Bill Text: MS SB2912 | 2018 | Regular Session | Enrolled
Bill Title: Mississippi Medicaid Program; extend repealer on provider assessments.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Passed) 2018-03-05 - Approved by Governor [SB2912 Detail]
Download: Mississippi-2018-SB2912-Enrolled.html
MISSISSIPPI LEGISLATURE
2018 Regular Session
To: Finance
By: Senator(s) Wiggins
Senate Bill 2912
(As Sent to Governor)
AN ACT TO AMEND SECTION 43-13-145, MISSISSIPPI CODE OF 1972, TO EXTEND THE AUTOMATIC REPEALER ON THE SECTION WHICH PROVIDES FOR CERTAIN PROVIDER ASSESSMENTS UNDER THE MISSISSIPPI MEDICAID PROGRAM; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 43-13-145, Mississippi Code of 1972, is amended as follows:
43-13-145. (1) (a) Upon each nursing facility licensed by the State of Mississippi, there is levied an assessment in an amount set by the division, equal to the maximum rate allowed by federal law or regulation, for each licensed and occupied bed of the facility.
(b) A nursing facility is exempt from the assessment levied under this subsection if the facility is operated under the direction and control of:
(i) The United States Veterans Administration or other agency or department of the United States government;
(ii) The State Veterans Affairs Board; or
(iii) The University of Mississippi Medical Center.
(2) (a) Upon each intermediate care facility for individuals with intellectual disabilities licensed by the State of Mississippi, there is levied an assessment in an amount set by the division, equal to the maximum rate allowed by federal law or regulation, for each licensed and occupied bed of the facility.
(b) An intermediate care facility for individuals with intellectual disabilities is exempt from the assessment levied under this subsection if the facility is operated under the direction and control of:
(i) The United States Veterans Administration or other agency or department of the United States government;
(ii) The State Veterans Affairs Board; or
(iii) The University of Mississippi Medical Center.
(3) (a) Upon each psychiatric residential treatment facility licensed by the State of Mississippi, there is levied an assessment in an amount set by the division, equal to the maximum rate allowed by federal law or regulation, for each licensed and occupied bed of the facility.
(b) A psychiatric residential treatment facility is exempt from the assessment levied under this subsection if the facility is operated under the direction and control of:
(i) The United States Veterans Administration or other agency or department of the United States government;
(ii) The University of Mississippi Medical Center; or
(iii) A state agency or a state facility that either provides its own state match through intergovernmental transfer or certification of funds to the division.
(4) Hospital assessment.
(a) (i) Subject to
and upon fulfillment of the requirements and conditions of paragraph (f) below,
and notwithstanding any other provisions of this section, effective for state
fiscal years 2016 * * * , 2017 and fiscal year 2018 through fiscal year 2021,
an annual assessment on each hospital licensed in the state is imposed on each
non-Medicare hospital inpatient day as defined below at a rate that is
determined by dividing the sum prescribed in this subparagraph (i), plus the
nonfederal share necessary to maximize the Disproportionate Share Hospital
(DSH) and inpatient Medicare Upper Payment Limits (UPL) Program payments
and inpatient hospital access payments, by the total number of non-Medicare
hospital inpatient days as defined below for all licensed Mississippi
hospitals, except as provided in paragraph (d) below. If the state matching
funds percentage for the Mississippi Medicaid program is sixteen percent (16%)
or less, the sum used in the formula under this subparagraph (i) shall be
Seventy-four Million Dollars ($74,000,000.00). If the state matching funds
percentage for the Mississippi Medicaid program is twenty-four percent (24%) or
higher, the sum used in the formula under this subparagraph (i) shall be One
Hundred Four Million Dollars ($104,000,000.00). If the state matching funds
percentage for the Mississippi Medicaid program is between sixteen percent
(16%) and twenty-four percent (24%), the sum used in the formula under this
subparagraph (i) shall be a pro rata amount determined as follows: the current
state matching funds percentage rate minus sixteen percent (16%) divided by
eight percent (8%) multiplied by Thirty Million Dollars ($30,000,000.00) and
add that amount to Seventy-four Million Dollars ($74,000,000.00). However, no
assessment in a quarter under this subparagraph (i) may exceed the assessment
in the previous quarter by more than Three Million Seven Hundred Fifty Thousand
Dollars ($3,750,000.00) (which would be Fifteen Million Dollars
($15,000,000.00) on an annualized basis). The division shall publish the state
matching funds percentage rate applicable to the Mississippi Medicaid program
on the tenth day of the first month of each quarter and the assessment
determined under the formula prescribed above shall be applicable in the quarter
following any adjustment in that state matching funds percentage rate. The
division shall notify each hospital licensed in the state as to any projected
increases or decreases in the assessment determined under this subparagraph
(i). However, if the Centers for Medicare and Medicaid Services (CMS) does not
approve the provision in Section 43-13-117(39) requiring the division to
reimburse crossover claims for inpatient hospital services and crossover claims
covered under Medicare Part B for dually eligible beneficiaries in the same
manner that was in effect on January 1, 2008, the sum that otherwise would have
been used in the formula under this subparagraph (i) shall be reduced by Seven
Million Dollars ($7,000,000.00).
(ii) In addition
to the assessment provided under subparagraph (i), effective for state fiscal
years 2016 * * * through fiscal year 2021, an
additional annual assessment on each hospital licensed in the state is imposed
on each non-Medicare hospital inpatient day as defined below at a rate that is
determined by dividing twenty-five percent (25%) of any provider reductions in
the Medicaid program as authorized in Section 43-13-117(F) for that fiscal year
up to the following maximum amount, plus the nonfederal share necessary to
maximize the Disproportionate Share Hospital (DSH) and inpatient Medicare Upper
Payment Limits (UPL) Program payments and inpatient hospital access
payments, by the total number of non-Medicare hospital inpatient days as
defined below for all licensed Mississippi hospitals: in fiscal year 2010, the
maximum amount shall be Twenty-four Million Dollars ($24,000,000.00); in fiscal
year 2011, the maximum amount shall be Thirty-two Million Dollars
($32,000,000.00); and in fiscal year 2012 and thereafter, the maximum amount
shall be Forty Million Dollars ($40,000,000.00). Any such deficit in the
Medicaid program shall be reviewed by the PEER Committee as provided in Section
43-13-117(F).
(iii) In addition
to the assessments provided in subparagraphs (i) and (ii), effective for state
fiscal years 2016 * * *, 2017 and fiscal year 2018 through fiscal year 2021,
an additional annual assessment on each hospital licensed in the state is
imposed pursuant to the provisions of Section 43-13-117(F) if the cost
containment measures described therein have been implemented and there are
insufficient funds in the Health Care Trust Fund to reconcile any remaining
deficit in any fiscal year. If the Governor institutes any other additional
cost containment measures on any program or programs authorized under the
Medicaid program pursuant to Section 43-13-117(F), hospitals shall be
responsible for twenty-five percent (25%) of any such additional imposed
provider cuts, which shall be in the form of an additional assessment not to
exceed the twenty-five percent (25%) of provider expenditure reductions. Such
additional assessment shall be imposed on each non-Medicare hospital inpatient
day in the same manner as assessments are imposed under subparagraphs (i) and
(ii).
(b) Payment and definitions.
(i) The hospital
assessment as described in this subsection (4) * * * shall be assessed and collected monthly
no later than the fifteenth calendar day of each month; provided, however, that
the first three (3) monthly payments shall be assessed but not be collected
until collection is satisfied for the third monthly (September) payment and the
second three (3) monthly payments shall be assessed but not be collected until
collection is satisfied for the sixth monthly (December) payment and provided
that the portion of the assessment related to the DSH payments shall be paid in
three (3) one-third (1/3) installments due no later than the fifteenth calendar
day of the payment month of the DSH payments required by Section 43-13-117(A)(18),
which shall be paid during the second, third and fourth quarters of the state
fiscal year, and provided that the assessment related to any inpatient UPL
payment(s) shall be paid no later than the fifteenth calendar day of the payment
month of the UPL payment(s) and provided assessments related to inpatient
hospital access payments will be collected beginning the initial month that the
division funds MHAP.
(ii) Definitions. For purposes of this subsection (4):
1. "Non-Medicare hospital inpatient day" means total hospital inpatient days including subcomponent days less Medicare inpatient days including subcomponent days from the hospital's 2013 Medicare cost report on file with CMS.
a. Total hospital inpatient days shall be the sum of Worksheet S-3, Part 1, column 8 row 14, column 8 row 16, and column 8 row 17, excluding column 8 rows 5 and 6.
b. Hospital Medicare inpatient days shall be the sum of Worksheet S-3, Part 1, column 6 row 14, column 6 row 16.00, and column 6 row 17, excluding column 6 rows 5 and 6.
c. Inpatient days shall not include residential treatment or long-term care days.
2. "Subcomponent inpatient day" means the number of days of care charged to a beneficiary for inpatient hospital rehabilitation and psychiatric care services in units of full days. A day begins at midnight and ends twenty-four (24) hours later. A part of a day, including the day of admission and day on which a patient returns from leave of absence, counts as a full day. However, the day of discharge, death, or a day on which a patient begins a leave of absence is not counted as a day unless discharge or death occur on the day of admission. If admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one (1) subcomponent inpatient day.
(c) The assessment provided in this subsection is intended to satisfy and not be in addition to the assessment and intergovernmental transfers provided in Section 43-13-117(A)(18). Nothing in this section shall be construed to authorize any state agency, division or department, or county, municipality or other local governmental unit to license for revenue, levy or impose any other tax, fee or assessment upon hospitals in this state not authorized by a specific statute.
(d) Hospitals operated by the United States Department of Veterans Affairs and state-operated facilities that provide only inpatient and outpatient psychiatric services shall not be subject to the hospital assessment provided in this subsection.
(e) Multihospital systems, closure, merger and new hospitals.
(i) If a hospital conducts, operates or maintains more than one (1) hospital licensed by the State Department of Health, the provider shall pay the hospital assessment for each hospital separately.
(ii) Notwithstanding any other provision in this section, if a hospital subject to this assessment operates or conducts business only for a portion of a fiscal year, the assessment for the state fiscal year shall be adjusted by multiplying the assessment by a fraction, the numerator of which is the number of days in the year during which the hospital operates, and the denominator of which is three hundred sixty-five (365). Immediately upon ceasing to operate, the hospital shall pay the assessment for the year as so adjusted (to the extent not previously paid).
(f) Applicability.
The hospital assessment imposed by this subsection shall not take effect and/or shall cease to be imposed if:
(i) The assessment is determined to be an impermissible tax under Title XIX of the Social Security Act; or
(ii) CMS revokes its approval of the division's 2009 Medicaid State Plan Amendment for the methodology for DSH payments to hospitals under Section 43-13-117(A)(18).
This subsection (4) is
repealed on July 1, * * *
2021.
(5) Each health care facility that is subject to the provisions of this section shall keep and preserve such suitable books and records as may be necessary to determine the amount of assessment for which it is liable under this section. The books and records shall be kept and preserved for a period of not less than five (5) years, during which time those books and records shall be open for examination during business hours by the division, the Department of Revenue, the Office of the Attorney General and the State Department of Health.
(6) Except as provided in subsection (4) of this section, the assessment levied under this section shall be collected by the division each month beginning on March 31, 2005.
(7) All assessments collected under this section shall be deposited in the Medical Care Fund created by Section 43-13-143.
(8) The assessment levied under this section shall be in addition to any other assessments, taxes or fees levied by law, and the assessment shall constitute a debt due the State of Mississippi from the time the assessment is due until it is paid.
(9) (a) If a health care facility that is liable for payment of an assessment levied by the division does not pay the assessment when it is due, the division shall give written notice to the health care facility by certified or registered mail demanding payment of the assessment within ten (10) days from the date of delivery of the notice. If the health care facility fails or refuses to pay the assessment after receiving the notice and demand from the division, the division shall withhold from any Medicaid reimbursement payments that are due to the health care facility the amount of the unpaid assessment and a penalty of ten percent (10%) of the amount of the assessment, plus the legal rate of interest until the assessment is paid in full. If the health care facility does not participate in the Medicaid program, the division shall turn over to the Office of the Attorney General the collection of the unpaid assessment by civil action. In any such civil action, the Office of the Attorney General shall collect the amount of the unpaid assessment and a penalty of ten percent (10%) of the amount of the assessment, plus the legal rate of interest until the assessment is paid in full.
(b) As an additional or alternative method for collecting unpaid assessments levied by the division, if a health care facility fails or refuses to pay the assessment after receiving notice and demand from the division, the division may file a notice of a tax lien with the chancery clerk of the county in which the health care facility is located, for the amount of the unpaid assessment and a penalty of ten percent (10%) of the amount of the assessment, plus the legal rate of interest until the assessment is paid in full. Immediately upon receipt of notice of the tax lien for the assessment, the chancery clerk shall forward the notice to the circuit clerk who shall enter the notice of the tax lien as a judgment upon the judgment roll and show in the appropriate columns the name of the health care facility as judgment debtor, the name of the division as judgment creditor, the amount of the unpaid assessment, and the date and time of enrollment. The judgment shall be valid as against mortgagees, pledgees, entrusters, purchasers, judgment creditors and other persons from the time of filing with the clerk. The amount of the judgment shall be a debt due the State of Mississippi and remain a lien upon the tangible property of the health care facility until the judgment is satisfied. The judgment shall be the equivalent of any enrolled judgment of a court of record and shall serve as authority for the issuance of writs of execution, writs of attachment or other remedial writs.
(10) As soon as possible after July 1, 2009, the Division of Medicaid shall submit to the Centers for Medicare and Medicaid Services (CMS) a state plan amendment or amendments (SPA) regarding the hospital assessment established under subsection (4) of this section. In addition to defining the assessment established in subsection (4) of this section, the state plan amendment or amendments shall include any amendments necessary to provide for the following additional annual Medicare Upper Payment Limits (UPL) Program and Disproportionate Share Hospital (DSH) payments to hospitals located in Mississippi that participate in the Medicaid program:
(a) Privately operated and nonstate government operated hospitals, within the meaning of 42 CFR Section 447.272, that have fifty (50) or fewer licensed beds as of January 1, 2009, shall receive an additional inpatient UPL payment equal to sixty-five percent (65%) of their fiscal year 2013 hospital specific inpatient UPL gap, before any payments under this subsection.
(b) General acute care hospitals licensed within the class of state hospitals shall receive an additional inpatient UPL payment equal to twenty-eight percent (28%) of their fiscal year 2013 inpatient payments, excluding DSH and UPL payments.
(c) General acute care hospitals licensed within the class of nonstate government hospitals shall receive an additional inpatient UPL payment determined by multiplying inpatient payments, excluding DSH and UPL, by the uniform percentage necessary to exhaust the maximum amount of inpatient UPL payments permissible under federal regulations. (For state fiscal year 2015 and fiscal year 2016, the state shall use 2013 inpatient payment data).
(d) In addition to other payments provided above, all hospitals licensed within the class of private hospitals shall receive an additional inpatient UPL payment determined by multiplying inpatient payments, excluding DSH and UPL, by the uniform percentage necessary to exhaust the maximum amount of UPL inpatient payments permissible under federal regulations. For state fiscal year 2015 and fiscal year 2016, the state shall use 2013 data.
(e) All hospitals satisfying the minimum federal DSH eligibility requirements (Section 1923(d) of the Social Security Act) shall, subject to OBRA 1993 payment limitations, receive an additional DSH payment. This additional DSH payment shall expend the balance of the federal DSH allotment and associated state share not utilized in DSH payments to state-owned institutions for treatment of mental diseases. The payment to each hospital shall be calculated by applying a uniform percentage to the uninsured costs of each eligible hospital, excluding state-owned institutions for treatment of mental diseases; however, that percentage for a state-owned teaching hospital located in Hinds County shall be multiplied by a factor of two (2).
(11) The portion of the hospital assessment provided in subsection (4) of this section associated with the MHAP shall not be in effect or implemented until the approval by CMS for the MHAP is obtained.
(12) The division shall implement DSH and UPL calculation methodologies that result in the maximization of available federal funds.
(13) The DSH and inpatient UPL payments shall be paid on or before December 31, March 31, and June 30 of each fiscal year, in increments of one-third (1/3) of the total calculated DSH and inpatient UPL amounts.
(14) The hospital assessment as described in subsection (4) above shall be assessed and collected monthly no later than the fifteenth calendar day of each month; provided, however, that the first three (3) monthly payments shall be assessed but not be collected until collection is satisfied for the third monthly (September) payment and the second three (3) monthly payments shall be assessed but not be collected until collection is satisfied for the sixth monthly (December) payment and provided that the portion of the assessment related to the DSH payments shall be paid in three (3) one-third (1/3) installments due no later than the fifteenth calendar day of the payment month of the DSH payments required by Section 43-13-117(A)(18), which shall be paid during the second, third and fourth quarters of the state fiscal year, and provided that the assessment related to any inpatient UPL payment(s) shall be paid no later than the fifteenth calendar day of the payment month of the UPL payment(s) and provided assessments related to MHAP will be collected beginning the initial month that the division funds MHAP.
(15) If for any reason any part of the plan for additional annual DSH and inpatient UPL payments to hospitals provided under subsection (10) of this section is not approved by CMS, the remainder of the plan shall remain in full force and effect.
(16) Nothing in this section shall prevent the Division of Medicaid from facilitating participation in Medicaid supplemental hospital payment programs by a hospital located in a county contiguous to the State of Mississippi that is also authorized by federal law to submit intergovernmental transfers (IGTs) to the State of Mississippi to fund the state share of the hospital's supplemental and/or MHAP payments.
(17) Subsections (10)
through (16) of this section shall stand repealed on July 1, * * * 2021.
SECTION 2. This act shall take effect and be in force from and after July 1, 2018.
