Listed below are the updates and summaries of legislative bill enacted during past legislative sessions that revise the powers and duties of the Mississippi Division of Medicaid.
2015 Legislative Session Updates and Summary
House Bill 544 | HB 544 legislation
- Grants DOM authority to extend its current fiscal agent / eligibility system and Decision Support System/ Data Warehouse (DSS/DW) contracts for a period of up to 5 years.
House Bill 545 | HB 545 legislation
- Authorizes DOM’s Pharmacy and Therapeutics Committee to meet as needed.
- Establishes a 60 day deadline for provider appeals and revises DOM’s authority to collect any overpayments to providers after 60 days rather than 30.
- Repeals MS Code §43-13-117.3, which provided for a study on the implementation of a pilot program to provide bariatric surgery on the morbidly obese as a treatment option.
- Includes regulatory provisions related to “Medicaid planners” that requires individuals providing Medicaid planning services for compensation (excluding licensed attorneys or other individuals who are licensed to provide services that may include Medicaid planning services) to register annually with DOM.
Senate Bill 2588 | SB 2588 legislation
- Removes hospital inpatient Upper Payment Limits (UPL) payments and replaces them with the Mississippi Hospital Access Payment (MHAP) not later than December 1, 2015.
- Removed inpatient hospital services carve-out from the MississippiCAN program.
- Requires DOM to apply for a waiver amendment to increase payments for all adult day care facilities based on acuity of individual patients, with a maximum of $75 per day for the most acute patients.
- Authorizes DOM to contract with Provider Sponsored Health Plans (PSHP) as defined in SB 2441 for participation in MississippiCAN.
- Authorizes coordinated care organization participating in MississippiCAN to prior authorize non-emergency hospital admissions and retrospectively review the appropriateness of emergency hospital admissions.
- Grants DOM authority to approve the use of innovative payment models by the MCOs. Innovative payment models may only be implemented if both the provider and MCO are agreeable. MCOs may not require the use of innovative payment models as a condition of provider participation.
2014 Legislative Session Updates and Summary
House Bill 392 | HB 392 legislation
- Reestablishes the Health Information Technology Act.
- Requires the Mississippi Division of Medicaid to appoint a member of the Mississippi Health Information Network (MS-HIN) board of directors who shall be an employee of the Division to serve a two year term.
House Bill 1269 | HB 1269 legislation
- Establishes the Mississippi Long-Term Care Partnership Program within the Division.
- Requires the Division, in cooperation with the Insurance Commissioner, to submit applications to the US Department of Health and Human Services (HHS) to obtain approval to:
- Establish a process for pre-certification of long-term care insurance policies that meets all the requirements of the program;
- Establish minimum requirements that long-term care insurance policies must meet in order to qualify for pre-certification;
- Include provisions that Medicaid eligibility determinations in the long-term care or related waiver categories for individuals who are the beneficiaries of pre-certified long-term care insurance policies shall include a resource disregard of one dollar for every dollar of long-term care insurance benefits paid under the individual’s pre-qualified long-term care insurance policy for long-term care services;
- Include provisions for reciprocal agreements with other states to extend the same Medicaid eligibility protections to purchasers of long-term care policies in those states; and
- Include an outreach program to educate consumers about the need for long-term care, the availability of long-term care insurance, and the asset protection available under this law.
- Requires hospitals to offer flu vaccinations to certain patients prior to discharge.
House Bill 1275 | HB 1275 legislation
- Changes all references of “the mentally retarded” to “individuals with intellectual disabilities”
- Deletes the number of allowable outpatient emergency hospital services to comply with the Centers for Medicare and Medicaid Services (CMS) regulations.
- Allows the Division to update its reimbursement for nursing facilities services.
- Grants the Division the authority to continue to pay primary care physicians at the Medicare rate beyond December 31, 2014.
- Grants the Division the authority to implement a Medicare Upper Payment Limits (UPL) Program for physicians employed by public hospitals and also authorizes the Division to expand the program to other classes of hospitals upon successful implementation of the aforementioned program. Participating hospitals are required to reimburse physicians at a higher rate. Hospitals participating in the program will be required to participate in an intergovernmental transfer to fund the new program.
- Requires the Division to continue contracting with the Department of Health to provide Perinatal High Risk Management/Infant Services System (PHRM/ISS) services.
- Prohibits the Division from restricting coverage for medically appropriate treatment for individuals who are diagnosed with a terminal condition.
- Prohibits the Division from requiring beneficiaries with hemophilia to participate in the managed care program.
- Requires the Division to conduct a study and develop a plan which outlines the advantages and disadvantages of including inpatient hospital services in the managed care program. In developing this plan, the Division is required to analyze the effect this will have on UPL payments to hospitals and develop methods to offset any reduction in UPL payments that may occur. The report must be submitted by December 31, 2015.
- Allows the Division to include all children in the Mississippi Coordinated Access Network (MSCAN) program.
- Requires any contractor participating in the managed care program to provide statistical data to the Legislature and the Division which will be shared with provider groups in order to improve patient access, appropriate utilization, cost savings and health outcomes.
- Requires that all provider appeals filed after July 1, 2014, shall be filed to the Chancery Court of Hinds County and that bond be posted.
- Grants the Division the authority to extend its contract with Xerox Corporation for a period of three years.
- Includes changes to Mississippi Code Section 43-13-125 intended to prevent the Division from being forced to compromise its interests at unreasonably low percentage reductions.
- Requires that all payments be remitted to the Division within 60 days from the date of a settlement or entry of a final judgment.
- Includes a change to the UPL distribution model which would only affect psychiatric hospitals.
- Updates the hospital assessment and supplemental payment model to use hospitals’ 2013 data.
- Authorizes the Division to operate its Children’s Health Insurance Program (CHIP) under its current managed care contracts.
- Requires the Division to develop a study to analyze the impact of referrals by physicians for advanced imaging services using equipment owned in full or in part by the referring physician. The results of the study must be reported to the Chairmen of the Senate Public Health and Welfare Committee and the House of Representatives Medicaid Committees by Dec. 15, 2014.
During the 2014 Legislative session, the Legislature authorized a $1,000 salary increase for all state employees making less than $30,000 a year who have not received a salary increase since July 1, 2010. Any state employee that makes more than $30,000 and has not received a salary increase since July 1, 2010 is eligible for an increase in pay up to 5 percent.