MISSISSIPPI LEGISLATURE
2025 Regular Session
To: Medicaid
By: Senator(s) Fillingane
AN ACT TO AMEND SECTION 43-13-145, MISSISSIPPI CODE OF 1972, TO REVISE HOSPITAL TAX ASSESSMENT RATES TO BE A PERCENTAGE OF NET REVENUE; TO PROVIDE THAT A LICENSED PSYCHIATRIC HOSPITAL SHALL BE ASSESSED IN THE AMOUNT OF 40% OF NET PATIENT REVENUE, THAT LICENSED HOSPITALS, OTHER THAN PSYCHIATRIC HOSPITALS, SHALL BE ASSESSED IN THE AMOUNT OF 1% OF NET PATIENT REVENUE, UP TO A MAXIMUM OF $20,000,000.00 OF NET PATIENT REVENUE, IN THE AMOUNT OF 9.28% OF NET PATIENT REVENUE IN EXCESS OF $20,000,000.00 UP TO A MAXIMUM OF $200,000,000.00 OF NET PATIENT REVENUE WITH ADDITIONAL ASSESSMENT RATES FOR REVENUE IN EXCESS OF $200,000,000.00, AND THAT HOSPITALS OPERATED BY THE UNITED STATES DEPARTMENT OF VETERANS AFFAIRS AND HOSPITALS OPERATED BY THE STATE DEPARTMENT OF MENTAL HEALTH SHALL BE EXEMPT FROM SUCH ASSESSMENTS; TO DELETE AND DEFINE TERMS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 43-13-145, Mississippi Code of 1972, is amended as follows:
43-13-145. (1) (a) Upon each nursing facility licensed by the State of Mississippi, there is levied an assessment in an amount set by the division, equal to the maximum rate allowed by federal law or regulation, for each licensed and occupied bed of the facility.
(b) A nursing facility is exempt from the assessment levied under this subsection if the facility is operated under the direction and control of:
(i) The United States Veterans Administration or other agency or department of the United States government; or
(ii) The State Veterans Affairs Board.
(2) (a) Upon each intermediate care facility for individuals with intellectual disabilities licensed by the State of Mississippi, there is levied an assessment in an amount set by the division, equal to the maximum rate allowed by federal law or regulation, for each licensed and occupied bed of the facility.
(b) An intermediate care facility for individuals with intellectual disabilities is exempt from the assessment levied under this subsection if the facility is operated under the direction and control of:
(i) The United States Veterans Administration or other agency or department of the United States government;
(ii) The State Veterans Affairs Board; or
(iii) The University of Mississippi Medical Center.
(3) (a) Upon each psychiatric residential treatment facility licensed by the State of Mississippi, there is levied an assessment in an amount set by the division, equal to the maximum rate allowed by federal law or regulation, for each licensed and occupied bed of the facility.
(b) A psychiatric residential treatment facility is exempt from the assessment levied under this subsection if the facility is operated under the direction and control of:
(i) The United States Veterans Administration or other agency or department of the United States government;
(ii) The University of Mississippi Medical Center; or
(iii) A state agency or a state facility that either provides its own state match through intergovernmental transfer or certification of funds to the division.
(4) Hospital assessment.
(a) * * * Subject to and upon fulfillment of the
requirements and conditions of paragraph (f) * * * of this subsection, and
notwithstanding any other provisions of this section, an annual assessment on
each hospital licensed in the state, except as provided in paragraph (d) of
this subsection, is imposed on an amount calculated as a percentage of
each * * * hospital's net patient revenue, as
defined below and at * * * the * * * respective
rates set forth below. The total tax assessed will encompass the
nonfederal share necessary to maximize the Disproportionate Share Hospital
(DSH) and * * * Mississippi Hospital Access
Program * * * (MHAP) payments and such other hospital
supplemental payments as may be developed pursuant to Section 43-13-117(A)(18) * * *. If the state-matching funds
percentage for the Mississippi Medicaid program is sixteen percent (16%) or
less, the sum used in the formula under this * * * paragraph shall be
Seventy-four Million Dollars ($74,000,000.00). If the state-matching funds
percentage for the Mississippi Medicaid program is twenty-four percent (24%) or
higher, the sum used in the formula under this * * * paragraph shall be One
Hundred Four Million Dollars ($104,000,000.00). If the state-matching funds
percentage for the Mississippi Medicaid program is between sixteen percent
(16%) and twenty-four percent (24%), the sum used in the formula under this * * * paragraph shall be a
pro rata amount determined as follows: the current state-matching funds
percentage rate minus sixteen percent (16%) divided by eight percent (8%)
multiplied by Thirty Million Dollars ($30,000,000.00) and add that amount to
Seventy-four Million Dollars ($74,000,000.00). However, no assessment in a
quarter under this * * * paragraph may exceed the assessment in the
previous quarter by more than Three Million Seven Hundred Fifty Thousand
Dollars ($3,750,000.00) (which would be Fifteen Million Dollars
($15,000,000.00) on an annualized basis). The division shall publish the state-matching
funds percentage rate applicable to the Mississippi Medicaid program on the
tenth day of the first month of each quarter and the assessment determined
under the formula prescribed above shall be applicable in the quarter following
any adjustment in that state-matching funds percentage rate. The division
shall notify each hospital licensed in the state as to any projected increases
or decreases in the assessment determined under this * * * paragraph. However,
if the Centers for Medicare and Medicaid Services (CMS) does not approve the
provision in Section 43-13-117(39) requiring the division to reimburse
crossover claims for inpatient hospital services and crossover claims covered
under Medicare Part B for dually eligible beneficiaries in the same manner that
was in effect on January 1, 2008, the sum that otherwise would have been used
in the formula under this * * * subparagraph (i) paragraph shall be reduced by Seven
Million Dollars ($7,000,000.00).
( * * *i) * * * Each licensed
psychiatric hospital shall be assessed in the amount of forty percent (40%) of
net patient revenue.
( * * *ii) * * * Each licensed
hospital, other than psychiatric hospitals, shall be assessed in the amount of
one percent (1%) of net patient revenue, up to a maximum of Twenty Million
Dollars ($20,000,000.00) of net patient revenue.
(iii) Each licensed hospital, other than psychiatric hospitals, shall be assessed in the amount of nine and twenty-eight one hundredths percent (9.28%) of net patient revenue in excess of Twenty Million Dollars ($20,000,000.00) up to a maximum of Two Hundred Million Dollars ($200,000,000.00) of net patient revenue.
(iv) Each licensed hospital, other than psychiatric hospitals, shall be assessed on net patient revenue in excess of Two Hundred Million Dollars ($200,000,000.00) proportionately in an amount to be determined annually to fund the remaining balance of the assessment as provided for in paragraph (a) of this subsection. The additional annual assessment shall be based on a uniform percentage of each of such licensed hospital's net patient revenue in excess of Two Hundred Million Dollars ($200,000,000.00).
(v) Hospitals operated by the United States Department of Veterans Affairs and hospitals operated by the State Department of Mental Health shall be exempt from the assessments set forth in this subsection.
(b) Definitions.
(i) [Deleted]
(ii) For purposes of this subsection (4):
1. * * *
"Net patient revenue" means net hospital patient
revenue, exclusive of non-Hospital revenue, as defined on the annual Hospital
Medicaid DSH survey.
2. * * * "Psychiatric hospital"
means a freestanding facility which is licensed as a psychiatric hospital and
does not include hospitals operated by the State Department of Mental Health.
(c) The assessment provided in this subsection is intended to satisfy and not be in addition to the assessment and intergovernmental transfers provided in Section 43-13-117(A)(18). Nothing in this section shall be construed to authorize any state agency, division or department, or county, municipality or other local governmental unit to license for revenue, levy or impose any other tax, fee or assessment upon hospitals in this state not authorized by a specific statute.
(d) Hospitals operated by the United States Department of Veterans Affairs and state-operated facilities that provide only inpatient and outpatient psychiatric services shall not be subject to the hospital assessment provided in this subsection.
(e) Multihospital systems, closure, merger, change of ownership and new hospitals.
(i) If a hospital conducts, operates or maintains more than one (1) hospital licensed by the State Department of Health, the provider shall pay the hospital assessment for each hospital separately.
(ii) Notwithstanding any other provision in this section, if a hospital subject to this assessment operates or conducts business only for a portion of a fiscal year, the assessment for the state fiscal year shall be adjusted by multiplying the assessment by a fraction, the numerator of which is the number of days in the year during which the hospital operates, and the denominator of which is three hundred sixty-five (365). Immediately upon ceasing to operate, the hospital shall pay the assessment for the year as so adjusted (to the extent not previously paid).
(iii) The division shall determine the tax for new hospitals and hospitals that undergo a change of ownership in accordance with this section, using the best available information, as determined by the division.
(f) Applicability.
The hospital assessment imposed by this subsection shall not take effect and/or shall cease to be imposed if:
(i) The assessment is determined to be an impermissible tax under Title XIX of the Social Security Act; or
(ii) CMS revokes its approval of the division's 2009 Medicaid State Plan Amendment for the methodology for DSH payments to hospitals under Section 43-13-117(A)(18).
(5) Each health care facility that is subject to the provisions of this section shall keep and preserve such suitable books and records as may be necessary to determine the amount of assessment for which it is liable under this section. The books and records shall be kept and preserved for a period of not less than five (5) years, during which time those books and records shall be open for examination during business hours by the division, the Department of Revenue, the Office of the Attorney General and the State Department of Health.
(6) [Deleted]
(7) All assessments collected under this section shall be deposited in the Medical Care Fund created by Section 43-13-143.
(8) The assessment levied under this section shall be in addition to any other assessments, taxes or fees levied by law, and the assessment shall constitute a debt due the State of Mississippi from the time the assessment is due until it is paid.
(9) (a) If a health care facility that is liable for payment of an assessment levied by the division does not pay the assessment when it is due, the division shall give written notice to the health care facility demanding payment of the assessment within ten (10) days from the date of delivery of the notice. If the health care facility fails or refuses to pay the assessment after receiving the notice and demand from the division, the division shall withhold from any Medicaid reimbursement payments that are due to the health care facility the amount of the unpaid assessment and a penalty of ten percent (10%) of the amount of the assessment, plus the legal rate of interest until the assessment is paid in full. If the health care facility does not participate in the Medicaid program, the division shall turn over to the Office of the Attorney General the collection of the unpaid assessment by civil action. In any such civil action, the Office of the Attorney General shall collect the amount of the unpaid assessment and a penalty of ten percent (10%) of the amount of the assessment, plus the legal rate of interest until the assessment is paid in full.
(b) As an additional or alternative method for collecting unpaid assessments levied by the division, if a health care facility fails or refuses to pay the assessment after receiving notice and demand from the division, the division may file a notice of a tax lien with the chancery clerk of the county in which the health care facility is located, for the amount of the unpaid assessment and a penalty of ten percent (10%) of the amount of the assessment, plus the legal rate of interest until the assessment is paid in full. Immediately upon receipt of notice of the tax lien for the assessment, the chancery clerk shall forward the notice to the circuit clerk who shall enter the notice of the tax lien as a judgment upon the judgment roll and show in the appropriate columns the name of the health care facility as judgment debtor, the name of the division as judgment creditor, the amount of the unpaid assessment, and the date and time of enrollment. The judgment shall be valid as against mortgagees, pledgees, entrusters, purchasers, judgment creditors and other persons from the time of filing with the clerk. The amount of the judgment shall be a debt due the State of Mississippi and remain a lien upon the tangible property of the health care facility until the judgment is satisfied. The judgment shall be the equivalent of any enrolled judgment of a court of record and shall serve as authority for the issuance of writs of execution, writs of attachment or other remedial writs.
(10) (a) To further the provisions of Section 43-13-117(A)(18), the Division of Medicaid shall submit to the Centers for Medicare and Medicaid Services (CMS) any documents regarding the hospital assessment established under subsection (4) of this section. In addition to defining the assessment established in subsection (4) of this section if necessary, the documents shall describe any supplement payment programs and/or payment methodologies as authorized in Section 43-13-117(A)(18) if necessary.
(b) All hospitals satisfying the minimum federal DSH eligibility requirements (Section 1923(d) of the Social Security Act) may, subject to OBRA 1993 payment limitations, receive a DSH payment. This DSH payment shall expend the balance of the federal DSH allotment and associated state share not utilized in DSH payments to state-owned institutions for treatment of mental diseases. The payment to each hospital shall be calculated by applying a uniform percentage to the uninsured costs of each eligible hospital, excluding state-owned institutions for treatment of mental diseases; however, that percentage for a state-owned teaching hospital located in Hinds County shall be multiplied by a factor of two (2).
(11) The division shall implement DSH and supplemental payment calculation methodologies that result in the maximization of available federal funds.
(12) The DSH payments shall be paid on or before December 31, March 31, and June 30 of each fiscal year, in increments of one-third (1/3) of the total calculated DSH amounts. Supplemental payments developed pursuant to Section 43-13-117(A)(18) shall be paid monthly.
(13) Payment.
(a) The hospital assessment as described in subsection (4) for the nonfederal share necessary to maximize the Medicare Upper Payments Limits (UPL) Program payments and hospital access payments and such other supplemental payments as may be developed pursuant to Section 43-3-117(A)(18) shall be assessed and collected monthly no later than the fifteenth calendar day of each month.
(b) The hospital assessment as described in subsection (4) for the nonfederal share necessary to maximize the Disproportionate Share Hospital (DSH) payments shall be assessed and collected on December 15, March 15 and June 15.
(c) The annual hospital assessment and any additional hospital assessment as described in subsection (4) shall be assessed and collected on September 15 and on the 15th of each month from December through June.
(14) If for any reason any part of the plan for annual DSH and supplemental payment programs to hospitals provided under subsection (10) of this section and/or developed pursuant to Section 43-13-117(A)(18) is not approved by CMS, the remainder of the plan shall remain in full force and effect.
(15) Nothing in this section shall prevent the Division of Medicaid from facilitating participation in Medicaid supplemental hospital payment programs by a hospital located in a county contiguous to the State of Mississippi that is also authorized by federal law to submit intergovernmental transfers (IGTs) to the State of Mississippi to fund the state share of the hospital's supplemental and/or MHAP payments.
(16) This section shall stand repealed on July 1, 2028.
SECTION 2. This act shall take effect and be in force from and after July 1, 2025.