SB2867: Medicaid; make various amendments to the provisions of the program.

Legislative Summary

An Act To Amend Section 43-13-115, Mississippi Code Of 1972, To Make Certain Technical Amendments To The Provisions That Provide For Medicaid Eligibility And To Modify Age And Income And Eligibility Criteria To Reflect The Current Criteria; To Require The Division Of Medicaid To Submit A Waiver By July 1, 2025, To The Center For Medicare And Medicaid Services (cms) To Authorize The Division To Conduct Less Frequent Medical Redeterminations For Eligible Children Who Have Certain Long-term Or Chronic Conditions That Do Not Need To Be Reidentified Every Year; To Provide That Men Of Reproductive Age Are Eligible Under The Family Planning Program; To Conform With Federal Law To Allow Children In Foster Care To Be Eligible Until Their 26th Birthday; To Eliminate The Requirement That The Division Must Apply To Cms For Waivers To Provide Services For Certain Individuals Who Are End Stage Renal Disease Patients On Dialysis, Cancer Patients On Chemotherapy Or Organ Transplant Recipients On Antirejection Drugs; To Amend Section 43-13-117, Mississippi Code Of 1972, To Make Certain Technical Amendments To The Provisions That Provide For Medicaid Services To Comply With Federal Law; To Eliminate The Option For Certain Rural Hospitals To Elect Against Reimbursement For Outpatient Hospital Services Using The Ambulatory Payment Classification (apc) Methodology; To Require The Division To Update The Case-mix Payment System And Fair Rental Reimbursement System As Necessary To Maintain Compliance With Federal Law; To Authorize The Division To Implement A Quality Or Value-based Component To The Nursing Facility Payment System; To Require The Division To Reimburse Pediatricians For Certain Primary Care Services As Defined By The Division At 100% Of The Rate Established Under Medicare; To Require The Division To Reimburse For One Pair Of Eyeglasses Every Two Years Instead Of Every Five Years For Certain Beneficiaries; To Authorize Oral Contraceptives To Be Prescribed And Dispensed In Twelve-month Supply Increments Under Family Planning Services; To Authorize The Division To Reimburse Ambulatory Surgical Care (asc) Based On 90% Of The Medicare Asc Payment System Rate In Effect July 1 Of Each Year As Set By Cms; To Authorize The Division To Provide Reimbursement For Devices Used For The Reduction Of Snoring And Obstructive Sleep Apnea; To Direct The Division To Allow Physicians At Any Hospital To Participate In Any Medicare Upper Payment Limits Program (upl), Allowable Delivery System Or Provider Payment Initiative Established By The Division, Subject To Federal Limitations On Collection Of Provider Taxes; To Provide That The Division May, In Consultation With The Mississippi Hospital Association, Develop Alternative Models For Distribution Of Medical Claims And Supplemental Payments For Inpatient And Outpatient Hospital Services; To Update And Clarify Language About The Division's Transition From The Medicare Upper Payment Limits Program (upl) To The Mississippi Hospital Access Program (mhap); To Provide That The Division Shall Maximize Total Federal Funding For Mhap, Upl And Other Supplemental Payment Programs In Effect For State Fiscal Year 2025 And Shall Not Change The Methodologies, Formulas, Models Or Preprints Used To Calculate The Distribution Of Supplemental Payments To Hospitals From Those Methodologies, Formulas, Models Or Preprints In Effect And As Approved By The Centers For Medicare And Medicaid Services For State Fiscal Year 2025; To Authorize The Division To Contract With The State Department Of Health To Provide For A Perinatal High Risk Management/infant Services System For Any Eligible Beneficiary That Cannot Receive Such Services Under A Different Program; To Authorize The Division To Reimburse For Services At Certified Community Behavioral Health Centers; To Extend To July 1, 2027, The Date Of The Repealer On The Provision Of Law That Provides That The Division Shall Reimburse For Outpatient Hospital Services Provided To Eligible Medicaid Beneficiaries Under The Age Of Twenty-one Years By Border City University-affiliated Pediatric Teaching Hospitals, Which Was Repealed By Operation Of Law In 2024; To Limit The Payment For Providing Services To Mississippi Medicaid Beneficiaries Under The Age Of Twenty-one Years Who Are Treated By A Border City University-affiliated Pediatric Teaching Hospital; To Require The Division To Develop And Implement A Method For Reimbursement Of Autism Spectrum Disorder Services Based On A Continuum Of Care For Best Practices In Medically Necessary Early Intervention Treatment; To Require The Division To Reimburse For Preparticipation Physical Evaluations; To Require The Division To Reimburse For United States Food And Drug Administration Approved Medications For Chronic Weight Management Or For Additional Conditions In The Discretion Of The Medical Provider; To Require The Division To Provide Coverage And Reimbursement For Any Nonstatin Medication Approved By The United States Food And Drug Administration That Has A Unique Indication To Reduce The Risk Of A Major Cardiovascular Event In Primary Prevention And Secondary Prevention Patients; To Require The Division To Provide Coverage And Reimbursement For Any Nonopioid Medication Approved By The United States Food And Drug Administration For The Treatment Or Management Of Pain; To Reduce The Length Of Notice The Division Must Provide The Medicaid Committee Chairmen For Proposed Rate Changes And To Provide That Such Legislative Notice May Be Expedited; To Require The Division To Reimburse Ambulance Transportation Service Providers That Provide An Assessment, Triage Or Treatment For Eligible Medicaid Beneficiaries; To Set Certain Reimbursement Levels For Such Providers; To Extend To July 1, 2029, The Date Of The Repealer On Such Section; To Amend Section 43-13-121, Mississippi Code Of 1972, To Authorize The Division To Extend Its Medicaid Enterprise System And Fiscal Agent Services, Including All Related Components And Services, Contracts In Effect On June 30, 2025, For Additional Five-year Periods If The System Continues To Meet The Needs Of The State, The Annual Cost Continues To Be A Fair Market Value, And The Rate Of Increase Is No More Than Five Percent Or The Current Consumer Price Index, Whichever Is Less; To Authorize The Division To Enter Into A Two-year Contract With A Vendor To Provide Support Of The Division's Eligibility System; To Reduce The Length Of Notice The Division Must Provide The Medicaid Committee Chairmen For A Proposed State Plan Amendment And To Provide That Such Legislative Notice May Be Expedited; To Amend Section 43-13-305, Mississippi Code Of 1972, To Provide That When A Third Party Payor Requires Prior Authorization For An Item Or Service Furnished To A Medicaid Recipient, The Payor Shall Accept Authorization Provided By The Division Of Medicaid That The Item Or Service Is Covered Under The State Plan As If Such Authorization Were The Prior Authorization Made By The Third Party Payor For Such Item Or Service; To Amend Section 43-13-117.7, Mississippi Code Of 1972, To Provide That The Division Shall Not Reimburse Or Provide Coverage For Gender Transition Procedures For Any Person; To Amend Section 43-13-145, Mississippi Code Of 1972, To Provide That A Quarterly Hospital Assessment May Exceed The Assessment In The Prior Quarter By More Than $3,750,000.00 If Such Increase Is To Maximize Federal Funds That Are Available To Reimburse Hospitals For Services Provided Under New Programs For Hospitals, For Increased Supplemental Payment Programs For Hospitals Or To Assist With State Matching Funds As Authorized By The Legislature; To Authorize The Division To Reduce Or Eliminate The Portion Of The Hospital Assessment Applicable To Long-term Acute Care Hospitals And Rehabilitation Hospitals If Cms Waives Certain Requirements; To Amend Section 43-13-115.1, Mississippi Code Of 1972, To Remove The Requirement That A Pregnant Woman Must Provide Proof Of Her Pregnancy And Documentation Of Her Monthly Family Income When Seeking A Determination Of Presumptive Eligibility; To Create New Section 41-140-1, Mississippi Code Of 1972, To Define Terms; To Create New Section 41-140-3, Mississippi Code Of 1972, To Require The State Department Of Health To Develop And Promulgate Written Educational Materials And Information For Health Care Professionals And Patients About Maternal Mental Health Conditions; To Require Hospitals Providing Birth Services To Provide Such Educational Materials To New Parents And, As Appropriate, Other Family Members; To Require That Such Materials Be Provided To Any Woman Who Presents With Signs Of A Maternal Mental Health Disorder; To Create New Section 41-140-5, Mississippi Code Of 1972, To Require Any Health Care Provider Or Nurse Midwife Who Renders Postnatal Care Or Pediatric Infant Care To Ensure That The Postnatal Care Patient Or Birthing Mother Of The Pediatric Infant Care Patient, As Applicable, Is Offered Screening For Postpartum Depression And To Provide Appropriate Referrals If Such Patient Or Mother Is Deemed Likely To Be Suffering From Postpartum Depression; To Amend Section 43-13-107, Mississippi Code Of 1972, To Establish A Medicaid Advisory Committee And Beneficiary Advisory Committee As Required Pursuant To Federal Regulations; To Provide That All Members Of The Medical Care Advisory Committee Serving On January 1, 2025, Shall Be Selected To Serve On The Medicaid Advisory Committee, And Such Members Shall Serve Until July 1, 2028; And For Related Purposes.