Senate Bill 2662

AN ACT TO CREATE NEW SECTION 43-13-117.6, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT THE DIVISION OF MEDICAID SHALL REIMBURSE FOR OUTPATIENT HOSPITAL SERVICES PROVIDED TO ELIGIBLE MEDICAID BENEFICIARIES UNDER THE AGE OF 21 BY BORDER CITY UNIVERSITY-AFFILIATED PEDIATRIC TEACHING HOSPITALS; TO PROVIDE THAT THE DIVISION SHALL SEEK ANY NECESSARY WAIVERS AND MAKE ANY REQUIRED AMENDMENTS TO ITS STATE PLAN; TO PROVIDE THAT ON OR AFTER JANUARY 1, 2022, SUCH SERVICES SHALL BE REIMBURSED BASED ON REASONABLE COSTS WITH INTERIM PAYMENTS AND A YEAR-END COST SETTLEMENT; AND FOR RELATED PURPOSES.

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

SECTION 1. The following shall be codified as Section 43-13-117.6, Mississippi Code of 1972:

43-13-117.6. (1) The Division of Medicaid shall reimburse for outpatient hospital services provided to eligible Medicaid beneficiaries under the age of twenty-one (21) by border city university-affiliated pediatric teaching hospitals. The division shall seek any necessary waivers, make any required amendments to its state plan or revise any contracts authorized under Section 43-13-117(H) as necessary to provide the services authorized under this section. Effective for claims with dates of service on or after January 1, 2022, outpatient hospital services provided to Medicaid beneficiaries under the age of twenty-one (21) at border city university-affiliated pediatric teaching hospitals shall be reimbursed based on reasonable costs with interim payments and a year-end cost settlement. The division shall utilize cost data in accordance with federal law and federal regulations consistent with the method used for identifying cost for private hospital access payments. The division shall use the lesser of the reasonable costs or customary charges to establish cost settlements. The cost settlements shall be calculated using the methods and standards used by the Medicare Program.

(2) As used in this section, a border city university-affiliated pediatric teaching hospital shall mean an out-of-state hospital located within a county contiguous to the state line that submits to the division a copy of a current and effective affiliation agreement with an accredited university, and documentation establishing that the hospital is university-affiliated, is licensed and designated as a pediatric hospital or pediatric primary hospital within its home state, maintains at least five different intern pediatric specialty training programs, and maintains at least one hundred (100) operated beds dedicated exclusively for the treatment of patients under the age of twenty-one (21).

(3) It is the intent of the Legislature that the cost of providing services to Medicaid beneficiaries under the age of twenty-one (21) who are treated by a border city university-affiliated pediatric teaching hospital shall not exceed the cost of providing the same services to individuals in hospitals in the state.

SECTION 2. This act shall take effect and be in force from and after July 1, 2022.