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, TO MODIFY AGE AND INCOME ELIGIBILITY CRITERIA, AND TO CONFORM WITH FEDERAL LAW TO ALLOW CHILDREN IN FOSTER CARE TO BE ELIGIBLE UNTIL THEIR 26TH BIRTHDAY; TO AUTHORIZE THE DIVISION OF MEDICAID TO APPLY FOR A FEDERAL FAMILY PLANNING WAIVER; TO ELIMINATE THE REQUIREMENT THAT THE DIVISION MUST APPLY TO THE CENTER FOR MEDICARE AND MEDICAID SERVICES (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, AS AMENDED BY HOUSE BILL NO. 970, 2024 REGULAR SESSION, TO MAKE CERTAIN TECHNICAL AMENDMENTS TO THE PROVISIONS THAT PROVIDE FOR MEDICAID SERVICES, TO COMPLY WITH FEDERAL LAW; TO PROVIDE THAT THE DIVISION SHALL REIMBURSE FOR ONE PAIR OF EYEGLASSES EVERY TWO YEARS INSTEAD OF EVERY FIVE YEARS FOR CERTAIN BENEFICIARIES; TO ELIMINATE THE OPTION FOR CERTAIN RURAL HOSPITALS TO ELECT AGAINST REIMBURSEMENT FOR OUTPATIENT HOSPITAL SERVICES USING THE AMBULATORY PAYMENT CLASSIFICATION (APC) METHODOLOGY; TO PROVIDE THAT THE DIVISION SHALL UPDATE THE CASE MIX PAYMENT SYSTEM AND FAIR RENTAL REIMBURSEMENT SYSTEM AS NECESSARY TO MAINTAIN COMPLIANCE WITH FEDERAL LAW; TO PROVIDE THAT THE DIVISION OF MEDICAID MAY 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 REVISE CERTAIN PROVISIONS RELATED TO FAMILY PLANNING SERVICES, INCLUDING THAT ORAL CONTRACEPTIVES MAY BE PRESCRIBED AND DISPENSED IN 12-MONTH SUPPLY INCREMENTS; TO PROVIDE THAT THE DIVISION MAY REIMBURSE AMBULATORY SURGICAL CARE (ASC) BASED ON 100% 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 NEUROMUSCULAR TONGUE MUSCLE STIMULATORS AND/OR FOR ALTERNATIVE METHODS FOR THE REDUCTION OF SNORING AND OBSTRUCTIVE SLEEP APNEA; TO INCLUDE ADDITIONAL LICENSED PROVIDERS IN THE DIVISION'S UPPER PAYMENT LIMITS PROGRAM; TO AUTHORIZE 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 PROVIDE THAT THE DIVISION MAY, TO THE FULLEST EXTENT FEASIBLE, REPLACE THE ADDITIONAL REIMBURSEMENT FOR HOSPITAL INPATIENT SERVICES UNDER THE INPATIENT MEDICARE UPPER PAYMENT LIMITS (UPL) PROGRAM WITH ADDITIONAL REIMBURSEMENT UNDER THE MHAP AND OTHER PAYMENT PROGRAMS; TO DELETE TECHNICAL PROVISIONS RELATED TO THE MISSISSIPPI HOSPITAL ACCESS PROGRAM (MHAP); TO PROVIDE THAT SUPPLEMENTAL PAYMENTS TO A HOSPITAL SHALL NOT DECREASE BY MORE THAN 5% WHEN COMPARED TO A HOSPITAL'S PRIOR YEAR PAYMENT UNLESS THAT HOSPITAL HAS CLOSED, OR CHANGED SERVICES OR PATIENT VOLUME WHICH IMPACTS THAT HOSPITAL'S PAYMENT, AND THE DIVISION SHALL NOT SUBSTANTIALLY CHANGE THE METHODOLOGIES USED TO CALCULATE A HOSPITAL'S SUPPLEMENTAL PAYMENT; TO PROVIDE THAT THE DIVISION SHALL 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 THE DATE OF REPEAL 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 21 BY BORDER CITY UNIVERSITY AFFILIATED PEDIATRIC TEACHING HOSPITALS, WHICH WAS REPEALED BY OPERATION OF LAW IN 2024; 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 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 PROVIDE THAT THE DIVISION SHALL REIMBURSE FOR PREPARTICIPATION PHYSICAL EVALUATIONS; TO PROVIDE THAT THE DIVISION SHALL REIMBURSE FOR UNITED STATES FOOD AND DRUG ADMINISTRATION APPROVED GLUCAGON-LIKE PEPTIDE-1 (GLP-1) AGONIST MEDICATIONS FOR CHRONIC WEIGHT MANAGEMENT OR FOR ADDITIONAL CONDITIONS IN THE DISCRETION OF THE MEDICAL PROVIDER; TO PROHIBIT THE DIVISION OF MEDICAID AND CERTAIN MANAGED CARE ENTITIES FROM REQUIRING OR IMPOSING ANY STEP THERAPY PROTOCOL WITH RESPECT TO A DRUG THAT IS APPROVED BY THE UNITED STATES FDA FOR THE TREATMENT OF POSTPARTUM DEPRESSION; TO REQUIRE THE DIVISION TO PROVIDE COVERAGE AND REIMBURSEMENT FOR POSTPARTUM DEPRESSION SCREENING; TO EXTEND THE DATE OF REPEAL ON SUCH SECTION; TO AMEND SECTION 43-13-121, MISSISSIPPI CODE OF 1972, 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 REVISE CERTAIN PROVISIONS RELATED TO MEDICAID AND THIRD-PARTY BENEFITS TO COMPLY WITH FEDERAL LAW; TO AMEND SECTION 43-11-1, MISSISSIPPI CODE OF 1972, TO DEFINE ADULT DAY CARE FACILITY; TO AMEND SECTION 43-11-8, MISSISSIPPI CODE OF 1972, TO PROVIDE FEES FOR ADULT DAY CARE FACILITY LICENSURE AND LICENSE RENEWAL; TO AMEND SECTION 43-11-13, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT BEGINNING JULY 1, 2026, TO OPERATE AN ADULT DAY CARE CENTER IN MISSISSIPPI, A FACILITY PROVIDER SHALL BE LICENSED WITH THE LICENSING DIVISION OF THE STATE DEPARTMENT OF HEALTH; TO ESTABLISH THAT MISSISSIPPI MEDICAID WAIVER PROVIDERS ARE REQUIRED TO HAVE A STATE LICENSE AND HAVE A MEDICAID PROVIDER CONTRACT WITH THE DIVISION OF MEDICAID; TO AMEND SECTION 43-13-117.1, MISSISSIPPI CODE OF 1972, TO REQUIRE THE DIVISION TO REIMBURSE ADULT DAY CARE CENTERS; 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 A PERSON OVER 18 YEARS OF AGE; TO AMEND SECTION 37-33-167, MISSISSIPPI CODE OF 1972, TO MAKE A MINOR, NONSUBSTANTIVE REVISION; 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 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 AMEND SECTION 41-7-191, MISSISSIPPI CODE OF 1972, TO REVISE CERTAIN PROVISIONS RELATING TO A HOSPITAL THAT HAS A CERTIFICATE OF NEED FOR A FORTY BED PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY IN DESOTO COUNTY; TO PROVIDE THAT THERE SHALL BE NO PROHIBITION OR RESTRICTIONS ON PARTICIPATION IN THE MEDICAID PROGRAM FOR SUCH FACILITY THAT WOULD NOT OTHERWISE APPLY TO ANY OTHER SUCH FACILITY; TO CREATE NEW SECTION 83-9-47, MISSISSIPPI CODE OF 1972, TO PROHIBIT INSURERS PROVIDING PRESCRIPTION DRUG COVERAGE FROM REQUIRING OR IMPOSING ANY STEP THERAPY PROTOCOL WITH RESPECT TO DRUGS APPROVED BY THE UNITED STATES FOOD AND DRUG ADMINISTRATION (FDA) FOR THE TREATMENT OF POSTPARTUM DEPRESSION; 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 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 CREATE NEW SECTION 83-9-48, MISSISSIPPI CODE OF 1972, TO DEFINE "INSURER" AND REQUIRE INSURERS TO PROVIDE COVERAGE FOR POSTPARTUM DEPRESSION SCREENING; AND FOR RELATED PURPOSES.

Statutes affected:
As Introduced: 43-13-115, 43-13-117, 43-13-121, 43-13-305, 43-11-1, 43-11-8, 43-11-13, 43-13-117.1, 43-13-117.7, 37-33-167, 43-13-145, 43-13-115.1, 41-7-191
Committee Substitute: 43-13-115, 43-13-117, 43-13-121, 43-13-305, 43-11-1, 43-11-8, 43-11-13, 43-13-117.1, 43-13-117.7, 37-33-167, 43-13-145, 43-13-115.1, 41-7-191