House Bill 898

AN ACT TO AMEND SECTION 43-13-117, MISSISSIPPI CODE OF 1972, TO EXTEND THE DATE OF THE REPEALER ON THE COMPREHENSIVE LIST OF THE TYPES OF CARE AND SERVICES COVERED BY MEDICAID; TO DIRECT THE DIVISION OF MEDICAID TO DEVELOP AND IMPLEMENT A HOSPITAL READMISSIONS REDUCTION PROGRAM DESIGNED TO REDUCE POTENTIALLY PREVENTABLE READMISSIONS; TO PROVIDE THAT RURAL HOSPITALS THAT HAVE FIFTY OR FEWER LICENSED BEDS SHALL BE GIVEN THE OPTION TO BE REIMBURSED UNDER MEDICAID FOR OUTPATIENT HOSPITAL SERVICES BASED ON 101% OF THE MEDICARE RATE FOR THOSE SERVICES INSTEAD OF USING THE AMBULATORY PAYMENT CLASSIFICATION (APC) METHODOLOGY; TO REDUCE THE ANNUAL NUMBER OF HOME LEAVE DAYS FOR PATIENTS IN NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES; TO DELETE THE ANNUAL LIMIT ON PHYSICIAN VISITS; TO DIRECT THE DIVISION TO INCREASE THE FEES FOR PHYSICIAN'S SERVICES; TO AUTHORIZE THE DIVISION TO REIMBURSE OBSTETRICIANS AND GYNECOLOGISTS FOR CERTAIN PRIMARY CARE SERVICES AS DEFINED BY THE DIVISION AT 100% OF THE RATE ESTABLISHED UNDER MEDICARE; TO DELETE THE ANNUAL LIMITS ON HOME HEALTH SERVICES VISITS; TO DELETE THE RESTRICTION ON THE REIMBURSEMENT RATE FOR EMERGENCY MEDICAL TRANSPORTATION SERVICES; TO DELETE THE MONTHLY PRESCRIPTION LIMIT FOR MEDICAID BENEFICIARIES; TO DIRECT THE DIVISION TO ALLOW PHYSICIAN–ADMINISTERED DRUGS TO BE BILLED AND REIMBURSED AS EITHER A MEDICAL CLAIM OR PHARMACY POINT-OF-SALE TO ALLOW GREATER ACCESS TO CARE; TO PROVIDE THAT THE COVERAGE OF DENTAL AND ORTHODONTIC SERVICES WILL BE DETERMINED BY THE DIVISION; TO PROVIDE THAT CERTAIN SERVICES PROVIDED BY A PSYCHIATRIST MAY BE REIMBURSED AT UP TO 100% OF THE MEDICARE RATE; TO AUTHORIZE THE DIVISION TO DEVELOP AND IMPLEMENT AN ALTERNATIVE FEE FOR SERVICE UPPER PAYMENT LIMITS MODEL IN ACCORDANCE WITH FEDERAL LAWS AND REGULATIONS IF NECESSARY TO PRESERVE SUPPLEMENTAL FUNDING; TO PROVIDE THAT FEDERALLY QUALIFIED HEALTH CENTERS PROVIDING AMBULATORY SERVICES SHALL BE REIMBURSED BY THE MEDICAID PROSPECTIVE PAYMENT SYSTEM AS APPROVED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES; TO AUTHORIZE INSTEAD OF REQUIRE THAT TARGETED CASE MANAGEMENT SERVICES FOR HIGH-COST BENEFICIARIES BE DEVELOPED FOR ALL SERVICES COVERED BY THIS SECTION; TO PROVIDE THAT MEDICATION-ASSISTED COMPREHENSIVE TREATMENT SERVICES FOR PERSONS DIAGNOSED WITH AN OPIOID SUBSTANCE USE DISORDER OR OTHER HIGHLY ADDICTIVE SUBSTANCE USE DISORDER WILL BE COVERED UNDER MEDICAID; TO DIRECT THE DIVISION TO ALLOW BENEFICIARIES BETWEEN THE AGES OF TEN AND EIGHTEEN YEARS TO RECEIVE VACCINES THROUGH A PHARMACY VENUE; TO INCLUDE OUTPATIENT HOSPITAL SERVICES IN THE LIST OF SERVICES THAT ARE EXEMPT FROM THE FIVE PERCENT REDUCTION IN THE PROVIDER REIMBURSEMENT RATE; TO PROVIDE THAT THE EXEMPTIONS FROM THE FIVE PERCENT REDUCTION IN THE PROVIDER REIMBURSEMENT RATE APPLICABLE TO CERTAIN SERVICES PROVIDED UNDER THIS SECTION WILL NOT BE IN EFFECT IF CURRENT OR PROJECTED EXPENDITURES OF THE DIVISION ARE REASONABLY ANTICIPATED BY THE DIVISION TO EXCEED THE AMOUNT OF FUNDS APPROPRIATED TO THE DIVISION FOR ANY FISCAL YEAR; TO DELETE THE PROHIBITION ON THE DIVISION FROM MAKING CERTAIN CHANGES TO THE SERVICES AUTHORIZED UNDER THIS SECTION WITHOUT AN AMENDMENT TO THIS SECTION BY THE LEGISLATURE; TO REVISE THE ACTIONS THAT THE DIVISION MAY TAKE TO REDUCE COSTS IF CURRENT OR PROJECTED EXPENDITURES OF THE DIVISION ARE REASONABLY ANTICIPATED BY THE DIVISION TO EXCEED THE AMOUNT OF FUNDS APPROPRIATED TO THE DIVISION FOR ANY FISCAL YEAR; TO PROVIDE THAT THE DIVISION AND THE CONTRACTORS PARTICIPATING IN THE MANAGED CARE PROGRAM, A COORDINATED CARE PROGRAM OR A PROVIDER-SPONSORED HEALTH PLAN SHALL BE SUBJECT TO ANNUAL PROGRAM AUDITS PERFORMED BY THE OFFICE OF THE STATE AUDITOR, THE PEER COMMITTEE AND/OR AN INDEPENDENT THIRD PARTY; TO PROHIBIT MANAGED CARE ORGANIZATIONS FROM REQUIRING THEIR PROVIDERS TO BE CREDENTIALED BY THE ORGANIZATION IN ORDER TO RECEIVE REIMBURSEMENT; TO PROVIDE THAT FROM AND AFTER JULY 1, 2019, THE LEGISLATURE SHALL NOT APPROPRIATE ANY FUNDS FOR CERTAIN CONTRACTS BETWEEN THE DIVISION AND THE MANAGED CARE ENTITIES WITH WHICH THE DIVISION HAS CONTRACTED TO PROVIDE MEDICAID SERVICES ON A CAPITATED BASIS UNDER A MANAGED CARE PROGRAM IMPLEMENTED BY THE DIVISION; TO PROVIDE THAT THE DIVISION SHALL TERMINATE THOSE CONTRACTS WITH THE MANAGED CARE ENTITIES ON JULY 1, 2019, AND SHALL ISSUE A REQUEST FOR PROPOSALS TO SELECT NOT LESS THAN THREE MANAGED CARE ENTITIES TO PROVIDE MEDICAID SERVICES ON A CAPITATED BASIS UNDER A MANAGED CARE PROGRAM AFTER JULY 1, 2019; TO AUTHORIZE THE DIVISION TO ESTABLISH A PILOT PROGRAM FOR THREE YEARS TO EVALUATE AN ALTERNATIVE MANAGED CARE PAYMENT MODEL FOR MEDICALLY COMPLEX CHILDREN; AND FOR RELATED PURPOSES.

In the House of Representatives

• Jason White

  Sponsor

• House of Representatives floor amendmentPending

• House of Representatives floor amendmentPending

• House of Representatives floor amendmentPending

• House of Representatives floor amendmentPending

l9n doesn't hold this bill's text yet.

In the House of Representatives Jan 11 – Feb 8

1. Jan 11Referred to the House committee on Medicaid
2. Jan 30Reported from committee in the House: title sufficient, do pass as a committee substitute
3. Feb 7Read the third time in the House
4. Feb 8Committee substitute adopted in the House
5. Amended in the House
6. Passed the House as amended

In the Senate Feb 12 – Feb 27

1. Feb 12Sent to the Senate
2. Feb 16Referred to the Senate committee on Medicaid
3. Feb 27Died in committee in the Senate