Senate Bill 2213

AN ACT TO CODIFY SECTION 43-13-117.5, MISSISSIPPI CODE OF 1972, TO AUTHORIZE AND DIRECT THE DIVISION OF MEDICAID TO STUDY AND IMPLEMENT A PILOT PROGRAM REGARDING AN ALTERNATIVE MANAGED CARE PAYMENT MODEL FOR CHILDREN WITH COMPLEX MEDICAL CONDITIONS (CMC) RECEIVING SERVICES FROM THE UNIVERSITY OF MISSISSIPPI MEDICAL CENTER (UMMC); 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 43-13-117.5, Mississippi Code of 1972:

43-13-117.5. The Division of Medicaid is authorized and directed to study the feasibility of implementing a pilot program to provide an alternative managed care payment model for children with complex medical conditions (CMC) receiving services from the University of Mississippi Medical Center (UMMC). The managed care payment model would establish a pediatric organization to function as an integrated pediatric network with a capitation agreement with managed care entities, which would redirect funding to provide Medicaid services to the CMC population consisting of children with significant chronic conditions in two or more body systems or a single dominant chronic condition, pursuant to guidelines developed by the Children's Hospital Association for medically complex children under a partnership contract and not require any additional funding from the State General Fund. The pediatric care network shall be managed by UMMC and may include its employed physicians, community pediatricians and other health care providers in the State of Mississippi. The pediatric care network may contract with managed care entities for the network to provide all medical services to the CMC population selected for participation for one (1) capitated fee or reimbursement through another innovative payment model designed by UMMC and Medicaid to share any savings in program costs that are achieved. If a pilot program is deemed feasible by Medicaid and UMMC, such a program shall be implemented on or before July 1, 2020, and a report of findings and recommendations be prepared by Medicaid and UMMC and provided to the Office of the Governor and the Chairmen of the Senate and House Medicaid Committees on or before July 1, 2023, in order to evaluate the effectiveness of the pilot program in reducing costs within the Medicaid program and in providing improved health and well-being of the affected patients.

SECTION 2. This act shall take effect and be in force from and after July 1, 2019.