1998 Regular Session
To: Public Health and Welfare; Appropriations
By: Representatives Moody, Stevens, Holland
House Bill 1665
(As Passed the House)
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 STATE AND PUBLIC SCHOOL EMPLOYEES HEALTH INSURANCE MANAGEMENT BOARD SHALL IMPLEMENT AND ADMINISTER THE PROGRAM, WITH THE ADVICE OF AN ADVISORY COMMITTEE; TO PROVIDE THAT THE DIVISION OF MEDICAID SHALL RECEIVE STATE AND FEDERAL FUNDS FOR THE PROGRAM AND SHALL PROVIDE THE FUNDS TO THE BOARD; TO SPECIFY THE ELIGIBILITY FOR PARTICIPANTS IN THE PROGRAM; TO SPECIFY THE COVERED BENEFITS UNDER THE PROGRAM; TO PROVIDE THAT THE BOARD 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; 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 committee" means the Children's Health Care Advisory Committee created under Section 5 of this act.
(c) "Board" means the State and Public School Employees Health Insurance Management Board created under Section 25-15-303.
(d) "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.
(e) "Covered benefits" means the types of health care benefits and services provided to eligible recipients under the Children's Health Care Program.
(f) "Department" means the Department of Finance and Administration.
(g) "Division" means the Division of Medicaid in the Office of the Governor.
(h) "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.
(i) "Plan" means the State Child Health Plan.
(j) "Program" means the Children's Health Care Program established by this act.
(k) "Recipient" means a person who is eligible for assistance under the program.
(l) "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 State and Public School Employees Health Insurance Management Board created under Section 25-15-303, with the advice of the Children's Health Care Advisory Committee created under subsection (2) of this section. The department shall provide the board, on a full-time basis, with such personnel and technical support as necessary and sufficient to effectively administer the program.
(2) There is created the Children's Health Care Advisory Committee to serve in an advisory capacity to the board in implementing and administering the program. The advisory committee shall be composed of the following members:
(a) One (1) member of the board appointed by the chairman of the board, who shall serve as the chairman of the advisory committee;
(b) The Executive Director of the Division of Medicaid;
(c) The Executive Director of the State Department of Health; and
(d) Two (2) health care professionals who provide health care services to children, who shall be appointed by the Governor.
Members of the advisory committee shall not receive any compensation or per diem for their duties, but those members who are not state officers or employees may receive reimbursement for their travel expenses incurred in attending meetings of the advisory committee, as provided for under Section 25-3-41.
(3) In carrying out its functions under this act, the board, with the advice of the advisory committee, 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 and Periodic Screening, Diagnosis and Treatment (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 board 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 annually by the Department of Human Services and shall cover twelve (12) continuous months under either the program or Medicaid.
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 shall include early and periodic screening and diagnosis services at least equal to those provided under the Medicaid program. The benefits and services offered and available to state employees under the State Employees Health Insurance Plan shall be used as the benchmark for benefits and services under the program, with an emphasis on preventive and primary care.
SECTION 9. (1) (a) The board, with the advice of the advisory committee, 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 board 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 board 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 board shall adopt, in accordance with Section 25-43-1 et seq. and with the advice of the advisory committee, 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. Sections 1 through 11 of this act shall stand repealed on July 1, 2000.
SECTION 13. This act shall take effect and be in force from and after its passage.