1998 Regular Session
To: Public Health and Welfare; Appropriations
By: Representatives Moody, Stevens, Holland
House Bill 1665
AN ACT TO BE ENTITLED THE MISSISSIPPI CHILDREN'S HEALTH CARE ACT; TO PROVIDE FOR THE ESTABLISHMENT OF THE CHILDREN'S HEALTH CARE PROGRAM IN MISSISSIPPI; TO PROVIDE THAT THE DEPARTMENT OF FINANCE AND ADMINISTRATION AND THE DIVISION OF MEDICAID SHALL DEVELOP A STATE CHILD HEALTH PLAN TO PROVIDE HEALTH CARE ASSISTANCE TO ELIGIBLE UNINSURED, LOW-INCOME CHILDREN IN MISSISSIPPI; TO PROVIDE THAT THE DEPARTMENT SHALL SUBMIT THE PLAN TO THE UNITED STATES SECRETARY OF HEALTH AND HUMAN SERVICES FOR APPROVAL; TO PROVIDE THAT AFTER THE PLAN HAS BEEN DEVELOPED AND APPROVED, THE DEPARTMENT SHALL IMPLEMENT AND ADMINISTER THE PROGRAM, WITH THE ADVICE OF THE STATE EMPLOYEES HEALTH INSURANCE ADVISORY COUNCIL; TO PROVIDE THAT THE DIVISION OF MEDICAID SHALL RECEIVE STATE AND FEDERAL FUNDS FOR THE PROGRAM AND SHALL PROVIDE THE FUNDS TO THE DEPARTMENT; TO SPECIFY THE ELIGIBILITY FOR PARTICIPANTS IN THE PROGRAM; TO SPECIFY THE COVERED BENEFITS UNDER THE PROGRAM; TO PROVIDE THAT THE DEPARTMENT SHALL CONTRACT TO PROVIDE THE COVERAGE AND SERVICES UNDER THE PROGRAM; TO PROVIDE CERTAIN CRITERIA FOR INSURERS TO BE ELIGIBLE TO RECEIVE THE CONTRACT; TO AUTHORIZE FAMILIES TO RECEIVE PREMIUM SUBSIDIES FOR EMPLOYER-BASED DEPENDENT COVERAGE; TO AUTHORIZE RULES AND REGULATIONS FOR THE IMPLEMENTATION OF THE PROGRAM; TO AMEND SECTION 25-15-9, MISSISSIPPI CODE OF 1972, IN CONFORMITY TO THE PRECEDING PROVISIONS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. This act shall be known as and may be cited as the Mississippi Children's Health Care Act.
SECTION 2. For the purpose of initiating and expanding child health care assistance to uninsured, low-income children in an effective manner that is coordinated with other sources of health benefits coverage for children, there is established a Children's Health Care Program in Mississippi, which shall be financed by state appropriations and federal matching funds received by the state under the State Children's Health Insurance Program established by Title XXI of the federal Social Security Act, as amended.
SECTION 3. As used in this act, the following definitions shall have the meanings ascribed in this section, unless the context indicates otherwise:
(a) "Act" means the Mississippi Children's Health Care Act.
(b) "Advisory council" means the State Employees Health Insurance Advisory Council created under Section 25-15-9.
(c) "Child" means an individual born after September 30, 1983, who has not attained the age of nineteen (19), and who is not eligible for Medicaid benefits.
(d) "Covered benefits" means the types of health care benefits and services provided to eligible recipients under the Children's Health Care Program.
(e) "Department" means the Department of Finance and Administration.
(f) "Division" means the Division of Medicaid in the Office of the Governor.
(g) "Low-income child" means a child whose family income does not exceed one hundred thirty-three percent (133%) of the poverty level for a family of the size involved.
(h) "Plan" means the State Child Health Plan.
(i) "Program" means the Children's Health Care Program established by this act.
(j) "Recipient" means a person who is eligible for assistance under the program.
(k) "State Child Health Plan" means the plan that sets forth the manner and means by which the State of Mississippi will provide health care assistance to eligible uninsured, low-income children consistent with the provisions of Title XXI of the federal Social Security Act, as amended.
SECTION 4. (1) The Department of Finance and Administration and the Division of Medicaid shall develop the State Child Health Plan, which shall set forth the manner and means by which the State of Mississippi will provide health care assistance to eligible uninsured, low-income children under the Children's Health Care Program. The plan must be consistent with and meet the applicable requirements of Title XXI of the federal Social Security Act, as amended, and shall include:
(a) The method by which health care benefits and services provided under the program will be coordinated with other sources of health benefits coverage for children;
(b) A description of the covered benefits and the eligibility standards for recipients; and
(c) Methods used to assure the quality and appropriateness of care and access to covered benefits.
(2) The department shall submit the plan to the United States Secretary of Health and Human Services for approval.
SECTION 5. (1) After the plan has been developed and approved, the program shall be implemented and administered by the department, with the advice of the State Employees Health Insurance Advisory Council created under Section 25-15-9.
(2) No change in the terms of the plan may be made effective unless the executive director of the department or his designee has provided notice to the advisory council and has called a meeting of the advisory council at least fifteen (15) days before the effective date of the change. If the advisory council does not meet to advise the department on the proposed changes, the changes to the plan shall become effective at such time as the department has informed the advisory council that the changes will become effective.
(3) In carrying out its functions under this act, the department shall:
(a) Contract with a company or association, in the manner prescribed in Section 9 of this act, for the provision of coverage and services under the program;
(b) Coordinate coverage and services under the program with the Medicaid Early Periodic Screening and Diagnostic Testing (EPSDT) program and the State Department of Health's children's health programs; and
(c) Make reports to the federal government and to the Legislature on the implementation of the program.
SECTION 6. The Division of Medicaid shall receive state appropriations for the program and federal matching funds under the State Children's Health Insurance Program established by Title XXI of the federal Social Security Act, as amended, and shall provide those funds to the department for the administration of the program. The Legislature shall include those funds as a line item in the appropriation to the Division of Medicaid.
SECTION 7. (1) Persons eligible to receive covered benefits under this act shall be low-income children who meet the eligibility standards set forth in the plan.
(2) The eligibility of children for covered benefits under the program shall be determined by the Department of Human Services.
SECTION 8. The covered benefits under the program shall include all health care benefits and services required to be included as covered benefits under Title XXI of the federal Social Security Act, as amended, and the benefits and services offered and available to state employees under the State Employees Health Insurance Plan shall be used as the benchmark, with an emphasis on preventive and primary care.
SECTION 9. (1) (a) The department shall execute a contract or contracts to provide the health care coverage and services under the program, after first receiving bids. The contract or contracts may be executed with one or more corporations or associations licensed to transact life and accident and health insurance business in this state. No corporation or association with fewer than five (5) years' experience in the life and health insurance field may submit bids. All of the coverage and services to be provided under the program may be included in one or more similar contracts, or the coverage and services may be classified into different types with each type included under one or more similar contracts issued by the same or different companies.
(b) Within thirty (30) days after receiving bids, the department shall execute a contract or contracts with the company or association that has submitted the best and most cost-effective bid, or shall reject all bids. If the department rejects all bids, it shall notify all bidders of the rejection and shall actively solicit new bids.
(2) To be eligible for a contract under this section, a company or association must offer a qualified child health plan to eligible children without regard to their health status and without the imposition of a preexisting condition exclusion, except that a preexisting condition exclusion may be applied if the qualified child health plan is provided through a group health plan or group health insurance coverage, consistent with the limitations on the imposition of preexisting condition exclusions in connection with such coverage under state and federal law. Premium and cost-sharing amounts are limited to the following:
(a) No deductibles, coinsurance or other cost-sharing is permitted with respect to benefits for well-baby and well-child care including age-appropriate immunizations.
(b) Premiums, enrollment fees or similar charges may not exceed the maximum monthly charge permitted consistent with federal law. Deductibles and other cost-sharing shall not exceed an amount that is nominally consistent with standards provided under federal law.
SECTION 10. The plan shall include a procedure by which families with employer-based dependent coverage available may, at the option of the family, choose to utilize program funds to subsidize the cost of premiums for the employer-based coverage, if the benefits under the employer-based coverage are substantially the same as those offered under the plan.
SECTION 11. The department shall adopt, in accordance with Section 25-43-1 et seq., and with the advice of the advisory council, rules and regulations for the implementation of the program, and for the coordination of the program with the state's other medical assistance programs.
SECTION 12. Section 25-15-9, Mississippi Code of 1972, is amended as follows:
25-15-9. (1) (a) The department shall design a plan of health insurance for state employees which provides benefits for semiprivate rooms in addition to other incidental coverages which the department deems necessary. The amount of the coverages shall be in such reasonable amount as may be determined by the department to be adequate, after due consideration of current health costs in Mississippi. The plan shall also include major medical benefits in such amounts as the department shall determine. The department is also authorized to accept bids for such alternate coverage and optional benefits as the department shall deem proper. The department may employ or contract for such consulting or actuarial services as may be necessary to formulate the State Employees Health Insurance Plan, and to assist the department in the preparation of specifications and in the process of advertising for the bids for the plan. The department is authorized to promulgate rules and regulations to implement the provisions of this subsection.
The department shall develop plans for the insurance plan authorized by this section in accordance with the provisions of Section 25-15-5.
(b) There is created the State Employees Health Insurance Advisory Council to advise the department in the formulation of the State Employees Health Insurance Plan. The council shall be composed of the State Insurance Commissioner or his designee, an employee-representative of the institutions of higher learning appointed by the board of trustees thereof, an employee-representative of the Department of Transportation appointed by the director thereof, an employee-representative of the State Tax Commission appointed by the Commissioner of Revenue, an employee-representative of the Mississippi Department of Health appointed by the State Health Officer, an employee-representative of the Mississippi Department of Corrections appointed by the Commissioner of Corrections, and an employee-representative of the Department of Human Services appointed by the Executive Director of Human Services.
The Lieutenant Governor may designate the Secretary of the Senate, the Chairman of the Senate Appropriations Committee and the Chairman of the Senate Insurance Committee, and the Speaker of the House of Representatives may designate the Clerk of the House, the Chairman of the House Appropriations Committee and the Chairman of the House Insurance Committee, to attend any meeting of the * * * advisory council. The appointing authorities may designate an alternate member from their respective houses to serve when the regular designee is unable to attend such meetings of the council. Such designees shall have no jurisdiction or vote on any matter within the jurisdiction of the council. For attending meetings of the council, such legislators shall receive per diem and expenses which shall be paid from the contingent expense funds of their respective houses in the same amounts as provided for committee meetings when the Legislature is not in session; however, no per diem and expenses for attending meetings of the council will be paid while the Legislature is in session. No per diem and expenses will be paid except for attending meetings of the council without prior approval of the proper committee in their respective houses.
(c) No change in the terms of the State Employees Health Insurance Plan may be made effective unless the Executive Director of the Department of Finance and Administration, or his designee, has provided notice to the * * * advisory council and has called a meeting of the council at least fifteen (15) days before the effective date of such change. In the event that the advisory council does not meet to advise the department on the proposed changes, the changes to the plan shall become effective at such time as the department has informed the advisory council that the changes shall become effective.
(d) In addition to its duties under this article, the advisory council shall advise the department in the implementation and administration of the Mississippi Children's Healthcare Act established in Sections 1 through 11 of this act.
(e) Medical benefits for retired employees and dependents under age sixty-five (65) years. The same health insurance coverage as for all other active employees and their dependents shall be available to retired employees and all dependents under age sixty-five (65) years, the level of benefits to be the same level as for all other active participants. This section will apply to those employees who retire due to one hundred percent (100%) medical disability as well as those employees electing early retirement.
(f) Medical benefits for retired employees over age sixty-five (65) years. The health insurance coverage available to retired employees over age sixty-five (65) years, and all dependents over age sixty-five (65) years, shall be the major medical coverage with the lifetime maximum of One Million Dollars ($1,000,000.00). Benefits shall be reduced by Medicare benefits as though such Medicare benefits were the base plan.
All covered individuals shall be assumed to have full Medicare coverage, Parts A and B; and any Medicare payments under both Parts A and B shall be computed to reduce benefits payable under this plan.
(2) Nonduplication of benefits--reduction of benefits by Title XIX benefits: When benefits would be payable under more than one (1) group plan, benefits under those plans will be coordinated to the extent that the total benefits under all plans will not exceed the total expenses incurred.
Benefits for hospital or surgical or medical benefits shall be reduced by any similar benefits payable in accordance with Title XIX of the Social Security Act or under any amendments thereto, or any implementing legislation.
Benefits for hospital or surgical or medical benefits shall be reduced by any similar benefits payable by workers' compensation. (3) Schedule of life insurance benefits--group term: The amount of term life insurance for each active employee shall not be in excess of One Hundred Thousand Dollars ($100,000.00), or twice the amount of the employee's annual wage to the next highest One Thousand Dollars ($1,000.00), whichever may be less, but in no case less than Thirty Thousand Dollars ($30,000.00), with a like amount for accidental death and dismemberment on a twenty-four-hour basis. The plan will further contain a premium waiver provision if a covered employee becomes totally and permanently disabled prior to age sixty-five (65) years. Retired employees shall be eligible to continue life insurance coverage in an amount of Two Thousand Dollars ($2,000.00), Four Thousand Dollars ($4,000.00) or Ten Thousand Dollars ($10,000.00) into retirement. The Department of Finance and Administration shall prepare a report to the Legislative Budget Office on or before October 1, 1995, recommending any changes to the maximum group life coverages applicable to retired employees prescribed herein, and providing options as to any expected additional costs associated with increasing such benefits.
(4) Any eligible employee who on March 1, 1971, was participating in a group life insurance program which has provisions different from those included herein and for which the State of Mississippi was paying a part of the premium may, at his discretion, continue to participate in such plan. Such employee shall pay in full all additional costs, if any, above the minimum program established by this article. Under no circumstances shall any individual who begins employment with the state after March 1, 1971, be eligible for the provisions of this paragraph.
(5) Any participant of the State Employees Health Insurance Plan who otherwise would lose coverage and who would be eligible as a dependent under an existing Public School Employees Health Insurance Plan contract may transfer to the Public School Employees Health Insurance Plan as a dependent under the existing contract. Any participant of the Public School Employees Health Insurance Plan who otherwise would lose coverage and who would be eligible as a dependent under an existing State Employees Health Insurance Plan contract may transfer to the State Employees Health Insurance Plan as a dependent under the existing contract. A transfer pursuant to this subsection must occur within thirty-one (31) days of losing coverage. Credit shall be given for any deductible amount satisfied, out-of-pocket expenses and time served toward the twelve-month pre-existing waiting period.
(6) If both spouses are eligible employees who participate in the plan, the benefits shall apply individually to each spouse by virtue of his or her participation in the plan. If those spouses also have one or more eligible dependents participating in the plan, the cost of their dependents shall be calculated at a special family plan rate. The cost for participation by the dependents shall be paid by the spouse who elects to carry such dependents under his or her coverage. The special family plan rate shall also apply if the state employee's spouse is a covered eligible employee under the Public School Employees Health Insurance Plan.
(7) (a) The department may offer medical savings accounts as defined in Section 71-9-3 as a plan option. Provided, however, that prior to offering such accounts as a plan option, the Department of Finance and Administration shall prepare and present to the Senate and House Insurance Committees by December 15, 1996, a comprehensive study of medical savings accounts to include a proposed implementation timetable and potential actuarial effects of such accounts on the existing state employee health plan. The department's study shall also include, but not be limited to, recommended employer contribution levels, recommended employee contribution levels, recommendations on annual rollover of balances or withdrawals for nonmedical purposes, and recommendations on medical coverage for persons who expend their account balances. The department shall use existing staff resources and those of other agencies to conduct this study. In no case shall the department employ a consultant or contractor other than an actuary to conduct this study. No later than July 15, 1996, the Department of Finance and Administration shall meet with the staff of the PEER Committee and the Legislative Budget Office to receive recommendations on the issues and methods which the department shall consider in preparing its report. No later than October 15, 1996, the Department of Finance and Administration shall submit a copy of its draft report to the PEER Committee and the Legislative Budget Office which shall analyze the report and prepare comments for publication in the final report to be submitted to the House and Senate Insurance Committees on December 15, 1996.
(b) In no case shall the department offer medical savings accounts as an option to health plan participants prior to January 1, 1998.
(8) Any premium differentials, differences in coverages, discounts determined by risk or by any other factors shall be uniformly applied to all active employees participating in the insurance plan. It is the intent of the Legislature that the state contribution to the plan be the same for each employee throughout the state.
SECTION 13. This act shall take effect and be in force from and after its passage.