providers at a rate that is less than the 1154
normal Medicaid reimbursement rate. It is the intent of the 1155
Legislature that all managed care entities described in this 1156
subsection (H), in collaboration with the division, develop and 1157
implement innovative payment models that incentivize improvements 1158
in health care quality, outcomes, or value, as determined by the 1159
division. Participation in the provider network of any managed 1160
care, coordinated care, provider-sponsored health plan, or similar 1161
contractor shall not be conditioned on the provider's agreement to 1162
accept such alternative payment models; 1163
(d) Implement a prior authorization and 1164
utilization review program for medical services, transportation 1165
services and prescription drugs that is more stringent than the 1166
prior authorization processes used by the division in its 1167
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administration of the Medicaid program. Not later than December 1168
2, 2021, the contractors that are receiving capitated payments 1169
under a managed care delivery system established under this 1170
subsection (H) shall submit a report to the Chairmen of the House 1171
and Senate Medicaid Committees on the status of the prior 1172
authorization and utilization review program for medical services, 1173
transportation services and prescription drugs that is required to 1174
be implemented under this subparagraph (d); 1175
(e) [Deleted] 1176
(f) Implement a preferred drug list that is more 1177
stringent than the mandatory preferred drug list established by 1178
the division under subsection (A)(9) of this section; 1179
(g) Implement a policy which denies beneficiaries 1180
with hemophilia access to the federally funded hemophilia 1181
treatment centers as part of the Medicaid Managed Care network of 1182
providers. 1183
Each health maintenance organization, coordinated care 1184
organization, provider-sponsored health plan, or other 1185
organization paid for services on a capitated basis by the 1186
division under any managed care program or coordinated care 1187
program implemented by the division under this section shall use a 1188
clear set of level of care guidelines in the determination of 1189
medical necessity and in all utilization management practices, 1190
including the prior authorization process, concurrent reviews, 1191
retrospective reviews and payments, that are consistent with 1192
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widely accepted professional standards of care. Organizations 1193
participating in a managed care program or coordinated care 1194
program implemented by the division may not use any additional 1195
criteria that would result in denial of care that would be 1196
determined appropriate and, therefore, medically necessary under 1197
those levels of care guidelines. 1198
(2) Notwithstanding any provision of this section, the 1199
recipients eligible for enrollment into a Medicaid Managed Care 1200
Program authorized under this subsection (H) may include only 1201
those categories of recipients eligible for participation in the 1202
Medicaid Managed Care Program as of January 1, 2021, the 1203
Children's Health Insurance Program (CHIP), and the CMS-approved 1204
Section 1115 demonstration waivers in operation as of January 1, 1205
2021. No expansion of Medicaid Managed Care Program contracts may 1206
be implemented by the division without enabling legislation from 1207
the Mississippi Legislature. 1208
(3) (a) Any contractors receiving capitated payments 1209
under a managed care delivery system established in this section 1210
shall provide to the Legislature and the division statistical data 1211
to be shared with provider groups in order to improve patient 1212
access, appropriate utilization, cost savings and health outcomes 1213
not later than October 1 of each year. Additionally, each 1214
contractor shall disclose to the Chairmen of the Senate and House 1215
Medicaid Committees the administrative expenses costs for the 1216
prior calendar year, and the number of full-equivalent employees 1217
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located in the State of Mississippi dedicated to the Medicaid and 1218
CHIP lines of business as of June 30 of the current year. 1219
(b) The division and the contractors participating 1220
in the managed care program, a coordinated care program or a 1221
provider-sponsored health plan shall be subject to annual program 1222
reviews or audits performed by the Office of the State Auditor, 1223
the PEER Committee, the Department of Insurance and/or independent 1224
third parties. 1225
(c) Those reviews shall include, but not be 1226
limited to, at least two (2) of the following items: 1227
(i) The financial benefit to the State of 1228
Mississippi of the managed care program, 1229
(ii) The difference between the premiums paid 1230
to the managed care contractors and the payments made by those 1231
contractors to health care providers, 1232
(iii) Compliance with performance measures 1233
required under the contracts, 1234
(iv) Administrative expense allocation 1235
methodologies, 1236
(v) Whether nonprovider payments assigned as 1237
medical expenses are appropriate, 1238
(vi) Capitated arrangements with related 1239
party subcontractors, 1240
(vii) Reasonableness of corporate 1241
allocations, 1242
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(viii) Value-added benefits and the extent to 1243
which they are used, 1244
(ix) The effectiveness of subcontractor 1245
oversight, including subcontractor review, 1246
(x) Whether health care outcomes have been 1247
improved, and 1248
(xi) The most common claim denial codes to 1249
determine the reasons for the denials. 1250
The audit reports shall be considered public documents and 1251
shall be posted in their entirety on the division's website. 1252
(4) All health maintenance organizations, coordinated 1253
care organizations, provider-sponsored health plans, or other 1254
organizations paid for services on a capitated basis by the 1255
division under any managed care program or coordinated care 1256
program implemented by the division under this section shall 1257
reimburse all providers in those organizations at rates no lower 1258
than those provided under this section for beneficiaries who are 1259
not participating in those programs. 1260
(5) No health maintenance organization, coordinated 1261
care organization, provider-sponsored health plan, or other 1262
organization paid for services on a capitated basis by the 1263
division under any managed care program or coordinated care 1264
program implemented by the division under this section shall 1265
require its providers or beneficiaries to use any pharmacy that 1266
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ships, mails or delivers prescription drugs or legend drugs or 1267
devices. 1268
(6) (a) Not later than December 1, 2021, the 1269
contractors who are receiving capitated payments under a managed 1270
care delivery system established under this subsection (H) shall 1271
develop and implement a uniform credentialing process for 1272
providers. Under that uniform credentialing process, a provider 1273
who meets the criteria for credentialing will be credentialed with 1274
all of those contractors and no such provider will have to be 1275
separately credentialed by any individual contractor in order to 1276
receive reimbursement from the contractor. Not later than 1277
December 2, 2021, those contractors shall submit a report to the 1278
Chairmen of the House and Senate Medicaid Committees on the status 1279
of the uniform credentialing process for providers that is 1280
required under this subparagraph (a). 1281
(b) If those contractors have not implemented a 1282
uniform credentialing process as described in subparagraph (a) by 1283
December 1, 2021, the division shall develop and implement, not 1284
later than July 1, 2022, a single, consolidated credentialing 1285
process by which all providers will be credentialed. Under the 1286
division's single, consolidated credentialing process, no such 1287
contractor shall require its providers to be separately 1288
credentialed by the contractor in order to receive reimbursement 1289
from the contractor, but those contractors shall recognize the 1290
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credentialing of the providers by the division's credentialing 1291
process. 1292
(c) The division shall require a uniform provider 1293
credentialing application that shall be used in the credentialing 1294
process that is established under subparagraph (a) or (b). If the 1295
contractor or division, as applicable, has not approved or denied 1296
the provider credentialing application within sixty (60) days of 1297
receipt of the completed application that includes all required 1298
information necessary for credentialing, then the contractor or 1299
division, upon receipt of a written request from the applicant and 1300
within five (5) business days of its receipt, shall issue a 1301
temporary provider credential/enrollment to the applicant if the 1302
applicant has a valid Mississippi professional or occupational 1303
license to provide the health care services to which the 1304
credential/enrollment would apply. The contractor or the division 1305
shall not issue a temporary credential/enrollment if the applicant 1306
has reported on the application a history of medical or other 1307
professional or occupational malpractice claims, a history of 1308
substance abuse or mental health issues, a criminal record, or a 1309
history of medical or other licensing board, state or federal 1310
disciplinary action, including any suspension from participation 1311
in a federal or state program. The temporary 1312
credential/enrollment shall be effective upon issuance and shall 1313
remain in effect until the provider's credentialing/enrollment 1314
application is approved or denied by the contractor or division. 1315
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The contractor or division shall render a final decision regarding 1316
credentialing/enrollment of the provider within sixty (60) days 1317
from the date that the temporary provider credential/enrollment is 1318
issued to the applicant. 1319
(d) If the contractor or division does not render 1320
a final decision regarding credentialing/enrollment of the 1321
provider within the time required in subparagraph (c), the 1322
provider shall be deemed to be credentialed by and enrolled with 1323
all of the contractors and eligible to receive reimbursement from 1324
the contractors. 1325
(7) (a) Each contractor that is receiving capitated 1326
payments under a managed care delivery system established under 1327
this subsection (H) shall provide to each provider for whom the 1328
contractor has denied the coverage of a procedure that was ordered 1329
or requested by the provider for or on behalf of a patient, a 1330
letter that provides a detailed explanation of the reasons for the 1331
denial of coverage of the procedure and the name and the 1332
credentials of the person who denied the coverage. The letter 1333
shall be sent to the provider in electronic format. 1334
(b) After a contractor that is receiving capitated 1335
payments under a managed care delivery system established under 1336
this subsection (H) has denied coverage for a claim submitted by a 1337
provider, the contractor shall issue to the provider within sixty 1338
(60) days a final ruling of denial of the claim that allows the 1339
provider to have a state fair hearing and/or agency appeal with 1340
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the division. If a contractor does not issue a final ruling of 1341
denial within sixty (60) days as required by this subparagraph 1342
(b), the provider's claim shall be deemed to be automatically 1343
approved and the contractor shall pay the amount of the claim to 1344
the provider. 1345
(c) After a contractor has issued a final ruling 1346
of denial of a claim submitted by a provider, the division shall 1347
conduct a state fair hearing and/or agency appeal on the matter of 1348
the disputed claim between the contractor and the provider within 1349
sixty (60) days, and shall render a decision on the matter within 1350
thirty (30) days after the date of the hearing and/or appeal. 1351
(8) It is the intention of the Legislature that the 1352
division evaluate the feasibility of using a single vendor to 1353
administer pharmacy benefits provided under a managed care 1354
delivery system established under this subsection (H). Providers 1355
of pharmacy benefits shall cooperate with the division in any 1356
transition to a carve-out of pharmacy benefits under managed care. 1357
(9) The division shall evaluate the feasibility of 1358
using a single vendor to administer dental benefits provided under 1359
a managed care delivery system established in this subsection (H). 1360
Providers of dental benefits shall cooperate with the division in 1361
any transition to a carve-out of dental benefits under managed 1362
care. 1363
(10) It is the intent of the Legislature that any 1364
contractor receiving capitated payments under a managed care 1365
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delivery system established in this section shall implement 1366
innovative programs to improve the health and well-being of 1367
members diagnosed with prediabetes and diabetes. 1368
(11) It is the intent of the Legislature that any 1369
contractors receiving capitated payments under a managed care 1370
delivery system established under this subsection (H) shall work 1371
with providers of Medicaid services to improve the utilization of 1372
long-acting reversible contraceptives (LARCs). Not later than 1373
December 1, 2021, any contractors receiving capitated payments 1374
under a managed care delivery system established under this 1375
subsection (H) shall provide to the Chairmen of the House and 1376
Senate Medicaid Committees and House and Senate Public Health 1377
Committees a report of LARC utilization for State Fiscal Years 1378
2018 through 2020 as well as any programs, initiatives, or efforts 1379
made by the contractors and providers to increase LARC 1380
utilization. This report shall be updated annually to include 1381
information for subsequent state fiscal years. 1382
(12) The division is authorized to make not more than 1383
one (1) emergency extension of the contracts that are in effect on 1384
July 1, 2021, with contractors who are receiving capitated 1385
payments under a managed care delivery system established under 1386
this subsection (H), as provided in this paragraph (12). The 1387
maximum period of any such extension shall be one (1) year, and 1388
under any such extensions, the contractors shall be subject to all 1389
of the provisions of this subsection (H). The extended contracts 1390
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shall be revised to incorporate any provisions of this subsection 1391
(H). 1392
(I) [Deleted] 1393
(J) There shall be no cuts in inpatient and outpatient 1394
hospital payments, or allowable days or volumes, as long as the 1395
hospital assessment provided in Section 43-13-145 is in effect. 1396
This subsection (J) shall not apply to decreases in payments that 1397
are a result of: reduced hospital admissions, audits or payments 1398
under the APR-DRG or APC models, or a managed care program or 1399
similar model described in subsection (H) of this section. 1400
(K) In the negotiation and execution of such contracts 1401
involving services performed by actuarial firms, the Executive 1402
Director of the Division of Medicaid may negotiate a limitation on 1403
liability to the state of prospective contractors. 1404
(L) The Division of Medicaid shall reimburse for services 1405
provided to eligible Medicaid beneficiaries by a licensed birthing 1406
center in a method and manner to be determined by the division in 1407
accordance with federal laws and federal regulations. The 1408
division shall seek any necessary waivers, make any required 1409
amendments to its State Plan or revise any contracts authorized 1410
under subsection (H) of this section as necessary to provide the 1411
services authorized under this subsection. As used in this 1412
subsection, the term "birthing centers" shall have the meaning as 1413
defined in Section 41-77-1(a), which is a publicly or privately 1414
owned facility, place or institution constructed, renovated, 1415
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leased or otherwise established where nonemergency births are 1416
planned to occur away from the mother's usual residence following 1417
a documented period of prenatal care for a normal uncomplicated 1418
pregnancy which has been determined to be low risk through a 1419
formal risk-scoring examination. 1420
(M) This section shall stand repealed on July 1, 2028. 1421
SECTION 5. The following shall be codified as Section 1422
41-140-1, Mississippi Code of 1972: 1423
41-140-1. Definitions. (1) "Maternal health care facility" 1424
means any facility that provides prenatal or perinatal care, 1425
including, but not limited to, hospitals, clinics and other 1426
physician facilities. 1427
(2) "Maternal health care provider" means any physician, 1428
nurse or other authorized practitioner who attends to pregnant 1429
women and mothers of infants. 1430
SECTION 6. The following shall be codified as Section 1431
41-140-3, Mississippi Code of 1972: 1432
41-140-3. Education and awareness. (1) The State 1433
Department of Health shall develop written educational materials 1434
and information for health care professionals and patients about 1435
maternal mental health conditions, including postpartum 1436
depression. 1437
(a) The materials shall include information on the 1438
symptoms and methods of coping with postpartum depression, as well 1439
as treatment options and resources; 1440
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(b) The State Department of Health shall periodically 1441
review the materials and information to determine their 1442
effectiveness and ensure they reflect the most up-to-date and 1443
accurate information; 1444
(c) The State Department of Health shall post on its 1445
website the materials and information; and 1446
(d) The State Department of Health shall make available 1447
or distribute the materials and information in physical form upon 1448
request. 1449
(2) Hospitals that provide birth services shall provide 1450
departing new parents and other family members, as appropriate, 1451
with written materials and information developed under subsection 1452
(1) of this section, upon discharge from such institution. 1453
(3) Any facility, physician, health care provider or nurse 1454
midwife who renders prenatal care, postnatal care, or pediatric 1455
infant care, shall provide the materials and information developed 1456
under subsection (1)(a) of this section, to any woman who presents 1457
with signs of a maternal mental health disorder. 1458
SECTION 7. The following shall be codified as Section 1459
41-140-5, Mississippi Code of 1972: 1460
41-140-5. Screening and linkage to care. (1) Any 1461
physician, health care provider, or nurse midwife who renders 1462
postnatal care or who provides pediatric infant care shall ensure 1463
that the postnatal care patient or birthing mother of the 1464
pediatric infant care patient, as applicable, is offered screening 1465
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for postpartum depression, and, if such patient or birthing mother 1466
does not object to such screening, shall ensure that such patient 1467
or birthing mother is appropriately screened for postpartum 1468
depression in line with evidence-based guidelines, such as the 1469
Bright Futures Toolkit developed by the American Academy of 1470
Pediatrics. 1471
(2) If a health care provider administering screening in 1472
accordance with this section determines, based on the screening 1473
methodology administered, that the postnatal care patient or 1474
birthing mother of the pediatric infant care patient is likely to 1475
be suffering from postpartum depression, such health care provider 1476
shall provide appropriate referrals, including discussion of 1477
available treatments for postpartum depression, including 1478
pharmacological treatments. 1479
SECTION 8. The following shall be codified as Section 1480
83-9-48, Mississippi Code of 1972: 1481
83-9-48. Coverage of screening for postpartum depression. 1482
(1) An insurer shall provide coverage for postpartum depression 1483
screening required pursuant to Section 41-140-3. Such coverage 1484
shall provide for additional reimbursement for the administration 1485
of postpartum depression screening adequate to compensate the 1486
health care provider for the provision of such screening and 1487
consistent with ensuring broad access to postpartum depression 1488
screening in line with evidence-based guidelines. 1489
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ST: Postpartum depression; create new laws and
revise existing provisions related to.
(2) As used in this section, "insurer" means any hospital, 1490
health or medical expense insurance policy, hospital or medical 1491
service contract, employee welfare benefit plan, contract or 1492
agreement with a health maintenance organization or a preferred 1493
provider organization, health and accident insurance policy, or 1494
any other insurance contract of this type, including a group 1495
insurance plan. However, the term "insurer" does not include a 1496
preferred provider organization that is only a network of 1497
providers and does not define health care benefits for the purpose 1498
of coverage under a health care benefits plan. 1499
SECTION 9. This act shall take effect and be in force from 1500
and after July 1, 2026. 1501