MISSISSIPPI LEGISLATURE

1998 Regular Session

To: Public Health and Welfare; Appropriations

By: Senator(s) Hall

AN ACT TO CODIFY SECTIONS 43-13-401 THROUGH 43-13-419, MISSISSIPPI CODE OF 1972, TO BE ENTITLED THE MISSISSIPPI CHILDREN'S HEALTH CARE ACT OF 1998; TO ESTABLISH AND EMPOWER A MISSISSIPPI CHILD HEALTH CARE AUTHORITY TO DEVELOP AND SUBMIT TO THE SECRETARY OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES A STATE CHILD HEALTH PLAN TO PROVIDE HEALTH CARE SERVICES TO CERTAIN ELIGIBLE UNINSURED, LOW-INCOME CHILDREN IN MISSISSIPPI; TO AUTHORIZE THE DEPARTMENT OF FINANCE AND ADMINISTRATION TO ACT AS THE OVERSIGHT AGENCY FOR THE PROGRAM; TO PROVIDE ELIGIBILITY FOR PARTICIPANTS IN THE PLAN; TO PROVIDE FOR COVERED BENEFITS UNDER THE PLAN; TO PROVIDE CERTAIN CRITERIA FOR INSURERS PARTICIPATING IN THE PLAN; TO PROVIDE FOR FAMILY CHOICE; TO AUTHORIZE RULES AND REGULATIONS FOR THE IMPLEMENTATION OF THE PLAN; AND FOR RELATED PURPOSES. 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. The following provision shall be codified as Section 43-13-401, Mississippi Code of 1972:

43-13-401. Title of Article.

This article shall be entitled and cited as the Mississippi Children's Health Care Act of 1998.

SECTION 2. The following provision shall be codified as Section 43-13-403, Mississippi Code of 1972:

43-13-403. Purpose.

For the purpose of implementing a plan to initiate and expand the provision of 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 in accordance with the requirements for federal grants and other assistance under the State Children's Health Insurance Program, as established by Title XXI of the Social Security Act, as amended, there is hereby established a Children's Health Care Program in effect statewide, to be financed by state appropriations and federal matching funds and to be developed and administered by the Child Health Care Authority established under Section 4 of this act.

SECTION 3. The following provision shall be codified as Section 43-13-405, Mississippi Code of 1972:

43-13-405. Definitions.

When used in this article, the following definitions shall apply, unless the context indicates otherwise:

(a) "Act" means the Mississippi Children's Health Care Act of 1998.

(b) "Administering agency" means the Child Health Care Authority as established and organized under Section 4 of this act.

(c) "Child" means an individual under nineteen (19) years of age.

(d) "Covered benefits" means the types of health care and health care services provided to eligible recipients under the State Child Health Plan.

(e) "Low-income child" means a child whose family income is at or below one hundred fifty percent (150%) of the poverty line for a family of the size involved.

(f) "Oversight agency" means the Department of Finance and Administration.

(g) "Recipient" means a person who is eligible for assistance under the State Child Health Plan.

(h) "State Child Health Plan" means Mississippi's Child Health Plan that sets forth the manner and means whereby Mississippi will provide health care assistance to uninsured, low-income children consistent with the provisions of Title XXI of the Social Security Act, as amended.

SECTION 4. The following provision shall be codified as Section 43-13-407, Mississippi Code of 1972:

43-13-407. Administering Agency.

(1) There is hereby created a nonprofit legal entity to be known as the Mississippi Child Health Care Authority.

(2) (a) The authority shall operate subject to the supervision and approval of an eleven-member board of directors consisting of:

(i) Three (3) health care professionals with experience serving children, appointed by the Governor with the advice and consent of the Senate.

(ii) Two (2) representatives of private businesses that offer health coverage for their employees and dependents, appointed by the Governor with the advice and consent of the Senate.

(iii) One (1) representative of a Mississippi licensed insurance carrier that provides group health insurance in the state, appointed by the Governor with the advice and consent of the Senate.

(iv) One (1) representative of the general public who is a resident of the State of Mississippi with one or more children, appointed by the Governor with the advice and consent of the Senate.

(v) The Executive Director of the Division of Medicaid, the Executive Director of the State Department of Health, the Executive Director of the Department of Finance and Administration, and the Commissioner of Insurance, or their designees, who shall be nonvoting, ex officio members of the board.

(vi) Of those members appointed by the Governor, two (2) shall serve for a term of two (2) years, two (2) shall serve for a term of three (3) years, and three (3) shall serve for a term of four (4) years, and the Governor shall designate the period of service of each initial appointee at the time of appointment.

(vii) All terms after the initial term shall be for a period of four (4) years, and members may be reappointed.

(b) The board of directors shall elect one (1) of its members as chairman.

(c) Board members may be compensated from funds of the authority a per diem as prescribed in Section 25-3-69, Mississippi Code of 1972, and may be reimbursed for actual and necessary expenses incurred by them as members in the manner and amount provided in Section 25-3-41, Mississippi Code of 1972.

(d) Neither the board nor its employees shall be liable for any obligations of the authority. There shall be no liability on the part of and no cause of action shall arise against any member insurer or its agents or employees, the authority or its agents or employees, members of the board of directors or the Department of Finance and Administration for any action or omission by them in the performance of their powers and duties under this act. The board may provide in its bylaws or rules for indemnification of, and legal representation for, its members and employees.

(3) The Department of Finance and Administration, as oversight agency, shall receive state appropriations and federal matching funds for the State Children's Health Insurance Program provided under this act, and shall enter into appropriate agreements with the Child Health Care Authority for the administration of the Child Health Care Plan for the State of Mississippi. The Department of Finance and Administration shall examine and investigate the authority and make an annual report to the Legislature thereon. The Department of Finance and Administration shall have access to all data and records of the authority. Upon such investigation, the Department of Finance and Administration, if it deems necessary, shall require the board: (a) to contract with an outside independent actuarial firm to assess the solvency of the authority and for consultation as to the sufficiency and means of the funding of the authority, and the enrollment in and the eligibility, benefits and rate structure of the benefits plan to ensure the solvency of the authority, and (b) to close enrollment in the benefits plan at any time upon a determination by the outside independent actuarial firm that funds of the authority are insufficient to support the enrollment of additional persons.

(4) The Child Health Care Authority shall have the duty of administering all functions and responsibilities of the State Child Health Care Plan.

(5) In carrying out its functions under this article, the Child Health Care Authority is hereby empowered to:

(a) Employ personnel, as necessary, to properly administer the State Child Health Plan.

(b) Contract with authorized insurers or any provider of health care services, meeting standards established by the authority, for the provision of coverage and services under the State Child Health Plan.

(c) Contract with authorized insurers or any provider of health care services, meeting standards established by the authority: (i) for certifying the eligibility of children; (ii) for participation in the program and enrollment in the program; and (iii) for maintaining public awareness of the authority and the program. Existing health insurance sales and marketing methods, including the use of agents and payments of commissions, shall be utilized to inform families of the availability of the Child Health Insurance Program.

(d) Establish the administrative and accounting procedures for the operation of the Child Health Care Authority.

(e) Establish procedures under which applicants and participants in the program may have grievances reviewed by an impartial body and reported to the board of directors.

(f) Make necessary reports to the federal government and the Legislature on the implementation of the program.

(g) Require that all policy forms issued by the authority conform to standard forms developed by the authority and approved by the Department of Finance and Administration.

(h) Sue or be sued, including taking any legal actions necessary or proper to recover or collect assessments due the authority.

(i) Take any legal actions necessary to:

(i) Avoid the payment of improper claims against the authority or the coverage provided by or through the authority.

(ii) Recover any amounts erroneously or improperly paid by the authority.

(iii) Recover any amounts paid by the authority as a result of mistake of fact or law.

(iv) Recover other amounts due the authority.

(j) Establish, and modify from time to time as appropriate, rates, rate schedules, rate adjustments, expense allowances, agents' referral fees, claim reserve formulas and any other actuarial function appropriate to the operation of the authority.

(k) Appoint appropriate legal, actuarial and other committees as necessary to provide technical assistance in the operation of the plan, policy and other contract design, and any other function within the power of the authority.

(l) Coordinate services and coverage under the State Child Health Plan with the Division of Medicaid EPSDT and the State Department of Health's children's health programs.

SECTION 5. The following provision shall be codified as Section 43-13-409, Mississippi Code of 1972:

43-13-409. State Child Health Plan.

(1) The administering agency is hereby authorized to develop and submit to the Secretary of Health and Human Services for approval Mississippi's State Child Health Plan, which plan shall set forth the manner and means whereby the State of Mississippi will provide health care to certain eligible uninsured, low-income children. Prior to submission to the federal government, the administering agency shall submit the State Child Health Plan to the Department of Finance and Administration and the Governor for written approval.

(2) The State Child Health Plan shall include (a) the method by which health care benefits provided under the State Child Health Plan will be coordinated with other sources of health benefits coverage for children; (b) a description of the covered benefits, the eligibility standards for recipients which must be consistent with Title XXI of the Social Security Act, as amended; and (c) methods used to assure the quality and appropriateness of care and access to covered benefits. Such State Child Health Plan must be consistent with and meet the applicable requirements of Title XXI of the Social Security Act, as amended.

SECTION 6. The following provision shall be codified as Section 43-13-411, Mississippi Code of 1972:

43-13-411. Eligibility.

Persons eligible to receive health care and health care services under this act shall be the low-income children who meet the eligibility standards as set forth in the State Child Health Plan, which standards must be consistent with the requirements of Title XXI of the Social Security Act, as amended. In no event shall any defined group of eligible recipients cover children with higher family income without covering children with lower family income. Eligibility standards may not be based on a child having a pre-existing medical condition.

SECTION 7. The following provision shall be codified as Section 43-13-413, Mississippi Code of 1972:

43-13-413. Covered Benefits.

The covered benefits shall include all health care and health care services required to be included as covered benefits under Title XXI of the Social Security Act, as amended, and the benefits offered and available to state and public school district employees shall be used as the benchmark with an emphasis on preventive and primary care.

SECTION 8. The following provision shall be codified as Section 43-13-415, Mississippi Code of 1972:

43-13-415. Insurer Provisions.

(1) To be eligible for the state payment, a participating insurer shall offer a qualified child health plan to eligible children without regard to health status and without the imposition of 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.

(2) Premium and cost-sharing amounts are limited to the following:

(a) No deductibles, co-insurance 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.

(3) Existing health insurance sales and marketing methods, including the use of agents and payment of commissions, shall be utilized to inform families of the availability of the State Children's Health Insurance Program and assist them in obtaining coverage for children under the program.

SECTION 9. The following provision shall be codified as Section 43-13-417, Mississippi Code of 1972:

43-13-417. Family Choice.

The State Child Health Plan shall include a procedure by which families with employer-based dependent coverage available may utilize State Child Health Plan funds to subsidize the cost of premiums for such employer-based coverage, if the benefits under such plan are substantially the same as those offered by the administering agency.

SECTION 9. The following provision shall be codified as Section 43-13-419, Mississippi Code of 1972:

43-13-419. Rules and Regulations.

The administering agency shall adopt, in accordance with Section 25-43-1 et seq., Mississippi Code of 1972, rules and regulations for the implementation of the State Child Health Plan and the coordination of medical assistance programs established under this act with the state's other medical assistance programs, with the approval of the Department of Finance and Administration.

SECTION 10. This act shall take effect and be in force from and after its passage.