April 24, 2025
TO
THE MISSISSIPPI SENATE:
GOVERNOR’S VETO MESSAGE FOR SENATE BILL 2386
I am returning Senate Bill 2386: “AN ACT TO AMEND SECTION 43-13-115,
MISSISSIPPI CODE OF 1972, TO MAKE CERTAIN TECHNICAL AMENDMENTS TO THE
PROVISIONS THAT PROVIDE FOR MEDICAID ELIGIBILITY AND TO MODIFY AGE AND INCOME
AND ELIGIBILITY CRITERIA TO REFLECT THE CURRENT CRITERIA; TO REQUIRE THE
DIVISION OF MEDICAID TO SUBMIT A WAIVER BY JULY 1, 2025, TO THE CENTER FOR
MEDICARE AND MEDICAID SERVICES (CMS) TO AUTHORIZE THE DIVISION TO CONDUCT LESS
FREQUENT MEDICAL REDETERMINATIONS FOR ELIGIBLE CHILDREN WHO HAVE CERTAIN
LONG-TERM OR CHRONIC CONDITIONS THAT DO NOT NEED TO BE REIDENTIFIED EVERY YEAR;
TO PROVIDE THAT MEN OF REPRODUCTIVE AGE ARE ELIGIBLE UNDER THE FAMILY PLANNING
PROGRAM; TO CONFORM WITH FEDERAL LAW TO ALLOW CHILDREN IN FOSTER CARE TO BE
ELIGIBLE UNTIL THEIR 26TH BIRTHDAY; TO ELIMINATE THE REQUIREMENT THAT THE
DIVISION MUST APPLY TO CMS FOR WAIVERS TO PROVIDE SERVICES FOR CERTAIN
INDIVIDUALS WHO ARE END-STAGE RENAL DISEASE PATIENTS ON DIALYSIS, CANCER
PATIENTS ON CHEMOTHERAPY OR ORGAN TRANSPLANT RECIPIENTS ON ANTIREJECTION DRUGS;
TO AMEND SECTION 43-13-117, MISSISSIPPI CODE OF 1972, AS AMENDED BY HOUSE BILL
NO. 1401, 2025 REGULAR SESSION, TO MAKE CERTAIN TECHNICAL AMENDMENTS TO THE
PROVISIONS THAT PROVIDE FOR MEDICAID SERVICES TO COMPLY WITH FEDERAL LAW; TO
ELIMINATE THE OPTION FOR CERTAIN RURAL HOSPITALS TO ELECT AGAINST REIMBURSEMENT
FOR OUTPATIENT HOSPITAL SERVICES USING THE AMBULATORY PAYMENT CLASSIFICATION
(APC) METHODOLOGY; TO REQUIRE THE DIVISION TO UPDATE THE CASE-MIX PAYMENT
SYSTEM AND FAIR RENTAL REIMBURSEMENT SYSTEM AS NECESSARY TO MAINTAIN COMPLIANCE
WITH FEDERAL LAW; TO AUTHORIZE THE DIVISION TO IMPLEMENT A QUALITY OR
VALUE-BASED COMPONENT TO THE NURSING FACILITY PAYMENT SYSTEM; TO REQUIRE THE
DIVISION TO REIMBURSE PEDIATRICIANS FOR CERTAIN PRIMARY CARE SERVICES AS
DEFINED BY THE DIVISION AT 100% OF THE RATE ESTABLISHED UNDER MEDICARE; TO
REQUIRE THE DIVISION TO REIMBURSE FOR ONE PAIR OF EYEGLASSES EVERY TWO YEARS
INSTEAD OF EVERY FIVE YEARS FOR CERTAIN BENEFICIARIES; TO AUTHORIZE ORAL
CONTRACEPTIVES TO BE PRESCRIBED AND DISPENSED IN TWELVE-MONTH SUPPLY INCREMENTS
UNDER FAMILY PLANNING SERVICES; TO AUTHORIZE THE DIVISION TO REIMBURSE AMBULATORY
SURGICAL CARE (ASC) BASED ON 90% OF THE MEDICARE ASC PAYMENT SYSTEM RATE IN
EFFECT JULY 1 OF EACH YEAR AS SET BY CMS; TO AUTHORIZE THE DIVISION TO PROVIDE
REIMBURSEMENT FOR DEVICES USED FOR THE REDUCTION OF SNORING AND OBSTRUCTIVE
SLEEP APNEA; TO PROVIDE THAT NO LATER THAN DECEMBER 1, 2025, THE DIVISION
SHALL, IN CONSULTATION WITH THE MISSISSIPPI HOSPITAL ASSOCIATION, THE
MISSISSIPPI HEALTHCARE COLLABORATIVE, THE UNIVERSITY OF MISSISSIPPI MEDICAL
CENTER AND ANY OTHER HOSPITALS IN THE STATE, PROVIDE RECOMMENDATIONS TO THE
CHAIRMEN OF THE SENATE AND HOUSE MEDICAID COMMITTEES ON METHODS FOR ALLOWING
PHYSICIANS OR OTHER ELIGIBLE PROVIDERS EMPLOYED OR CONTRACTED AT ANY HOSPITAL
IN THE STATE TO PARTICIPATE IN ANY MEDICARE UPPER PAYMENT LIMITS (UPL) PROGRAM,
ALLOWABLE DELIVERY SYSTEM OR PROVIDER PAYMENT INITIATIVE ESTABLISHED BY THE
DIVISION, SUBJECT TO FEDERAL LIMITATIONS ON COLLECTION OF PROVIDER TAXES; TO
PROVIDE THAT THE DIVISION SHALL, IN CONSULTATION WITH THE MISSISSIPPI HOSPITAL
ASSOCIATION, THE MISSISSIPPI HEALTHCARE COLLABORATIVE, THE UNIVERSITY OF
MISSISSIPPI MEDICAL CENTER AND ANY OTHER HOSPITALS IN THE STATE, STUDY THE
FEASIBILITY OF OFFERING ALTERNATIVE MODELS FOR DISTRIBUTION OF MEDICAL CLAIMS
AND SUPPLEMENTAL PAYMENTS FOR INPATIENT AND OUTPATIENT HOSPITAL SERVICES AND TO
STUDY THE FEASIBILITY OF THE DIVISION ESTABLISHING A MEDICARE UPPER PAYMENT
LIMITS PROGRAM TO PHYSICIANS EMPLOYED OR CONTRACTED BY HOSPITALS WHO ARE ABLE
TO PARTICIPATE IN THE PROGRAM THROUGH AN INTERGOVERNMENTAL TRANSFER; TO UPDATE
AND CLARIFY LANGUAGE ABOUT THE DIVISION'S TRANSITION FROM THE MEDICARE UPPER
PAYMENT LIMITS (UPL) PROGRAM TO THE MISSISSIPPI HOSPITAL ACCESS PROGRAM (MHAP);
TO PROVIDE THAT THE DIVISION SHALL MAXIMIZE TOTAL FEDERAL FUNDING FOR MHAP, UPL
AND OTHER SUPPLEMENTAL PAYMENT PROGRAMS IN EFFECT FOR STATE FISCAL YEAR 2025
AND SHALL NOT CHANGE THE METHODOLOGIES, FORMULAS, MODELS OR PREPRINTS USED TO
CALCULATE THE DISTRIBUTION OF SUPPLEMENTAL PAYMENTS TO HOSPITALS FROM THOSE
METHODOLOGIES, FORMULAS, MODELS OR PREPRINTS IN EFFECT AND AS APPROVED BY THE
CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR STATE FISCAL YEAR 2025; TO
AUTHORIZE THE DIVISION TO CONTRACT WITH THE STATE DEPARTMENT OF HEALTH TO
PROVIDE FOR A PERINATAL HIGH RISK MANAGEMENT/INFANT SERVICES SYSTEM FOR ANY
ELIGIBLE BENEFICIARY WHO CANNOT RECEIVE SUCH SERVICES UNDER A DIFFERENT
PROGRAM; TO AUTHORIZE THE DIVISION TO REIMBURSE FOR SERVICES AT CERTIFIED
COMMUNITY BEHAVIORAL HEALTH CENTERS; TO EXTEND TO JULY 1, 2027, THE DATE OF THE
REPEALER ON THE PROVISION OF LAW THAT PROVIDES THAT THE DIVISION SHALL
REIMBURSE FOR OUTPATIENT HOSPITAL SERVICES PROVIDED TO ELIGIBLE MEDICAID
BENEFICIARIES UNDER THE AGE OF 21 YEARS BY BORDER CITY UNIVERSITY-AFFILIATED
PEDIATRIC TEACHING HOSPITALS, WHICH WAS REPEALED BY OPERATION OF LAW IN 2024;
TO LIMIT THE PAYMENT FOR PROVIDING SERVICES TO MISSISSIPPI MEDICAID
BENEFICIARIES UNDER THE AGE OF 21 YEARS WHO ARE TREATED BY A BORDER CITY
UNIVERSITY-AFFILIATED PEDIATRIC TEACHING HOSPITAL; TO REQUIRE THE DIVISION TO
DEVELOP AND IMPLEMENT A METHOD FOR REIMBURSEMENT OF AUTISM SPECTRUM DISORDER
SERVICES BASED ON A CONTINUUM OF CARE FOR BEST PRACTICES IN MEDICALLY NECESSARY
EARLY INTERVENTION TREATMENT; TO REQUIRE THE DIVISION TO REIMBURSE FOR
PREPARTICIPATION PHYSICAL EVALUATIONS; TO REQUIRE THE DIVISION TO REIMBURSE FOR
UNITED STATES FOOD AND DRUG ADMINISTRATION APPROVED MEDICATIONS FOR CHRONIC
WEIGHT MANAGEMENT OR FOR ADDITIONAL CONDITIONS IN THE DISCRETION OF THE MEDICAL
PROVIDER; TO REQUIRE THE DIVISION TO PROVIDE COVERAGE AND REIMBURSEMENT FOR ANY
NONSTATIN MEDICATION APPROVED BY THE UNITED STATES FOOD AND DRUG ADMINISTRATION
THAT HAS A UNIQUE INDICATION TO REDUCE THE RISK OF A MAJOR CARDIOVASCULAR EVENT
IN PRIMARY PREVENTION AND SECONDARY PREVENTION PATIENTS; TO REQUIRE THE
DIVISION TO PROVIDE COVERAGE AND REIMBURSEMENT FOR ANY NONOPIOID MEDICATION
APPROVED BY THE UNITED STATES FOOD AND DRUG ADMINISTRATION FOR THE TREATMENT OR
MANAGEMENT OF PAIN; TO REDUCE THE LENGTH OF NOTICE THE DIVISION MUST PROVIDE
THE MEDICAID COMMITTEE CHAIRMEN FOR PROPOSED RATE CHANGES AND TO PROVIDE THAT
SUCH LEGISLATIVE NOTICE MAY BE EXPEDITED; TO REQUIRE THE DIVISION TO REIMBURSE
AMBULANCE TRANSPORTATION SERVICE PROVIDERS THAT PROVIDE AN ASSESSMENT, TRIAGE
OR TREATMENT FOR ELIGIBLE MEDICAID BENEFICIARIES; TO SET CERTAIN REIMBURSEMENT
LEVELS FOR SUCH PROVIDERS; TO EXTEND TO JULY 1, 2029, THE DATE OF THE REPEALER
ON SUCH SECTION; TO AMEND SECTION 43-13-121, MISSISSIPPI CODE OF 1972, TO
AUTHORIZE THE DIVISION TO EXTEND ITS MEDICAID ENTERPRISE SYSTEM AND FISCAL AGENT
SERVICES, INCLUDING ALL RELATED COMPONENTS AND SERVICES, CONTRACTS IN EFFECT ON
JUNE 30, 2025, FOR AN ADDITIONAL TWO-YEAR PERIOD; TO AUTHORIZE THE DIVISION TO
ENTER INTO A TWO-YEAR CONTRACT WITH A VENDOR TO PROVIDE SUPPORT OF THE
DIVISION'S ELIGIBILITY SYSTEM; TO REDUCE THE LENGTH OF NOTICE THE DIVISION MUST
PROVIDE THE MEDICAID COMMITTEE CHAIRMEN FOR A PROPOSED STATE PLAN AMENDMENT AND
TO PROVIDE THAT SUCH LEGISLATIVE NOTICE MAY BE EXPEDITED; TO AMEND SECTION
43-13-305, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT WHEN A THIRD-PARTY PAYOR
REQUIRES PRIOR AUTHORIZATION FOR AN ITEM OR SERVICE FURNISHED TO A MEDICAID
RECIPIENT, THE PAYOR SHALL ACCEPT AUTHORIZATION PROVIDED BY THE DIVISION OF
MEDICAID THAT THE ITEM OR SERVICE IS COVERED UNDER THE STATE PLAN AS IF SUCH
AUTHORIZATION WERE THE PRIOR AUTHORIZATION MADE BY THE THIRD-PARTY PAYOR FOR
SUCH ITEM OR SERVICE; TO AMEND SECTION 43-13-117.7, MISSISSIPPI CODE OF 1972,
TO PROVIDE THAT THE DIVISION SHALL NOT REIMBURSE OR PROVIDE COVERAGE FOR GENDER
TRANSITION PROCEDURES FOR ANY PERSON; TO AMEND SECTION 43-13-145, MISSISSIPPI
CODE OF 1972, TO PROVIDE THAT A QUARTERLY HOSPITAL ASSESSMENT MAY EXCEED THE
ASSESSMENT IN THE PRIOR QUARTER BY MORE THAN $3,750,000.00 IF SUCH INCREASE IS
TO MAXIMIZE FEDERAL FUNDS THAT ARE AVAILABLE TO REIMBURSE HOSPITALS FOR
SERVICES PROVIDED UNDER NEW PROGRAMS FOR HOSPITALS, FOR INCREASED SUPPLEMENTAL
PAYMENT PROGRAMS FOR HOSPITALS OR TO ASSIST WITH STATE-MATCHING FUNDS AS
AUTHORIZED BY THE LEGISLATURE; TO AUTHORIZE THE DIVISION TO REDUCE OR ELIMINATE
THE PORTION OF THE HOSPITAL ASSESSMENT APPLICABLE TO LONG-TERM ACUTE CARE
HOSPITALS AND REHABILITATION HOSPITALS IF CMS WAIVES CERTAIN REQUIREMENTS; TO
CREATE NEW SECTION 41-140-1, MISSISSIPPI CODE OF 1972, TO DEFINE TERMS; TO
CREATE NEW SECTION 41-140-3, MISSISSIPPI CODE OF 1972, TO REQUIRE THE STATE
DEPARTMENT OF HEALTH TO DEVELOP AND PROMULGATE WRITTEN EDUCATIONAL MATERIALS
AND INFORMATION FOR HEALTH CARE PROFESSIONALS AND PATIENTS ABOUT MATERNAL
MENTAL HEALTH CONDITIONS; TO REQUIRE HOSPITALS PROVIDING BIRTH SERVICES TO
PROVIDE SUCH EDUCATIONAL MATERIALS TO NEW PARENTS AND, AS APPROPRIATE, OTHER
FAMILY MEMBERS; TO REQUIRE THAT SUCH MATERIALS BE PROVIDED TO ANY WOMAN WHO
PRESENTS WITH SIGNS OF A MATERNAL MENTAL HEALTH DISORDER; TO CREATE NEW SECTION
41-140-5, MISSISSIPPI CODE OF 1972, TO REQUIRE ANY HEALTH CARE PROVIDER OR
NURSE MIDWIFE WHO RENDERS POSTNATAL CARE OR PEDIATRIC INFANT CARE TO ENSURE
THAT THE POSTNATAL CARE PATIENT OR BIRTHING MOTHER OF THE PEDIATRIC INFANT CARE
PATIENT, AS APPLICABLE, IS OFFERED SCREENING FOR POSTPARTUM DEPRESSION AND TO
PROVIDE APPROPRIATE REFERRALS IF SUCH PATIENT OR MOTHER IS DEEMED LIKELY TO BE
SUFFERING FROM POSTPARTUM DEPRESSION; TO AMEND SECTION 43-13-107, MISSISSIPPI
CODE OF 1972, TO ESTABLISH A MEDICAID ADVISORY COMMITTEE AND BENEFICIARY
ADVISORY COMMITTEE AS REQUIRED PURSUANT TO FEDERAL REGULATIONS; TO PROVIDE THAT
ALL MEMBERS OF THE MEDICAL CARE ADVISORY COMMITTEE SERVING ON JANUARY 1, 2025,
SHALL BE SELECTED TO SERVE ON THE MEDICAID ADVISORY COMMITTEE, AND SUCH MEMBERS
SHALL SERVE UNTIL JULY 1, 2028; AND FOR RELATED PURPOSES.”
Senate Bill 2386, commonly
referred to as the annual Medicaid Technical Amendments Bill, like its nearly
identical and previously vetoed Grady Twin, Senate Bill 2867, seeks to expand
Medicaid in the state of Mississippi by amending eligibility requirements and
increasing covered services.
Specifically, the provisions in Senate Bill 2386, when aggregated, are
estimated to add total recuring costs of more than $40,000,000 to the annual
budget of the Division of Medicaid (“Division”) (of which the state share would
be approximately 24%). Such proposed expansion
unwisely comes at a time when federal funding of existing Medicaid services is
in question.
In addition, Senate Bill 2386 continues to improvidently
seek to remove the broad discretion afforded to the Division under federal law
to find creative ways to increase supplemental payments to hospitals under the Mississippi
Hospital Access Program (“MHAP”) by freezing the current methodology: “[The Division] shall not change the
methodologies, formulas, models or preprints used to calculate the distribution
of supplemental payments to hospitals from those methodologies, formulas,
models or preprints in effect and as approved by the Centers for Medicare and
Medicaid Services for state fiscal year 2025 as of December 31, 2024, except to
update the time period to the most recent annual period or as required by
federal law or regulation.” (See
Lines 1031-1058.) Such broad discretion
allowed the Division to increase recurring supplemental payments to hospitals
by a number greater than $700,000,000 annually, effective July 1, 2023. Thus, the effect of Senate Bill 2386 would be
to unwisely place the Division in a straitjacket, preventing it from finding
more creative and innovative ways to increase supplemental payments to
hospitals.
Additionally, in spite of
language seeking to freeze the MHAP, Senate Bill 2386 again authorizes the
inclusion of “a border city university-affiliated pediatric teaching hospital.
. . in a [supplemental] payment model. . . .”
(See Lines 1054-1058.) It
is logically nonsensical for Senate Bill 2386 to, on the one hand, freeze the
MHAP, while on the other hand, mandate that the Division open the program to
include an additional hospital. Complying with both requirements is a legal
impossibility. Further, delaying the
inclusion of this border city university-affiliated pediatric teaching hospital
in the MHAP until FY 2026 does not address the conundrum that this directive
places the Division.
As was the case with its
predecessor Senate Bill 2867, the instant bill presents some proposed changes
that would be beneficial to the Medicaid program, while others would be
problematic. Moreover, while Senate Bill
2386 does address one of the issues raised in the prior veto message by removing
the mandatory language directing the Division to expand eligibility for the
Medicare Upper Payment Limits program and requires the Division to study and
report back to the Legislature by December 1, 2025 methods for expanding the
program, any expansion of the program beyond its original design (to draw down
additional federal funds for the University of Mississippi Medical Center (“UMMC”))
would necessarily, absent a change in federal regulations, create a budget
deficit for UMMC that would have to be backfilled by a Legislative appropriation.
In short, because Senate Bill 2386 unwisely expands
Medicaid at a time when federal funding is in question, needlessly ties the
hands of the Division with respect to finding new and inventive ways to
increase supplemental payments to hospitals, and continues to have the
potential to threatened UMMC’s annual operating budget in the near future, I am
left with no choice but to veto the bill at this time.
Respectfully
submitted,
TATE
REEVES
GOVERNOR