Legislative Updates

Listed below are the updates and summaries of legislative bill enacted during the previous legislative session that revise the powers and duties of the Mississippi Division of Medicaid.

2024 Legislative Session Updates and Summary

House Bill 539 (Medicaid; provide for presumptive eligibility for pregnant women). HB 539 – History of Actions/Background (state.ms.us)

• The Division shall allow for qualified provider to determine that eligible pregnant women are presumptively eligible for Medicaid coverage for ambulatory prenatal care under certain conditions.

House Bill 970 (Medicaid; extend date of repealers on the services and managed care provisions and the provider assessment provisions). HB 970 – History of Actions/Background (state.ms.us)

• Extended the repealers in Miss. Code §43-13-117 and §43-13-145 from July 1, 2024, to July 1, 2028.

2023 Legislative Session Updates and Summary

House Bill 1125 (Regulate Experimental Adolescent Procedures (REAP) Act; create to regulate transgender procedures and surgeries). HB 1125 – History of Actions/Background (state.ms.us)

• The Division shall not reimburse or provide coverage for gender transition procedures for a person under eighteen (18) years of age.

Senate Bill 2212 (Recipients of Medicaid; extend postpartum coverage up to 12 months). SB 2212 – History of Actions/Background (state.ms.us)

• Extends postpartum eligibility coverage from 60 days to 12 months.

2022 Legislative Session Updates and Summary

House Bill 657: Medicaid; delete freeze on provider reimbursement rates and make various technical amendments to services section. (HB 657 legislation)

• Removes the “Chokehold” language and replaces the “Chokehold” with a reporting mechanism for when the Division proposes rate changes. The proposed rate changes would be reported to the Chairmen of the Senate and House Medicaid Committees, who could then hold a hearing and provide input on the proposed changes.
• Creates a reporting mechanism for when the Division proposes State Plan Amendments. The proposed amendments would be reported to the Chairmen of the Senate and House Medicaid Committees, who could then hold a hearing and provide input on the proposed amendments.
• Increases the reimbursement rates of restorative dental services by 5% over the previous fiscal years for 2023, 2024, and 2025.
• Prevents the Managed Care Organizations from setting a maximum dollar reimbursement for noninvasive ventilators or ventilator treatment, and these services will be reimbursed by the Managed Care Organizations on a continuous monthly payment for the duration of need throughout the valid prescription period.
• Establishes an Ambulance UPL.
• Provides supplemental payments to LeBonheur if certain conditions are met.
• Requires that Planning and Development Districts case management services to be reimbursed at the maximum rate approved by CMS.
• Requires the Division to evaluate the feasibility of using a single managed care vendor to administer dental benefits.
• Creates a new statutory provision requiring the Division to reimburse for services provided at licensed birthing centers.
• Creates a failsafe provision to where If CMS disapproves a SPA submitted to comply with changes in §43-13-117, the Division may operate under the previously approved State Plan.
• Some non-Medicaid related changes concerning prescribing home health services by nurse practitioners, physician assistants, and clinical nurse specialists. Allowing to prescribe or order home health services and plans of care.

House Bill 936: Hospice care services for terminally ill inmates; authorize MDOC to provide for those confined in facilities under MDOC jurisdiction. (HB 936 legislation)

• Allows the Division to apply for a waiver to CMS for authorized services to medically frail inmates who qualify for nursing home level care that are deemed to not be public safety risks, if funds are specifically appropriated or otherwise made available to the division.

2020 Legislative Session Updates and Summary

Senate Bill 2486 | SB 2486 legislation

• This bill authorized the Division of Medicaid to extend certain Management Information System and Support contracts for a period not to exceed two (2) years.

2019 Legislative Session Updates and Summary

Senate Bill 2268 | SB 2268 legislation

• Authorizes DOM to reimburse for services provided to eligible Medicaid beneficiaries by a licensed freestanding psychiatric hospital.

2018 Legislative Session Updates and Summary

Senate Bill 2836 | SB 2836 legislation

• Authorizes an optional alternative reimbursement methodology for outpatient hospital services provided at a rural hospital
• The Mississippi Division of Medicaid (DOM) may elect to grant rural hospitals that have 50 or fewer licensed beds the option not to be reimbursed for outpatient hospital services under the APC methodology and instead be reimbursed at 101% of the Medicare outpatient hospital services rate.
• Reduces the authorized number of home leave days for nursing facilities and intermediate care facilities for individuals with intellectual disabilities (ICF/IID)
• Nursing facility days were reduced from 52 to 42
• ICF/IID days were reduced from 84 to 63
• Removes the legislative cap on physician visits
• Removes the legislative cap on home health visits
• Removes the legislative cap on prescription drugs
• Requires DOM to reimburse obstetricians and gynecologists for certain primary care services at 100% of the Medicare rate
• Authorizes DOM to allow certain drugs, implantable drug system devices, and medical supplies, with limited distribution or limited access for beneficiaries and administered in an appropriate clinical setting, to be reimbursed as either a medical claim or pharmacy claim
• Requires DOM 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
• Directs DOM and the Coordinated Care Organizations (CCOs) to encourage the use of Alpha-Hydroxyprogesterone Caproate (17P)
• Recodifies dental and orthodontic services as a Medicaid covered service
• Directs the Medical Care Advisory Committee to study dental reimbursement rates
• Requires DOM to reimburse certain services provided by a psychiatrist at up to 100% of the Medicare rate
• Authorizes DOM to develop an alternative fee for service Upper Payment Limits (UPL) model if necessary to preserve supplemental funding
• Requires DOM to develop alternative models for distribution of medical claims and supplemental payments for inpatient and outpatient hospital services for the purposes of ensuring access to inpatient and outpatient care and maximizing available federal funding effective July 1, 2019, if possible, but not later than July 1, 2020
• Authorizes DOM to implement a transitional program for inpatient and outpatient payments and/or supplemental payments within certain parameters
• Codifies the reimbursement rate for Federally Qualified Health Centers (FQHCs)
• Authorizes DOM to provide treatment services for persons with opioid or other highly addictive substance dependency
• Requires DOM to allow beneficiaries between the ages of 10 and 18 years to receive vaccines through a pharmacy venue
• Exempts outpatient services from the 5% rate reduction established in Miss. Code Ann. § 43-13-117 (B)
• Requires the Medical Care Advisory Committee to study the 5% reduction and compare provider reimbursement rates to those applicable in other states
• Deletes Miss. Code Ann. § 43-13-117 (D)
• Clarifies the Governor’s authority to implement cost containment methods in the event of a budget deficit
• Encourages the CCOs to develop and implement innovative payment models that incentivize improvements in health care quality, outcomes, or value
• Prohibits the expansion of managed care without enabling legislation
• Establishes a commission to study and make recommendations on the expansion of Medicaid managed care to include additional categories of Medicaid beneficiaries and the feasibility of developing an alternative managed care payment model for medically complex children
• Requires the CCOs to submit statistical data to DOM and the legislature not later than October 1 of each year
• Subjects DOM and the CCOs to annual program audits performed by the Office of the State Auditor, PEER, and/or an independent third party contractor that has no existing contractual relationship with DOM
• Prohibits the CCOs from requiring its providers to be credentialed by the organization and requires that the CCOs recognize the credentialing of the providers by DOM
• Extends the repealer on Miss. Code Ann. § 43-13-117 from 2018 to 2021
• Revises the definition of “non-Medicare hospital inpatient day”
• Establishes parameters for the determination of the hospital assessment for new hospitals and hospitals that undergo a change of ownership
• Requires supplemental payments to be made monthly
• Extends the repealer on Miss. Code Ann. § 43-13-145 Subsection (4) and Subsections (10) through (15) from 2018 to 2024

Senate Bill 2296 | SB 2296 legislation

• Requires DOM and other insurance policies to permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for a partial supply if the prescriber or pharmacist determines the fill or refill to be in the best interest of the patient and the patient requests or agrees to a partial supply
• Prohibits DOM from denying coverage for the dispensing of a medication that is dispensed by a network pharmacy on the basis of such a partial supply
• Prohibits DOM from using payment structures incorporating prorated dispensing fees

Senate Bill 2463 | SB 2463 legislation

• Establishes a Mississippi Rare Disease Advisory Council led by UMMC and in cooperation with the Department of Health, DOM, and the Mississippi Health Information Network to prepare a comprehensive report on the state of rare diseases in the state, the status of the rare disease community, and the treatment and services provided to persons with rare diseases in the state

To comment on the enacted legislation, you can contact the Mississippi Division of Medicaid (DOM) multiple ways as listed below, including by phone, postal mail, and fax. If you choose to contact DOM in writing, you are advised to submit information by postal mail or fax to protect the confidentiality of your protected health information or personally identifiable information.

• Toll-free: 800-421-2408
• Phone: 601-359-6050
• Fax: 601-359-6294
• Mailing address: 550 High Street, Suite 1000, Jackson, MS 39201

For information about past updates, visit the Legislative Updates Archive webpage.