Mississippi Patient Protection Act of 2026; create.

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To: Insurance
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Senator(s) Blackwell, McMahan

COMMITTEE SUBSTITUTE
FOR
SENATE BILL NO. 2752

AN ACT TO CREATE THE "MISSISSIPPI PATIENT PROTECTION ACT OF 1
2026"; TO DECLARE LEGISLATIVE INTENT; TO DEFINE CERTAIN TERMS USED 2
IN THE ACT; TO PROVIDE THAT A HEALTH INSURER SHALL NOT 3
DISCRIMINATE AGAINST ANY PROVIDER WHO IS LOCATED WITHIN THE 4
GEOGRAPHIC COVERAGE AREA OF A HEALTH BENEFIT PLAN AND WHO IS 5
WILLING TO MEET THE TERMS AND CONDITIONS FOR PARTICIPATION 6
ESTABLISHED BY THE HEALTH INSURER; TO PROHIBIT A HEALTH INSURER 7
FROM IMPOSING A MONETARY ADVANTAGE OR PENALTY THAT WOULD AFFECT A 8
BENEFICIARY'S CHOICE AMONG THOSE HEALTH CARE PROVIDERS WHO 9
PARTICIPATE IN THE HEALTH BENEFIT PLAN; TO REQUIRE THE 10
COMMISSIONER OF INSURANCE TO ENFORCE THE STATE'S ANY WILLING 11
PROVIDER LAWS; TO PROVIDE INJUNCTIVE RELIEF FOR VIOLATIONS OF THIS 12
ACT; TO AUTHORIZE THE COMMISSIONER OF INSURANCE TO ADOPT 13
REGULATIONS TO IMPLEMENT THE ACT; TO AMEND SECTION 83-41-409, 14
MISSISSIPPI CODE OF 1972, IN CONFORMITY THERETO; AND FOR RELATED 15
PURPOSES. 16
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 17
SECTION 1. Sections 1 through 12 of this act shall be known 18
and may be cited as the "Mississippi Patient Protection Act of 19
2026." 20
SECTION 2. The Legislature finds that a patient should be 21
given the opportunity to see the health care provider of his or 22
her choice. In order to assure the citizens of the State of 23
Mississippi the right to choose a provider of their choice, it is 24
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the intent of the Legislature to provide the opportunity for 25
providers to participate in health benefit plans. 26
SECTION 3. As used in this act: 27
(a) "Department" means the Mississippi Department of 28
Insurance. 29
(b) "ERISA" means the federal Employee Retirement Income 30
Security Act of 1974, as amended, 29 USC, Section 1001 et seq. 31
(c) "Health benefit plan" means (i) any health 32
insurance policy or certificate, health maintenance organization 33
contract, hospital and medical service corporation contract or 34
certificate, self-insured plan or plan provided by a multiple 35
employer welfare arrangement, to the extent permitted by ERISA; or 36
(ii) any health benefit plan that affects the rights of a 37
Mississippi insured and bears a reasonable relation to the State 38
of Mississippi, whether delivered or issued for delivery in the 39
state; or (iii) the Mississippi State and School Employees Health 40
Insurance Plan; or (iv) the Mississippi Medicaid Program 41
established in Section 43-13-101 et seq. Health benefit plan 42
shall not include insurance arising out of a worker's compensation 43
claim. 44
(d) "Health care provider" or "provider" means an 45
individual or entity licensed by the State of Mississippi to 46
provide health care services, limited to the following type of 47
providers: 48
(i) Physicians and surgeons (M.D. and D.O.); 49
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(ii) Podiatrists; 50
(iii) Chiropractors; 51
(iv) Physical therapists; 52
(v) Speech pathologists; 53
(vi) Audiologists; 54
(vii) Dentists; 55
(viii) Optometrists; 56
(ix) Hospitals; 57
(x) Hospital-based services; 58
(xi) Psychologists; 59
(xii) Licensed professional counselors; 60
(xiii) Respiratory therapists; 61
(xiv) Pharmacists; 62
(xv) Occupational therapists; 63
(xvi) Long-term care facilities; 64
(xvii) Home health care providers; 65
(xviii) Hospice care providers; 66
(xix) Licensed ambulatory surgery centers; 67
(xx) Rural health clinics; 68
(xxi) Licensed certified social workers; 69
(xxii) Licensed psychological examiners; 70
(xxiii) Advanced practice nurses; 71
(xxiv) Licensed dieticians; 72
(xxv) Community mental health centers or clinics; 73
(xxvi) Certified orthotists; 74
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(xxvii) Prosthetists; 75
(xxviii) Licensed durable medical equipment 76
providers; and 77
(xxix) Opticians; 78
(xxx) Licensed vision or optical centers; and 79
(xxxi) Other health care practitioners as 80
determined by the department in rules promulgated under the 81
Mississippi Administrative Procedures Law, Section 25-43-101 et 82
seq. 83
The term "health care provider" or "provider" includes 84
independent clinical laboratories. 85
(e) "Health insurer" or "health care insurer" means any 86
entity that is authorized by the State of Mississippi to offer or 87
provide health benefit plans, policies, subscriber contracts or 88
any other contracts of similar nature which indemnify or 89
compensate health care providers for the provision of health care 90
services. For purposes of this act, the term includes managed 91
care organizations, health maintenance organizations, and any 92
entity that contracts with or administers benefits for the 93
Mississippi Medicaid Program or other state health programs. 94
(f) "Independent clinical laboratory" means a 95
laboratory that is independent both of the attending or consulting 96
physician's office and of a hospital, where microbiological, 97
serological, chemical, hematological, biophysical, radiobioassay, 98
cytological, immunohematological, immunological, pathological or 99
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other examinations are performed on materials derived from the 100
human body, to provide information for the diagnosis, prevention, 101
or treatment of a disease or assessment of a medical condition. 102
(g) "Any willing provider law" means a law that 103
prohibits discrimination against a provider willing to meet the 104
terms and conditions for participation established by a health 105
insurer, or that otherwise precludes an insurer from prohibiting 106
or limiting participation by a provider who is willing to accept a 107
health insurer's terms and conditions for participation in the 108
provision of services through a health benefit plan. 109
(h) "Noninsurer" means an entity that is not required 110
to obtain authorization from the department to do business as a 111
health insurer but that does have a provider network. 112
(i) "Self-insured" includes self-funded and vice versa. 113
(j) "Vision benefit manager" or "administrator" means 114
an individual, company, organization, group, or other entity, 115
including without limitation a health insurer, third party 116
administrator, and a subcontractor, that creates, promotes, sells, 117
provides, advertises, or administers an integrated or stand-alone 118
vision benefit plan, vision benefit discount plan, or other 119
insurance policy or contract that provides vision benefits or 120
discounts to an insured individual pertaining to the provision of 121
covered services or covered items, which includes ophthalmic 122
devices. The term "Vision Benefit Manager" shall not be construed 123
to include a pharmacy benefit manager, nor any entity engaged in 124
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the administration or management of prescription drug benefits or 125
pharmacy services, including entities regulated under pharmacy 126
benefit manager statutes. 127
(k) "Ophthalmic devices" means eyeglass frames, lenses, 128
lens treatments and coatings, contact lenses, and other optical 129
appliances prescribed or furnished for the correction, protection, 130
or enhancement of vision. 131
(l) "Covered services" means vision-related clinical 132
services that are required to be covered under a health benefit 133
plan or vision benefit plan, including, without limitation, 134
comprehensive eye examinations (including dilation and imaging 135
when clinically indicated), refractions, examinations, contact 136
lens evaluations, fittings, medical eye care within an 137
optometrist's scope of practice, and follow-up care when included 138
within a plan's benefits. 139
(m) "Covered items" means ophthalmic devices furnished 140
under a health benefit plan or vision benefit plan when such 141
devices are included within the plan's benefits. 142
(n) "Comprehensive eye examination" means an in-person 143
or telehealth encounter performed by a licensed optometrist or 144
ophthalmologist that includes a history, refraction, assessment of 145
ocular health, and such diagnostic testing and dilation as 146
clinically indicated, for the diagnosis, treatment, or management 147
of ocular conditions. 148
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SECTION 4. A health insurer shall not discriminate against 149
any provider who is located within the geographic coverage area of 150
the health benefit plan and who is willing to meet the terms and 151
conditions for participation established by the health insurer. 152
SECTION 5. Nothing in Sections 1 through 12 of this act 153
shall be construed to require or prohibit the same reimbursement 154
to different types of providers whose licensed scope of practice 155
differs, nor shall anything in this act be construed to require or 156
prohibit coverage of the services of any particular type of 157
provider. 158
SECTION 6. (1) A health care insurer shall not, directly or 159
indirectly: 160
(a) Impose a monetary advantage or penalty under a 161
health benefit plan that would affect a beneficiary's choice among 162
those health care providers who participate in the health benefit 163
plan according to the terms offered. "Monetary advantage or 164
penalty" includes: 165
(i) A higher copayment; 166
(ii) A reduction in reimbursement for services; or 167
(iii) Promotion of one health care provider over 168
another by these methods; 169
(b) Impose upon a beneficiary of health care services 170
under a health benefit plan any copayment, fee or condition that 171
is not equally imposed upon all beneficiaries in the same benefit 172
category, class or copayment level under that health benefit plan 173
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when the beneficiary is receiving services from a participating 174
health care provider pursuant to that health benefit plan; or 175
(c) Prohibit or limit a health care provider that is 176
qualified under Sections 1 through 12 of this act and is willing 177
to accept the health benefit plan's operating terms and 178
conditions, schedule of fees, covered expenses and utilization 179
regulations and quality standards, from the opportunity to 180
participate in that plan. 181
(2) Nothing in Sections 1 through 12 of this act shall 182
prevent a health benefit plan from instituting measures designed 183
to maintain quality and to control costs, including, but not 184
limited to, the utilization of a gatekeeper system, as long as 185
such measures are imposed equally on all providers in the same 186
class. 187
(3) Insurers shall establish relevant, objective standards 188
for initial consideration of providers and for providers to 189
continue as a participating provider in the plan. Standards shall 190
be reasonably related to service provided but not based solely on 191
the volume of procedures performed by the provider. Selection or 192
participation standards based on the economics or capacity of a 193
provider's practice shall be adjusted to account for case mix, 194
severity of illness, patient age and other features that may 195
account for higher-than-or lower-than-expected costs. All data 196
profiling or other data analysis pertaining to participating 197
providers shall be done in a manner which is valid and reasonable. 198
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Plans shall not use criteria that would allow an issuer to avoid 199
high-risk populations by excluding providers because they are 200
located in geographic areas that contain populations or providers 201
presenting a risk of higher-than-average claims, losses, or health 202
services utilization or that would exclude providers because they 203
treat or specialize in treating populations presenting a risk of 204
higher-than-average claims, losses, or health services 205
utilization. 206
SECTION 7. Any person adversely affected by a violation of 207
Sections 1 through 12 of this act may sue in a court of competent 208
jurisdiction for injunctive relief against the health insurer. 209
SECTION 8. (1) A health benefit plan delivered or issued 210
for delivery to any person in this state in violation of Sections 211
1 through 12 of this act, but otherwise binding on the health 212
insurer shall be held valid, but shall be construed as provided in 213
Sections 1 through 12 of this act. 214
(2) Any health benefit plan or related policy, rider or 215
endorsement issued and otherwise valid that contains any 216
condition, omission or provision not in compliance with the 217
requirements of Sections 1 through 12 of this act shall not be 218
rendered invalid because of the noncompliance, but shall be 219
construed and applied in accordance with, such condition, omission 220
or provision as would have applied if it had been in full 221
compliance with Sections 1 through 12 of this act. 222
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SECTION 9. The Commissioner of Insurance, acting through the 223
department, shall: 224
(a) Enforce the state's any willing provider laws using 225
powers granted to the commissioner in the Mississippi Insurance 226
Code; and 227
(b) Be entitled to seek an injunction against a health 228
insurer in a court of competent jurisdiction. 229
SECTION 10. (1) The state's any willing provider laws shall 230
not be construed: 231
(a) To require all physicians or a percentage of 232
physicians in the state or a locale to participate in the 233
provision of services for a health insurance organization; or 234
(b) To take away the authority of health maintenance 235
organizations that provide coverage of physician services to set 236
the terms and conditions for participation by physicians, though 237
health maintenance organizations shall apply such terms and 238
conditions in a nondiscriminatory manner. 239
(2) The state's any willing provider laws shall apply to: 240
(a) All health insurers, regardless of whether they are 241
providing insurance, including pre-paid coverage, or administering 242
or contracting to provide provider networks; 243
(b) All vision benefit managers or administrators; and 244
(c) All multiple employer welfare arrangements and 245
multiple employer trusts. 246
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(3) Nothing in the state's any willing provider laws shall 247
be construed to cover or regulate health care provider networks 248
offered by noninsurers. If an employer sponsoring a self-insured 249
health benefit plan contracts directly with providers or contracts 250
for a health care provider network through a noninsurer, then the 251
any willing provider law does not apply. If a health insurer 252
subcontracts with a noninsurer whose health care network does not 253
meet the requirements of the any willing provider law, then the 254
noninsurer may, but is not required to, create a separate health 255
care provider network that meets the requirements of the any 256
willing provider law. If the noninsurer chooses not to create the 257
separate health care provider network, then the responsibility for 258
compliance with the any willing provider law is the obligation of 259
the health insurer. 260
SECTION 11. The department shall adopt regulations to 261
implement the provisions of Sections 1 through 12 of this act and 262
may obtain any information from health benefit plans that is 263
necessary to determine if such plan should be certified or 264
enjoined. 265
SECTION 12. If any provision of this act or the application 266
thereof to any person or circumstance is held invalid, such 267
invalidity shall not affect other provisions or applications of 268
the act which can be given effect without the invalid provision or 269
application, and to this end the provisions of this act are 270
declared to be severable. 271
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SECTION 13. Section 83-41-409, Mississippi Code of 1972, is 272
amended as follows: 273
83-41-409. In order to be certified and recertified under 274
this article, a managed care plan shall: 275
(a) Provide enrollees or other applicants with written 276
information on the terms and conditions of coverage in easily 277
understandable language including, but not limited to, information 278
on the following: 279
(i) Coverage provisions, benefits, limitations, 280
exclusions and restrictions on the use of any providers of care; 281
(ii) Summary of utilization review and quality 282
assurance policies; and 283
(iii) Enrollee financial responsibility for 284
copayments, deductibles and payments for out-of-plan services or 285
supplies; 286
(b) Demonstrate that its provider network has providers 287
of sufficient number throughout the service area to assure 288
reasonable access to care with minimum inconvenience by plan 289
enrollees; 290
(c) File a summary of the plan credentialing criteria 291
and process and policies with the State Department of Insurance to 292
be available upon request; 293
(d) Provide a participating provider with a copy of 294
his/her individual profile if economic or practice profiles, or 295
both, are used in the credentialing process upon request; 296
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ST: Mississippi Patient Protection Act of 2026;
create.
(e) When any provider application for participation is 297
denied or contract is terminated, the reasons for denial or 298
termination shall be reviewed by the managed care plan upon the 299
request of the provider; * * * 300
(f) Establish procedures to ensure that all applicable 301
state and federal laws designed to protect the confidentiality of 302
medical records are followed * * *; and 303
(g) Comply with all requirements of Sections 1 through 304
12 of this act. 305
SECTION 14. This act shall take effect and be in force from 306
and after July 1, 2026. 307