The Mississippi Legislature is looking to reauthorize the Medicaid tech bill during the 2018 legislative session.
“We sat down together and we said that we have to approach it different from what has been done in the past. We don’t need to go in individually and bombard the legislature,” said Tim Moore President of the Mississippi Hospital Association. “So, we got together and looked at the tech bill, step by step, and looked at what needed to be cleaned up, what needs to be fixed, and we asked ourselves how we can do things that will benefit the recipients of Medicaid. That’s almost identical to what you see in the House bill.”
Moore added that within the House bill there were a few things added, including their desire to raise the limit on physician visits from six to 12.
In addition, the rural health portion of the bill which would allow hospitals under 50 beds to be reimbursed at 101% of the cost which is huge for the small rural hospitals. That portion of the bill removes the caps on prescriptions, it removes the cap on position visits and a number of other things.
“The bad thing in the Senate bill is that they allow the managed care companies to negotiate rates to providers,” Moore said. “That is a problem. If the only way they can save money is to pay providers less that is a problem. Their job was to manage the care, they have not done it over the years they have been here so, let’s not go after providers because that is not where the cost is.”
Moore said that hospitals have not received an increase from Medicaid in the past five to six years.
“Now, the aggregate numbers have gone up slightly because you have got more people in the Medicaid program than you did five years ago, but there has been no funding increase,” Moore said.
Summary of SB 2836 – Senate Medicaid Bill 2018.
- Lifts cap on physician visits, allows DOM to determine.
- Reimburses primary care, pediatric, OB/GYN, internal medicine and vaccine codes at 100% Medicare rate and requires MCOs to reimburse for these same services in the same manner.
- Removes 25 visit cap on home health.
- Removes the cap on prescription drugs, allows DOM to determine and sets reimbursement for pharmacy providers at rates no less than the maximum rate approved by CMS.
- Increases payments for dental fees removes the repealer on dental services
- Requires that each hospital receives no less than its OBRA; unless Medicaid, in consultation with MHA and all affected providers, develops and agree upon a fair and equitable alternative payment amount.
- Requires PEER review of the NET program by 1/1/19 and every two years thereafter.
- Deletes population health program in (42).
- provides for coverage of treatment of substance abuse disorders, tobacco cessation, alcohol and chemical dependency and opioid addictions, – not more than 30 days of inpatient treatment per year and clinic treatments for such shall not count against any limits
- Physician administered drugs shall be billed and reimbursed as either a medical claim or pharmacy point of sale to allow greater access to care.
- Allows children between ages of 10 and 18 to receive vaccines through a pharmacy venue.
- Adds reimbursement for 17P without PA requirements.
- DOM may contract with a health information technology company with experience in population health management to develop a pop health and data analytics program for Medicaid enrollees provided the cost for the contract remains less than $10 million per year over the duration of the contract.
- Adds inpatient coverage for inmates; suspends rather than terminates their eligibility and provide for disenrollment for an MCO upon incarceration expect for the inpatient services.
- Medical Care Advisory Committee does the following and reports by 1/1/19: develops a study and advises the division with respect to the effect of any 5% rate reduction; and, compares provider reimbursement rates to those applicable in other states in order to establish a fair and equitable reimbursement structure which encourages provider participation.
- Allows Medicaid flexibility to adjust rates, quantity of services and types of care available to beneficiaries by deleting the language prohibiting Medicaid from making such changes without legislative approval.
- Allows more flexibility to address deficits including reducing or eliminating any or all optional services; reducing reimbursement rates; any other cost containment measures deemed appropriate by the Governor. This removes the hospital protections regarding rate reductions by hospitals funding the state share through additional assessments.
- Requires all providers to keep records which document cost report information for three years after the date of submission of the cost report.
- Deletes requirement that MCOs reimburse no less than the Medicaid rates
- Prohibits expansion of Medicaid managed care program without enabling legislation. Establishes a commission to study expansion to all beneficiaries. Commission shall consist of: Chairmen of Senate/House Medicaid, Approps and one other Senator/Rep; DOM executive Director; MID Commissioner; hospital rep of a hospital operated in Mississippi appointed by Speaker; doctor appointed by Lt. Gov; pharmacist appointed by the Governor; mental health professional appointed by the Governor; findings shall be reported by 12/1/18.
- Extends repealer to 6/30/2021 on both 43-13-117 and 43-13-145.
- Adds a reverse repealer
Summary of HB 898 – House Medicaid Bill 2018
- Hospitals may (not shall) receive additional payment for baclofen pump.
- Authorizes DOM to adjust APR-DRGs by DOM or MCOs.
- Requires DOM to develop and implement a hospital readmission education program designed to reduce potentially preventable readmissions and may work with any MCO to operate the program.
- Authorizes Medicaid, but does not require it, to give rural hospitals the option to opt out of APC methodology in favor of 101% rate established by Medicare.
- Reduces nursing home bed-hold days from 52 to 42.
- Removes physician office visit cap and allows 100% Medicare rate for OB-GYN for certain primary care services
- Allows DOM to determine reimbursement rates for Emergency transportation services (currently set at 70% Medicare).
- Removes the cap on prescription drugs.
- Allows physician-administered drugs to be billed and reimbursed as either medical claims or pharmacy point of sale.
- Allows DOM to determine dental and orthodontic reimbursement.
- Reduces ICF-ID bed hold days from 84 to 63.
- Certain services by a psychiatrist may be reimbursed at up to 100% of the Medicare rate.
- Authorizes DOM to develop and implement an alternative fee for service UPL to preserve supplemental funding (this protects residual UPL).
- Removes fall back protection of UPL program if MHAP isn’t approved.
- Requires that FQHCs be reimbursed under PPS as approved by CMS.
- Study NET program by 1/1/19 and every two years thereafter.
- Deletes requirement for a targeted case management program.
- Authorizes medication-assisted comprehensive treatment services for opioid substance use disorder to be provided through outpatient, residential, hospital or a certified opiate treatment program.
- Allows children between ages of 10 and 18 to receive vaccines through a pharmacy venue.
- Removes the 5% withholding on outpatient hospital services( unless the division projects a deficit for any fiscal year)
- Allows Medicaid flexibility to adjust rates, the quantity of services and types of care available to beneficiaries by deleting the language prohibiting Medicaid from making such changes without legislative approval.
- Allows more flexibility to adjust deficits including reducing or eliminating any or all optional services; reducing reimbursement rates; imposing additional assessments; any other cost containment measures deemed appropriate by the Governor. This removes the hospital protections regarding rate reductions by hospitals funding the state share through additional assessments.
- Maintains that the MCOs pay at least what Medicaid pays.
- Subjects the MCOs to audits with specific measurable directives.
- Requires the MCOs to recognize the credentialing of providers by the Division of Medicaid and not require providers to be credentialed separately by the MCO in order to receive payments.
- Medicaid may establish a pilot program to begin on or before January 1, 2020, and operate for three years to evaluate an alternative managed care payment model for medically complex children.
