MISSISSIPPI LEGISLATURE

2026 Regular Session

To: Public Health and Human Services; Appropriations A

By: Representatives Summers, Butler-Washington, James-Jones

House Bill 1493

AN ACT BE KNOWN AS THE MISSISSIPPI MATERNAL HEALTH MOMNIBUS ACT; TO PROVIDE FOR A VARIETY OF MATERNAL HEALTH SERVICES FOR PREGNANT AND POSTPARTUM WOMEN; TO AMEND SECTION 27-65-111, MISSISSIPPI CODE OF 1972, TO EXEMPT FROM SALES TAXATION SALES OF CHILDREN'S DIAPERS, DIAPER BAGS, DIAPER RASH CREAM, BABY WIPES, BABY POWDER AND BABY FORMULA; TO AMEND SECTION 43-13-117, MISSISSIPPI CODE OF 1972, TO PROVIDE MEDICAID COVERAGE FOR CERTAIN SERVICES PROVIDED BY THIS ACT; AND FOR RELATED PURPOSES.

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

SECTION 1. This act shall be known and may be cited as the Mississippi Maternal Health Momnibus Act.

PART I. ESTABLISHMENT OF MATERNAL CARE ACCESS GRANT PROGRAM

SECTION 2. Definitions. The following definitions apply in Part I:

(a) "Culturally respectful congruent" means sensitive to and respectful of the preferred cultural values, beliefs, world view, and practices of the patient, and aware that cultural differences between patients and health care providers or other service providers must be proactively addressed to ensure that patients receive equitable, high-quality services that meet their needs.

(b) "Department" means the Mississippi Department of Human Services.

SECTION 3. Establishment of Grant Program. The department shall establish and administer a Maternal Care Access Grant Program to award competitive grants to eligible entities to establish or expand programs for the prevention of maternal mortality and severe maternal morbidity among black women. The department shall establish eligibility requirements for program participation that shall, at a minimum, require that applicants be community based organizations offering programs and resources aligned with evidence based practices for improving maternal health outcomes for black women.

SECTION 4. Outreach and Application Assistance. Beginning July 1, 2027, the department shall (a) conduct outreach to encourage eligible applicants to apply for grants under this program and (b) provide application assistance to eligible applicants on best practices for applying for grants under this program. In conducting the outreach required by this section, the department shall give special consideration to eligible applicants that meet the following criteria:

(i) Are based in, and provide support for, communities with high rates of adverse maternal health outcomes and significant racial and ethnic disparities in maternal health outcomes.

(ii) Are led by black women.

(iii) Offer programs and resources that are aligned with evidence based practices for improving maternal health outcomes for black women.

SECTION 5. Grant Awards. In awarding grants under this section, the department shall, to the extent possible, award grants to recipients to reflect different areas of the state. The department shall not award a single grant for less than Ten Thousand Dollars ($10,000) or more than Fifty Thousand Dollars ($50,000) per grant recipient. In selecting grant recipients, the department shall give special consideration to eligible applicants that meet all of the following criteria:

(a) Meet all of the criteria specified in Section 4 of this act.

(b) Offer programs and resources designed in consultation with and intended for black women.

(c) Offer programs and resources in the communities in which they are located that include any of the following activities:

(i) Promoting maternal mental health and maternal substance use disorder treatments that are aligned with evidence based practices for improving maternal mental health outcomes for black women.

(ii) Addressing social determinants of health for women in the prenatal and postpartum periods, including, but not limited to, any of the following:

1. Inadequate housing.

2. Transportation barriers.

3. Poor nutrition and a lack of access to healthy foods.

4. Need for lactation support.

5. Need for lead abatement and other efforts to improve air and water quality.

6. Lack of access to child care.

7. Need for baby supplies such as diapers, formula, clothing, baby and child equipment, and safe car seat installation.

8. Need for wellness and stress management programs.

9. Education about maternal health and well being.

10. Need for coordination across safety net and social support services and programs.

11. Barriers to employment.

(iii) Promoting evidence based health literacy and pregnancy, childbirth, and parenting education for women in the prenatal and postpartum periods, including group based programs and peer support groups.

(iv) Providing individually tailored support from doulas and other perinatal health workers to women from pregnancy through the postpartum period.

(v) Providing culturally respectful congruent training to perinatal health workers such as doulas, community health workers, peer supporters, certified lactation consultants, nutritionists and dietitians, social workers, home visitors, and navigators.

(vi) Conducting or supporting research on issues affecting black maternal health.

(vii) Developing other programs and resources that address community specific needs for women in the prenatal and postpartum periods and are aligned with evidence based practices for improving maternal health outcomes for black women.

SECTION 6. Technical Assistance to Grant Recipients. The department shall provide technical assistance to grant recipients regarding all of the following:

(a) Capacity building to establish or expand programs to prevent adverse maternal health outcomes among black women.

(b) Best practices in data collection, measurement, evaluation, and reporting.

(c) Planning centered around sustaining programs implemented with grant funds to prevent maternal mortality and severe maternal morbidity among black women when the grant funds have been expended.

PART II. IMPLICIT BIAS IN HEALTH CARE

SECTION 7. Department to establish implicit bias training program for health care professionals engaged in perinatal care. (1) The following definitions apply in Part II:

(a) "Health care professional" means a licensed physician or other health care provider licensed, registered, accredited, or certified to perform perinatal care and regulated under the authority of a health care professional licensing authority.

(b) "Health care professional licensing authority" means the State Department of Health or an agency, board, council, or committee with the authority to impose training or education requirements or licensure fees as a condition of practicing in this state as a health care professional.

(c) "Implicit bias" means a bias in judgment or behavior that results from subtle cognitive processes, including implicit prejudice and implicit stereotypes, that often operate at a level below conscious awareness and without intentional control.

(d) "Implicit prejudice" means prejudicial negative feelings or beliefs about a group that a person holds without being aware of them.

(e) "Implicit stereotypes" means the unconscious attributions of particular qualities to a member of a certain social group that are influenced by experience and based on learned associations between various qualities and social categories, including race and gender.

(f) "Perinatal care" means the provision of care during pregnancy, labor, delivery, and postpartum and neonatal periods.

(g) "Perinatal facility" means a hospital, clinic, or birthing center that provides perinatal care in this state.

(2) The department, in collaboration with (a) community based organizations led by black women that serve primarily black birthing people and (b) a historically black college or university or other institution that primarily serves minority populations, shall create or identify an evidence based implicit bias training program for health care professionals involved in perinatal care. The implicit bias training program shall include, at a minimum, all of the following components:

(i) Identification of previous or current unconscious biases and misinformation.

(ii) Identification of personal, interpersonal, institutional, structural, and cultural barriers to inclusion.

(iii) Corrective measures to decrease implicit bias at the interpersonal and institutional levels, including ongoing policies and practices for that purpose.

(iv) Information about the effects of implicit bias, including, but not limited to, ongoing personal effects of racism and the historical and contemporary exclusion and oppression of minority communities.

(v) Information about cultural identity across racial or ethnic groups.

(vi) Information about how to communicate more effectively across identities, including racial, ethnic, religious, and gender identities.

(vii) Information about power dynamics and organizational decision making.

(viii) Trauma informed care best practices and an emphasis on shared decision making between providers and patients.

(ix) Information about health inequities within the perinatal care field, including information on how implicit bias impacts maternal and infant health outcomes.

(x) Perspectives of diverse, local constituency groups and experts on particular racial, identity, cultural, and provider community relations issues in the community.

(xi) Information about socioeconomic bias.

(xii) Information about reproductive justice.

(3) Notwithstanding any other provision of law to the contrary, all health care professionals are required to complete the implicit bias training program established under this section as follows:

(a) Health care professionals who hold a current license, registration, accreditation, or certification on December 31, 2026, shall complete the training program no later than December 31, 2027.

(b) Health care professionals issued an initial license, registration, accreditation, or certification on or after January 1, 2027, shall complete the training program no later than one (1) year after the date of issuance.

A health care professional licensing authority shall not renew the license, registration, accreditation, or certification of a health care professional unless the health care professional

provides proof of completion of the training program established under this section within the twenty four month period leading up to the date of the renewal application.

(4) The department is encouraged to seek opportunities to make the implicit bias training program established under this section available to all health care professionals and to promote its use among the following groups:

(a) All maternity care providers and any employees who interact with pregnant and postpartum individuals in the provider setting, including front desk employees, sonographers, schedulers, health system employed lactation consultants, hospital or health system administrators, security staff, and other employees.

(b) Undergraduate programs that funnel into health professions schools.

(c) Providers of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) under Section 17 of the Child Nutrition Act of 1966.

(d) Obstetric emergency simulation trainings or related trainings.

(e) Emergency department employees, emergency medical technicians, and other specialized health care providers who interact with pregnant and postpartum individuals.

(5) The department shall collect the following information for the purpose of informing ongoing improvements to the implicit bias training program:

(a) Data on the causes of maternal mortality.

(b) Rates of maternal mortality, including rates distinguished by age, race, ethnicity, socioeconomic status, and geographic location within this state.

SECTION 8. Rights of perinatal care patients. (1) A patient receiving care at a perinatal care facility, defined as a hospital, clinic, or birthing center that provides perinatal care in this state, has the following rights:

(i) To be informed of continuing health care requirements following discharge.

(ii) To be informed that, if the patient so authorizes, and to the extent permitted by law, the hospital or health care facility may provide to a friend or family member information about the patient's continuing health care requirements following discharge.

(iii) To actively participate in decisions regarding the patient's medical care and the right to refuse treatment.

(iv) To receive appropriate pain assessment and treatment.

(v) To receive care and treatment free from discrimination on the basis of age, race, ethnicity, color, religion, ancestry, disability, medical condition, genetic information, marital status, sex, gender identity, gender expression, sexual orientation, socioeconomic status, citizenship, nationality, immigration status, primary language, or language proficiency.

(vi) To receive information on how to file a complaint with the Division of Health Facilities Licensure of the State Department of Health about any violation of these rights.

(2) Each perinatal care facility shall provide to each perinatal care patient upon admission to the facility, or as soon as reasonably practical following admission to the facility, a written copy of the rights enumerated in subsection (1) of this section. The facility may provide this information to the patient by electronic means, and it may be provided with other notices regarding patient rights."

PART III. SUPPORTING AND DIVERSIFYING LACTATION CONSULTANT

TRAINING PROGRAMS

SECTION 9. (1) The following definitions apply in Part III:

(a) "Historically Black Colleges and Universities" or "HBCUs" means institutions of higher education that were founded to educate black citizens who were historically restricted from attending predominantly white institutions of higher education.

(b) "Lactation consultants" means educators or counselors trained in breast feeding or chest feeding practices, lactation care, and lactation services.

(c) "Lactation services" means the clinical application of scientific principles and a multidisciplinary body of evidence for evaluation, problem identification, treatment, education, and consultation to childbearing families regarding lactation care and services.

(d) "Maternity care services" means health care related to an individual's pregnancy, childbirth, or postpartum recovery.

(e) "Preceptor" means a person who is a certified lactation consultant and meets the requirements of the International Board of Lactation Consultant Examiners to supervise lactation consultants in training during the training period.

SECTION 10. The State Department of Health shall provide technical assistance to Jackson State University, Alcorn State University, Mississippi Valley State University, Tougaloo College and Rust College with respect to the following:

(a) Developing culturally appropriate training content for the lactation consultant training programs funded by state appropriations.

(b) Recruiting persons from historically marginalized populations to enroll in the lactation consultant training programs offered at these universities and colleges.

(c) Recruiting historically underutilized providers to serve as teachers and preceptors in the lactation consultant training programs offered at these universities and colleges.

(d) Identifying rural and medically underserved areas of the state experiencing a shortage of lactation consultants in order to recruit program graduates to work in these areas.

PART IV. PERINATAL EDUCATION GRANT PROGRAM

SECTION 11. Definitions. The following definitions apply in Part IV:

(a) "Department" means the State Department of Health.

(b) "Perinatal education program" means a program that operates for the primary purpose of educating pregnant women and their families about healthy pregnancy, preparation for labor and birth, breast feeding, newborn care, or any combination of these.

SECTION 12. Establishment of Grant Program. The department shall establish and administer a Perinatal Education Grant Program to award competitive grants to eligible entities to establish or expand perinatal education programs in rural, underserved, or low wealth areas of the state. The department shall establish eligibility requirements for program participation, which shall, at a minimum, require that applicants be community-based organizations that offer perinatal education and resources aligned with evidence based practices for improving maternal health outcomes for black women.

SECTION 13. Outreach and Application Assistance. Beginning September 1, 2027, the department shall (a) conduct outreach to encourage eligible applicants to apply for grants under this program and (b) provide application assistance to eligible applicants on best practices for applying for grants under this program. In conducting the outreach required by this section, the department shall give special consideration to eligible applicants that meet the following criteria:

(i) Are based in, and provide support for, communities with high rates of adverse maternal health outcomes and significant racial and ethnic disparities in maternal health outcomes.

(ii) Are led by black women.

(iii) Offer programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for black women.

SECTION 14. Grant Awards. In awarding grants under this section, to the extent possible, the grant recipients shall reflect different areas of the state. The department shall not award a single grant for less than Ten Thousand Dollars ($10,000.00) or more than Fifty Thousand Dollars ($50,000.00) per grant recipient.

PART V. MOMNIBUS INITIATIVE

SECTION 15. The Legislature shall appropriate to the State Department of Health the sum of Six Million Five Hundred Thousand Dollars ($6,500,000.00) for each of the next two (2) fiscal years to create a Momnibus Initiative. The purpose of the Momnibus Initiative is to fund efforts to expand access to maternal and infant health care and parenting programs, supports, and services to families residing in geographic areas of the state where there is limited or no access to maternity care services, including obstetric providers, a hospital or birth center, prenatal care, or postpartum care. As part of this initiative, the department shall allocate and use the funds appropriated for the initiative to award directed grants on a competitive basis to nonprofit, community based, and faith based organizations that offer programs, supports, and services aligned with evidence based practices for a healthy pregnancy through the postpartum period, infant health and care, and parenting programs, supports, and services. The department shall establish an application process and eligibility criteria for awarding the grants authorized under this section.

PART VI. MEDICAID COVERAGE OF MATERNAL HEALTH SERVICES

SECTION 16. Depression screening for pregnant women. The Mississippi Medicaid Program shall reimburse for depression screening of a pregnant woman. The Division of Medicaid shall apply for any federal waiver, Medicaid state plan amendments, or other authority necessary to implement this section.

SECTION 17. Coverage of prenatal, delivery, and postpartum services. The Mississippi Medicaid Program shall reimburse for prenatal, delivery, and postpartum services separately in lieu of a global payment or an all inclusive payment methodology for maternity services. Prenatal, delivery, and postpartum services include, without limitation:

(a) Office visits;

(b) Laboratory fees;

(d) Blood work;

(e) Remote monitoring;

(f) Fetal nonstress tests; and

(g) Continuous glucose monitors or other services for gestational diabetes when medically necessary.

SECTION 18. Blood pressure monitoring for pregnant and postpartum women. The Mississippi Medicaid Program shall provide coverage and reimbursement for self measurement blood pressure monitoring services for pregnant women and postpartum women. Self measurement blood pressure monitoring services shall include:

(a) Validated blood pressure monitoring devices, such as a blood pressure cuff and replacement cuffs, as medically necessary, to diagnose or treat hypertension;

(b) Patient education and training on the setup and use of a self measurement blood pressure measurement device that is validated for clinical accuracy, device calibration, and the procedure for obtaining self measurement readings; and

(c) Collection of data reports by the patient or caregiver for submission to a health care provider to communicate blood pressure readings and create or modify treatment plans.

SECTION 19. Reimbursement for remote ultrasound procedures. (1) The Mississippi Medicaid Program shall reimburse for medically necessary remote ultrasound procedures utilizing established Current Procedural Terminology (CPT) codes for remote ultrasound procedures when the patient is in a residence or other off site location from the health care provider of the patient and the same standard of care is met. This subsection shall apply to the fee for service categories of the program and the managed care plan within the program.

(2) A remote ultrasound procedure shall be reimbursable when the health care provider uses digital technology that:

(a) Collects medical and other forms of health data from a patient and electronically transmits the information securely to a health care provider in a different location for interpretation and recommendation;

(b) Is compliant with the Health Insurance Portability and Accountability Act of 1996, 42 USC Section 1320d et seq., as it existed on July 1, 2026; and

Administration.

SECTION 20. Coverage for certain services provided by doulas. The Mississippi Medicaid Program shall reimburse doulas for home visitation related to prenatal care and postpartum care.

SECTION 21. Implementation and rules. The Division of Medicaid shall:

(a) Apply for any federal waiver, Medicaid state plan amendments, or other authority necessary to implement this Part; and

(b) Adopt rules as necessary to implement this Part.

PART VII COMPREHENSIVE AND EQUITABLE MATERNAL HEALTH CARE

SECTION 22. (1) As used in this section, the term:

(a) "Distant site" means a site at which an obstetric provider is located while providing health care services by means of telemedicine, which may include the home of such

obstetric provider.

(b) "Limited maternity care county" means a county in this state that has fewer than two (2) hospitals or birth centers offering obstetric care or fewer than sixty (60) obstetric providers per ten thousand (10,000) births.

(c) "Maternity care desert" means a county in this state that does not have a hospital or birth center offering obstetric care or an obstetric provider.

(d) "Obstetric provider" means a licensed physician or advanced practice registered nurse who is licensed to practice obstetrics and gynecology in this state.

(e) "Telemedicine" means the use of electronic information and telecommunications technologies that include, at minimum, audio and video equipment to enable two way, real-time interactive communication between a patient and an obstetric provider at a distant site, which services are compliant with federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy, security, and breach notification rules. Such term shall include audio-only, telephone communication only when two-way, real-time audio-visual communication is unavailable to or inaccessible by the patient or is infeasible, impractical, or otherwise not medically advisable, as determined by the obstetric provider providing telemedicine services to the patient.

(f) "Virtual prenatal care" means at home prenatal health care for a pregnant woman provided by an obstetric provider facilitated through the use of telemedicine and home monitoring devices or other equipment, as deemed appropriate by such obstetric provider. Such term includes consultations and monitoring, including, but not limited to, monitoring for conditions such as diabetes and hypertension; mental health evaluations; nutritional evaluations; and guidance on personal care.

(2) The State Department of Health shall develop, implement, and conduct a three-year pilot program to provide virtual prenatal care to pregnant women in limited maternity care counties and maternity care deserts to improve birth outcomes and to decrease maternal morbidity and mortality. The pilot program shall begin on July 1, 2027, and shall provide up to five (5) virtual prenatal care visits for each eligible pregnant woman. Such eligibility shall be established based on criteria, terms, and conditions as determined by the department.

(3) This section shall be contingent upon appropriations made by the Legislature specifically for the department for the purposes set forth in this section.

SECTION 23. (1) For purposes of this section, the term:

(a) "Limited maternity care county" means a county in this state that has fewer than two (2) hospitals or birth centers offering obstetric care or fewer than sixty (60) obstetric providers per ten thousand (10,0000) births.

(b) "Maternity care desert" means a county in this state that does not have a hospital or birth center offering obstetric care or an obstetric provider.

(c) "Obstetric provider" means a physician or advanced practice registered nurse licensed to practice obstetrics and gynecology in this state.

(d) "Postpartum care" means healthcare for a woman for a period of one year following a birth, miscarriage, stillbirth, or neonatal death. Such term includes physiological assessments, mental health evaluations, nutritional evaluations, and guidance on personal and newborn care. Such term includes at least four (4) visits with an obstetric provider as follows:

(i) An initial visit within twenty four (24) hours of a birth, miscarriage, stillbirth, or neonatal death;

(ii) A follow-up visit within the first three (3) weeks postpartum;

(iii) A follow-up visit within the first eight (8) weeks postpartum;

(iv) A comprehensive visit no later than twelve (12) weeks postpartum; and

(v) Intermediary and ongoing care as needed.

(2) The State Department of Health shall develop, implement, and conduct a three year pilot program for the purpose of providing postpartum care through mobile health clinics in limited maternity care counties and maternity care deserts, beginning on July 1, 2027. The department shall establish eligibility criteria, terms, and conditions for such pilot program.

(3) This section shall be contingent upon appropriations made by the Legislature specifically for the department for the purposes set forth in this section.

SECTION 24. (1) As used in this section, the term:

(a) "Eligible participant" means a pregnant or postpartum woman who meets the income eligibility guidelines set forth by the Mississippi WIC (Women, Infants, and Children) program, as of July 1, 2027.

(b) "Group prenatal care" means a structured class designed for pregnant women provided in a supportive group setting and based on an evidence-based model that is focused on equipping pregnant women with essential prenatal knowledge and skills, including, but not limited to, labor and delivery preparation, breastfeeding, lactation, and newborn care.

(c) "Group postpartum care" means a structured class designed for postpartum women provided in a supportive group setting focused on equipping such women with essential knowledge and skills for the postpartum period, including, but not limited to, physical recovery, nutrition, emotional well-being, maternal mental health, newborn care, and lactation support. With respect to postpartum women separated from their newborns due to child welfare intervention or any other cause, such term includes counseling sessions and any consultative sessions related to providing reunification assistance.

(d) "Postpartum woman" means a woman up to twelve (12) months after the end of a pregnancy.

(2) Subject to available funding, the State Department of Health shall develop, implement, and conduct a program to provide group prenatal care and group postpartum care to eligible participants, whether in-person or online. Such program shall begin on July 1, 2027, and shall provide up to five (5) group prenatal care visits and up to five (5) group postpartum care visits for each eligible participant at no cost to such participant.

(3) Any person providing group prenatal care or group postpartum care under the program shall have completed the appropriate training, as determined by the department.

SECTION 25. (1) As used in this section, the term:

(a) "Health care professional" means a physician or other health care practitioner licensed, accredited, or certified to perform specified physical, mental, or behavioral health care services consistent with his or her scope of practice under the laws of this state.

(b) "Implicit bias" means a bias in judgment or behavior that results from subtle cognitive processes, including implicit prejudice and implicit stereotypes that often operate at a level below conscious awareness and without intentional control.

(c) "Implicit prejudice" means prejudicial negative feelings or beliefs about a group that a person holds without being aware of them.

(d) "Implicit stereotypes" means the unconscious attributions of particular qualities to a member of a certain social group. Implicit stereotypes are influenced by experience and are based on learned associations between various qualities and social categories, including race or gender.

(e) "Perinatal care" means the provision of care during pregnancy, labor, delivery, and postpartum and neonatal periods.

(f) "Perinatal facility" means a hospital, clinic, or birthing center that provides perinatal care.

(g) "Pregnancy related death" means the death of a woman while pregnant or within three hundred sixty five (365) days of the end of a pregnancy, irrespective of the duration or site of the pregnancy, from any cause related to, or aggravated by, the pregnancy or its management, but not from accidental or incidental causes.

(2) Every perinatal facility in this state shall implement an evidence-based implicit bias program for all health care professionals involved in the perinatal care of patients within

such facility.

(3) An implicit bias program implemented pursuant to subsection (b) of this section shall include:

(a) Identification of previous or current unconscious biases and misinformation;

(b) Identification of personal, interpersonal, institutional, structural, and cultural barriers to inclusion;

(c) Corrective measures to decrease implicit bias at the interpersonal and institutional levels, including ongoing policies and practices for that purpose;

(d) Information on the effects, including, but not limited to, ongoing personal effects, of historical and contemporary exclusion and oppression of minority communities;

(e) Information about cultural identity across racial or ethnic groups;

(f) Information relative to communicating more effectively across identities, including racial, ethnic, religious, and gender identities;

(g) Discussion on power dynamics and organizational decision making;

(h) Discussion on health inequities within the perinatal care field, including information on how implicit bias impacts maternal and infant health outcomes;

(i) Perspectives of diverse, local constituency groups and experts on particular racial, identity, cultural, and provider-community relations issues in the community; and

(j) Information on reproductive justice.

(4) (a) A health care professional shall complete initial basic training through the implicit bias program based on the components described in subsection (3) of this section.

(b) Upon completion of the initial basic training, a health care professional shall complete a refresher course under the implicit bias program every two years thereafter, or on a more frequent basis if deemed necessary by the perinatal facility, in order to keep current with changing racial, identity, and cultural trends and best practices in decreasing interpersonal and institutional implicit bias.

(5) Each perinatal facility in this state shall provide a certificate of training completion to another perinatal facility or a training attendee upon request. A perinatal facility may accept a certificate of completion from another perinatal facility to satisfy the training requirement provided for in this section from a health care professional who works in more than one (1) perinatal facility.

(6) If a health care professional involved in the perinatal care of patients is not directly employed by a perinatal facility, the facility shall offer the training to such health care professional.

SECTION 26. (1) As used in this section, the term "maternal near miss" means a woman who survived a near death complication occurring during a pregnancy, during childbirth, or within forty-two (42) days of the end of a pregnancy.

(2) The State Department of Health shall create a comprehensive public awareness campaign targeting women located in rural and underserved communities to increase awareness about maternal health by developing and making available on the department's website educational materials and support resources. Such materials and resources shall include, but shall not be limited to:

(a) Information on prenatal care, including, but not limited to, nutrition, the importance of prenatal care visits, what to expect during such visits, and key prenatal screenings;

(b) Information on common causes of maternal

near-misses and strategies to reduce the risk of severe maternal morbidity;

(d) A geographically indexed guide on government funded, free, and low-cost services available to support pregnant and postpartum women, including, but not limited to, health care services, educational classes and peer support groups for prenatal and postpartum care, mental health counseling services, transportation assistance programs, and food assistance programs which shall include a description of the services offered and contact information.

(3) The department shall maintain a comprehensive webpage on its website dedicated to maternal health that includes all educational materials and support resources identified or

created pursuant to this section.

SECTION 27. As used in Sections 27 through 30 of this act, the term:

(a) "Advisory committee" or "committee" means the Regional Perinatal Center Advisory Committee established pursuant to Section 28 of this act.

(b) "Regional perinatal center" means a specially qualified hospital identified by the State Department of Health and designated to a specific geographic region to lead collaboration between hospitals and providers to increase the likelihood that deliveries are performed in a hospital with an appropriate level of care for mothers and infants.

SECTION 28. (1) There is established the Regional Perinatal Center Advisory Committee for the purpose of considering and making recommendations to the State Department of Health concerning the addition, reduction, or transition of regional perinatal centers in this state. The committee shall advise the commissioner on the estimated costs to the department necessary to implement such recommendations.

(2) The Regional Perinatal Center Advisory Committee shall be composed of not less than eleven (11) nor more than twenty one (21) members to be appointed by the State Health Officer, who shall appoint one (1) of such members to serve as chairperson. All appointments to the committee shall be for a term of four (4) years. A member shall serve until his or her successor has been duly appointed. The State Health Officer may reappoint any member.

(3) The advisory committee shall meet upon the call of the chairperson.

(4) Beginning on July 1, 2027, and every four (4) years thereafter, the advisory committee shall assess and make recommendations to the State Health Officer on the adequacy of the regional perinatal system and consider hospital or labor and delivery closures. Such assessment shall evaluate whether:

(a) Perinatal facilities in each region are equipped and prepared to stabilize infants and mothers before transport;

(b) Coordination exists between maternity care in each region and regional perinatal centers;

(c) All identified high risk pregnancies and deliveries are promptly evaluated in consultation with regional perinatal centers and referred to the appropriate designated regional perinatal center for the proper management and treatment of such conditions as needed;

(d) An adequate transport system is available in the region for the transfer of high risk mothers and infants and specifically considers:

(i) The distance and travel time between referring hospitals and regional perinatal centers;

(ii) The types of vehicles used for transport and whether a need exists for additional vehicles; and

(iii) The need for upgraded vehicles and transport equipment; and

(e) Each regional perinatal center provides:

(i) Consultation for patients requiring special services, including transport;

(ii) Coordination and assurance of follow up medical care for maternal and neonatal patients requiring special services;

(iii) Educational support to ensure quality care in institutions involved in perinatal health care in the region;

(iv) An annual education plan with all birthing centers in the region;

(v) Compilation and analysis of perinatal data from the center and referring hospitals; and

(vi) Coordination of perinatal health services within the region.

SECTION 29. To be designated as a regional perinatal center a hospital shall notify the State Department of Health of the following:

(a) Such hospital's ability to meet the standards for regional perinatal centers;

(b) Any additional funding necessary to bring such hospital up to the standards for regional perinatal centers;

limited to, transportation, shortage of facilities, and personnel;

(d) A description of perinatal care currently being provided;

(e) A description of services that can be provided by the center in patient care, education, and consultation to hospitals within the perinatal region; and

(f) Any other information requested by the department.

SECTION 30. Beginning on July 1, 2027, and every four (4) years thereafter, the State Department of Health shall present to the Governor, the Lieutenant Governor and the Speaker of the House of Representatives a plan for the designated perinatal centers in every region of the state. Such plan shall include funding considerations to aid hospitals in meeting the standards and for continuing requirements, including, but not limited to, patient care, professional education, training programs, and physical facilities.

SECTION 31. (1) As used in this section, the term:

(a) "Maternal mental health screening" means the use of an independent, evidence-based screening instrument that is in accordance with nationally recognized clinical practice guidelines developed by independent organizations or medical professional societies using a transparent methodology and reporting structure and with a conflict of interest policy. Such guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

(b) "Mental health care provider" means any person licensed under Title 73, Mississippi Code of 1972, to provide

prenatal, labor and delivery, or postpartum care, including without limitation physicians, psychiatrists, psychologists, advanced practice registered nurses, physician assistants, licensed clinical social workers, and licensed professional counselors and marriage and family therapists.

(c) "Telehealth services" means services provided via two way, real time interactive communication between a patient and a mental healthcare provider at a distant site through telecommunications equipment, which services are compliant with federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy, security, and breach notification rules.

(2) Each health benefit policy issued, delivered, or renewed in this state shall provide coverage for medically necessary:

(a) Maternal mental health screening during the prenatal period and twelve (12) months postpartum; and

(b) Care and treatment for those screenings positive for maternal mental health conditions.

(3) All services provided for in this section shall be covered whether provided in person or through telehealth services.

(4) The provisions of this section shall apply to all policies, contracts, and certificates executed, delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2027.

SECTION 32. (1) Except in cases where the woman refuses a maternal mental health screening, a pregnant or postpartum woman seeking health care from a physician or other health care provider shall be screened for perinatal mood and anxiety disorders, as determined necessary:

(a) At the pregnant woman's first prenatal visit;

(b) When the pregnant woman is from twenty-eight (28) through thirty-two (32) weeks gestation;

(d) At the woman's six week postpartum obstetrical visit;

(e) If there is a pregnancy loss and at the follow up obstetric visit after such loss; and

(f) At a pediatric visit occurring when the infant is three (3) months of age or, if there is no such visit, at the postpartum woman's health care visit any time from three (3) months to one (1) year after pregnancy loss or delivery.

(2) The right to refuse the mental health screening described in subsection (1) of this section shall not exist for a patient determined by the physician or other health care provider to be mentally incompetent.

(3) (a) The maternal mental health screening provided for in subsection (1) of this section shall be conducted by the physician or other health care provider who is providing prenatal, obstetric, or postpartum care of the pregnant woman or pediatric care of the woman's infant, as deemed necessary by such physician or health care provider. Each such screening shall use questionnaires that conform with nationally recognized clinical practice guidelines and shall be used for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of a woman's mental health, well being, disease, or condition as supported by medical and scientific evidence.

(b) Additional maternal mental health screenings, which may be refused, may be conducted at any other point during the pregnancy or the postpartum period as deemed necessary by the physician or other healthcare provider. Appropriate referral information and resources addressing perinatal mood or anxiety disorders shall be provided during such screenings.

(4) A physician or other health care provider who provides obstetric or pediatric care shall provide educational materials through electronic or other means on the signs and symptoms of perinatal mood and anxiety disorders to pregnant and postpartum women under his or her care, or to mothers of children under his or her care, as deemed necessary by such physician or health care provider.

(5) The provisions of this section shall not preclude any other health care provider acting within his or her scope of practice from screening for maternal mental health conditions or from providing referral information and resources or educational materials on perinatal mood and anxiety disorders.

(6) Relative to maternal mental health screenings, the department shall establish a comprehensive quality metrics program that includes:

(a) Process measures, including, but not limited to:

(i) Percentage of eligible patients screened at each required interval;

(ii) Time from positive screen to first behavioral health contact;

(iii) Completion rates for referrals to behavioral health services; and

(iv) Utilization rates of telehealth services;

(b) Outcome measures, including, but not limited to:

(i) Rates of postpartum depression and anxiety identification;

(ii) Emergency department utilization for mental health concerns;

(iii) Psychiatric hospitalization rates; and

(iv) Duration of treatment engagement;

(i) Screening and treatment rates stratified by race, ethnicity, and geographic location;

and

(ii) Disparities in access to care and outcomes; and

(d) Patient experience measures, including, but not limited to:

(i) Satisfaction with screening process;

(ii) Perceived barriers to care; and

(iii) Experiences with telehealth services.

(7) No later than July 1, 2027, the State Department of Health shall establish a three-year pilot program for remote maternal mental health screening and monitoring. Such program shall:

(a) Prioritize high risk populations and rural communities;

(b) Include telehealth services;

(d) Collect data on program effectiveness and barriers to care.

(8) The department may allocate sufficient funds for the pilot program provided for in subsection (7) of this section to support:

(a) Technology infrastructure and support;

(b) Provider training and technical assistance; and

(9) The department shall:

(a) Promulgate rules and regulations necessary to implement this section; and

(b) Establish a process for monitoring compliance.

(10) To implement the provisions of this section, the Division of Medicaid shall, when necessary, submit a Medicaid state plan amendment or waiver request to the United States Department of Health and Human Services.

SECTION 33. (1) It is the intent of the Legislature to advance maternal health outcomes by recognizing doula care as part of the maternal health care workforce. Doula care has been associated with Medicaid cost savings of around One Thousand Dollars ($1,000.00) per birth, a decreased likelihood of cesarean delivery, a reduced need for an epidural during labor, lower preterm birth rates, improved rates of breastfeeding, shorter births, reduced rates of perinatal mood and anxiety disorders, increased positive feelings about the birth experience, and feelings of empowerment about individual pregnancy outcomes.

(2) As used in this section, the term "doula" means a professional who provides physical, emotional, and informational support to clients before, during, and after childbirth to help them achieve a healthy and satisfying birth experience and who has completed the appropriate training, as determined by the State Department of Health.

(3) The Division of Medicaid shall develop, implement, and conduct a one-year pilot program to provide Medicaid coverage for doula care for pregnant Medicaid recipients. Beginning on July 1, 2027, such pilot program may provide reimbursement for up to five (5) doula visits for each pregnant Medicaid recipient, which may include visits for prepartum care, labor and delivery, and postpartum care.

(4) This section shall be contingent upon appropriations made by the Legislature specifically for the purposes set forth in this section.

PART VIII. SOCIAL DETERMINANTS IN MATERNAL HEALTH

SECTION 34. The State Department of Health, shall, to the extent that state funds are available for such purpose, expand the Mississippi WIC (Women, Infants, and Children) program, established in accordance with Section 17 of the Child Nutrition Act of 1966, 42 USC Section 1786, to cover children who have had their fifth birthday but have not yet attained their sixth birthday.

SECTION 35. As used in Sections 35 through 38 of this act, the term:

(a) "Early childhood services program" means a program that offers services designed to support the development and well being of infants and toddlers, including, but not limited to, early intervention, early learning, child care, or parenting education.

(b) "Early intervention" means services and support for infants and toddlers with developmental delays, chronic health conditions, and disabilities and their families. Such term includes early identification and screening of infants and toddlers for such developmental delays, conditions, and disabilities.

(d) "Essential support services program" means a program that offers housing assistance, food assistance, or nonemergency medical transportation services to pregnant and postpartum women in this state.

(e) "Grant program" means the Supporting Healthy Moms Grant Program established pursuant to Section 36 of this act.

(f) "Infant" or "toddler" means a child under three (3) years of age.

(g) "Parenting education" means courses designed for parents of infants and toddlers to enhance parenting skills and knowledge taught by educators possessing the appropriate qualifications, certifications, experience, as determined by the department.

(h) "Postpartum woman" means a woman up to one (1) year after the end of pregnancy.

(i) "Qualified sponsor" means a nonprofit organization incorporated in this state with a tax exempt status pursuant to Section 501(c)(3) of the Internal Revenue Code of 1986;

or governmental sponsor of a program that meets the conditions of this section.

SECTION 36. (1) Subject to available funding, the State Department of Health shall establish the Supporting Healthy Moms Grant Program to provide grant funding, on an annual basis, to qualified sponsors of eligible programs in this state that provide services focused on advancing and addressing social determinants of maternal health and that provide early childhood services.

(2) The department shall oversee the grant program and is authorized to contract with an external organization to implement and administer such grant program.

SECTION 37. To be considered for a grant under the grant program, a qualified organization shall:

(a) Have a primary mission of advancing maternal health, addressing social determinants of maternal health, or providing early childhood services;

(b) Have a system of financial accountability consistent with generally accepted accounting principles, including an annual budget;

(c) With respect to a nonprofit organization, have a board that hires and supervises a director who manages the organization's operations;

(d) Have provided services under an eligible program for a minimum of one (1) year;

(e) Provide free services under an eligible program; and

(f) Maintain confidentiality of all data, files, and records of clients related to the services provided and in compliance with state and federal laws.

SECTION 38. (1) The department shall approve each grant or expenditure of money from the grant program.

(2) The department's decision on the granting of funds from the grant program to qualified sponsors shall be based on a competitive selection process.

(3) The grant program may be used for expenditures related to the routine administration of the program; however, in any given year, expenditures for the routine administration of the grant program may not exceed ten percent (10%) of the total amount of money available in the grant fund.

SECTION 39. As used in Sections 39 through 43 of this act, the term:

(a) "Employer" means any person or entity that employs one or more employees and includes the state and its political subdivisions.

(b) "Pregnancy" means medical needs arising from pregnancy, childbirth, or related conditions, including, but not limited to, lactation.

(c) "Reasonable accommodations" includes, but is not limited to, more frequent or longer breaks, time off to recover from childbirth, acquisition or modification of equipment, seating, temporary transfer to a less strenuous or hazardous position, job restructuring, light duty, break time and private nonbathroom space for expressing breast milk, assistance with manual labor, or modified work schedules.

(d) "Undue hardship" means an action requiring significant difficulty or expense, when considered in light of the factors set forth in Section 42 of this act.

SECTION 40. (1) It shall constitute an unfair employment practice for an employer, unless such employer

can demonstrate that an undue hardship on such employer's program, enterprise, or business would result, to:

(a) Fail or refuse to make a reasonable accommodation to a job applicant or employee for circumstances related to pregnancy, if such job applicant or employee so requests;

(b) Take adverse action against a job applicant or an employee who requests or uses an accommodation;

(c) Deny employment opportunities to a job applicant or employee, if such denial is based on the need of the employer to make reasonable accommodations to such job applicant or employee for circumstances related to pregnancy;

(d) Require a job applicant or employee affected by pregnancy to accept an accommodation that such job applicant or employee chooses not to accept;

(e) Require an employee to take leave if another reasonable accommodation can be provided to such employee for circumstances related to pregnancy;

(f) Count an absence related to pregnancy against an employee under a no fault attendance policy; or

(g) Fail to reinstate such employee to such employee's original job or to an equivalent position with equivalent pay and accumulated seniority, retirement, fringe benefits, and

other applicable service credits when such employee's need for reasonable accommodations ceases.

(2) The employer shall in good faith engage in a timely and interactive process with the job applicant or employee to determine effective reasonable accommodations.

(3) (a) An employer shall provide written notice of the right to be free from discrimination in relation to pregnancy to:

(i) New employees at the commencement of employment;

(ii) Existing employees within one hundred twenty (120) days after the effective date of this act; and

(iii) Any employee who notifies such employer of her pregnancy within ten days of such notification.

(b) Such notice shall be conspicuously posted at an employer's place of business in an area accessible to employees and shall be available in English and other languages commonly spoken in such employer's place of business.

SECTION 41. The employer shall have the burden of proving undue hardship. In making a determination of undue hardship, the factors that may be considered include, but shall not be limited to:

(a) The nature and cost of the accommodation;

(b) The overall financial resources of the employer, the overall size of the business of the employer with respect to the number of employees, and the number, type, and location of its facilities; and

(c) The effect on expenses and resources or the impact otherwise of such accommodation upon the operation of the employer.

SECTION 42. (1) Any individual who is aggrieved by an unfair employment practice against such individual in violation of Sections 39 through 43 of this act may institute a civil action against the persons engaged in such prohibited conduct. Such action may be maintained in any court of competent jurisdiction and shall be commenced no later than one (1) year after the alleged prohibited conduct occurred.

(2) The court may grant as relief, as it deems appropriate, any permanent or temporary injunction, temporary restraining order, or other order, including, but not limited to, the hiring or reinstatement of the plaintiff to such individual's original position or an equivalent position. The court may award to the plaintiff back pay. The court may award court costs and reasonable attorney's fees to the prevailing party.

SECTION 43. Sections 39 through 43 of this act shall not be construed to preempt, limit, diminish, or otherwise affect any other provision of law relating to sex discrimination or pregnancy or in any way to diminish the coverage for pregnancy under any other provision of this title.

PART IX. MATERNAL HEALTH DATA COLLECTION, RESEARCH, AND INNOVATION

SECTION 44. (1) There is established within the State Department of Health a Severe Maternal Morbidity Review Committee to collect and track data on severe maternal morbidity and study and make recommendations on strategies to reduce severe maternal morbidity. The committee shall be multidisciplinary and composed of members as deemed appropriate by the department. The committee may contract with an external organization to assist in collecting, analyzing, and disseminating severe maternal morbidity information, organizing and convening meetings of the committee, and conducting other tasks as may be incident to these activities.

(2) The committee shall, in coordination with the Maternal Mortality Review Committee:

(a) Collect and track medical records and other relevant data on severe maternal morbidity, including, but not limited to, all of the following health conditions:

(i) Obstetric hemorrhage;

(ii) Hypertension;

(iii) Preeclampsia and eclampsia;

(iv) Venous thromboembolism;

(v) Sepsis;

(vi) Cerebrovascular accident; and

(vii) Amniotic fluid embolism;

(b) Collect and track data on pregnancy related deaths, including, but not limited to, deaths relative to the conditions provided in subparagraphs (A) through (G) of paragraph (1) of this subsection, indirect obstetric deaths, and other maternal disorders predominantly related to pregnancy and complications predominantly related to the postpartum period;

(d) Develop and make recommendations regarding reducing severe maternal morbidity;

(e) Disseminate findings and recommendations regarding reducing severe maternal morbidity; and

(f) Not later than July 1, 2027, complete a study on:

(i) Reducing severe maternal morbidity, including, but not limited to, all of the health conditions set forth in subparagraphs (i) through (vii) of paragraph (a) of this subsection; and

(ii) Identifying more effective methods for the early detection of, and interventions for, other pregnancy related medical conditions that can lead to an increased risk of severe maternal morbidity, including, but not limited, to hyperemesis gravidarum.

(3) (a) Health care providers licensed pursuant to Title 73, Mississippi Code of 1972, and health care facilities licensed pursuant to Title 41, Mississippi Code of 1972, shall provide reasonable access to the committee to all relevant medical records associated with a case under review by the committee within thirty (30) days of receiving a request for such records.

(b) A health care provider or health care facility providing access to medical records pursuant to this section shall not be held liable for civil damages or be subject to any criminal or disciplinary action for good faith efforts in providing such

records.

(4) (a) Information, records, reports, statements, notes, memoranda, or other data collected pursuant to this section shall not be admissible as evidence in any action of any kind in any court or before any other tribunal, board, agency, or person. Such information, records, reports, statements, notes, memoranda, or other data shall not be exhibited nor their contents disclosed in any way, in whole or in part, by any officer or representative of the department or any other person, except as may be necessary for the purpose of furthering the review of the committee of the case to which it relates. No person participating in such review shall disclose, in any manner, the information so obtained except in strict conformity with such review.

(b) All information, records, reports, statements, notes, memoranda, or other data obtained by the department, the committee, and other persons, agencies, or organizations so authorized by the department pursuant to this section shall be confidential.

(5) (a) All proceedings and activities of the committee under this section, opinions of members of such committee formed as a result of such proceedings and activities, and records obtained, created, or maintained pursuant to this section, including information, records, reports, statements, notes, memoranda, or other data procured by the department or any other person, agency, or organization acting jointly or under contract with the department in connection with the requirements of this section, shall be confidential and shall not be subject to Section 25-41-1 et seq., relating to open meetings, or Section 25-61-1 et seq., relating to open records, or subject to subpoena, discovery, or introduction into evidence in any civil or criminal proceeding; however, nothing in this section shall be construed to limit or restrict the right to discover or use in any civil or criminal proceeding anything that is available from another source and entirely independent of the committee's proceedings.

(b) Members of the committee shall not be questioned in any civil or criminal proceeding regarding the information presented in or opinions formed as a result of a meeting or communication of the committee; however, nothing in this section shall be construed to prevent a member of the committee from testifying to information obtained independently of the committee or which is public information.

(6) The data on severe maternal morbidity and on pregnancy related deaths collected pursuant to paragraphs (a) and (b) of subsection (2) of this section shall be compiled on a regular basis for distribution.

PART X. COVERAGE FOR BLOOD PRESSURE MONITORS

SECTION 45. (1) As used in this section, the following words and phrases shall be defined as provided in this subsection unless the context clearly indicates otherwise:

(a) "Enrollee" means an individual entitled to receive health care services under a government program.

(b) "Government program" means a program of government sponsored or government subsidized health care coverage.

(2) A government program shall provide coverage for medically necessary home blood pressure monitors that have been validated for clinical accuracy for pregnant or postpartum enrollees not more frequently than once every two (2) years.

SECTION 46. (1) As used in this section:

(a) "Health insurance policy" means a policy, subscriber contract, certificate or plan issued by a health insurer that provides medical or health care coverage. The term does not include any of the following:

(i) An accident only policy.

(ii) A credit only policy.

(iii) A long term care or disability income policy.

(iv) A specified disease policy.

(v) A Medicare supplement policy.

(vi) A fixed indemnity policy.

(vii) A hospital indemnity policy.

(viii) A dental only policy.

(ix) A vision only policy.

(x) A workers' compensation policy.

(xi) An automobile medical payment policy.

(xii) A policy under which benefits are provided by the Federal Government to active or former military personnel and their dependents.

(xiii) Any other similar policy providing for limited benefits.

(b) "Insurer" means an entity licensed by the Department of Insurance that offers, issues or renews an individual or group health insurance policy.

(2) A health insurance policy that is offered, issued or renewed in this state on or after the effective date of this act shall provide coverage, including reimbursement, for medically necessary blood pressure monitors for pregnant or postpartum insureds for each pregnancy.

PART XI. DOULA CERTIFICATION

SECTION 47. (1) The State Department of Health, in collaboration with the Division of Medicaid, shall conduct a study on certification of doulas that meet the requirements in subsection (2) of this section, including, but not limited to, establishment of a doula registry and reimbursement models for doula services, including Medicaid coverage. The department shall provide a report on the study, including its recommendations for legislation, not later than December 31, 2026.

(2) To be certified as a doula, a person must have:

(a) Received a certification to perform doula services from the Childbirth Education Association, the Doulas of North America (DONA), the Association of Labor Assistants and Childbirth Educators (ALACE), Birthworks International, the Childbirth and Postpartum Professional Association (CAPPA), Childbirth International, the International Center for Traditional Childbearing, or Commonsense Childbirth, Inc.; or

(b) Demonstrated:

(i) An understanding of basic anatomy and physiology as related to pregnancy, the childbearing process, breastfeeding or chestfeeding, and the postpartum period;

(ii) The capacity to employ different strategies for providing emotional support, education, and resources during the perinatal period;

(iii) Knowledge of and the ability to assist families with using a wide variety of nonclinical labor coping and physical comfort strategies;

(iv) An awareness of strategies to foster effective communication between clients, their families, support services, and healthcare providers; and

(v) Knowledge of community based, publicly funded and federally funded, and clinical resources available to the client for any need outside the doula's scope of practice;

(3) As used in this section, "doula services" means services that provide continuous emotional and physical support throughout labor and birth, and intermittently during the prenatal and postpartum periods.

PART XII. NUTRITION COUNSELING SERVICES

SECTION 48. Definitions. As used in Part XII, the following terms have the meanings as defined in this section:

(a) "Department" means the State Department of Health.

(b) "Division" means the Division of Medicaid.

(c) "Health care provider" means a physician, nurse practitioner, certified nurse midwife, physician assistant, registered dietitian, nutritionist, or other licensed provider authorized to provide prenatal, perinatal, or postpartum care under Mississippi law.

(d) "Nutrition counseling" means individualized, health literacy–appropriate education and planning provided in person, virtually, or telephonically by a qualified provider that includes assessment of dietary intake, nutritional risk, goal setting, and culturally appropriate guidance to support optimal maternal dietary practices.

(e) "Maternal care period" means the period from the date of pregnancy confirmation to twelve (12) months postpartum.

SECTION 49. Integration of Nutrition Counseling into Maternal Care. (1) All health care providers delivering maternal care in Mississippi shall incorporate nutrition counseling as an integrated and reimbursable component of prenatal, perinatal, and postpartum care consistent with evidence based guidelines.

(2) The department, in collaboration with the division, shall issue guidance and clinical protocols to standardize nutrition counseling components, including:

(a) Nutrition risk screening at initial prenatal visit and each trimester;

(b) Individualized counseling tailored to cultural, socioeconomic, medical, and obstetric considerations;

(d) Referral pathways to registered dietitians, WIC, community nutrition programs, and other certified specialists.

SECTION 50. Medicaid Coverage of Nutrition Counseling Services. (1) The division shall ensure that all Medicaid eligible pregnant and postpartum beneficiaries have access to medically necessary nutrition counseling services.

(2) The division shall:

(a) Establish provider enrollment categories that include registered dietitians, certified nutrition specialists, physicians, certified nurse midwives, nurse practitioners, and other qualified providers;

(b) Define reimbursable service codes and billing practices for nutrition counseling;

(d) Permit telehealth or virtual delivery of nutrition counseling where clinically appropriate.

SECTION 51. Private Health Plan Coverage. (1) All health benefit plans offered, issued, or renewed in Mississippi on or after the effective date of this act that provide maternity coverage shall also provide coverage for nutrition counseling services delivered during pregnancy and up to twelve (12) months postpartum. Coverage must be on terms no less favorable than those provided for other maternal care services.

(2) Nutrition counseling coverage under private plans shall not be subject to cost sharing that materially dissuades use by enrollees (e.g., high co pays or stringent visit limits inconsistent with clinical need).

SECTION 52. Guidance and Training. (1) The department shall develop and disseminate training and educational resources to support providers in delivering culturally competent nutrition counseling.

(2) Training shall address:

(a) Evidence based nutrition standards;

(b) Maternal dietary assessment tools;

(d) Integration with WIC and other community nutrition resources; and

(e) Documentation and referral workflows.

SECTION 53. Data Collection and Quality Monitoring. (1) The department, in collaboration with the division and health systems, shall collect data on utilization of maternal nutrition counseling services, including:

(a) Number of unique participants;

(b) Frequency and timing of counseling encounters;

(d) Clinical outcomes tied to maternal nutritional status (e.g., gestational diabetes management, prenatal weight gain adherence, birth outcomes).

(2) By December 1 annually, the department shall report to the Legislature on service delivery, access barriers, quality metrics, and recommendations for improvement.

SECTION 54. Implementation Timeline. (1) The department and the division shall issue initial protocols and implement coverage requirements no later than January 1, 2027.

(2) The department shall make guidance available to providers and community partners within six months of enactment.

SECTION 55. Appropriation and Funding. The department and division are authorized to accept federal funds, grants, and private support to implement this act.

SECTION 56. Section 27-65-111, Mississippi Code of 1972, is amended as follows:

27-65-111. The exemptions from the provisions of this chapter which are not industrial, agricultural or governmental, or which do not relate to utilities or taxes, or which are not properly classified as one (1) of the exemption classifications of this chapter, shall be confined to persons or property exempted by this section or by the Constitution of the United States or the State of Mississippi. No exemptions as now provided by any other section, except the classified exemption sections of this chapter set forth herein, shall be valid as against the tax herein levied. Any subsequent exemption from the tax levied hereunder, except as indicated above, shall be provided by amendments to this section.

No exemption provided in this section shall apply to taxes levied by Section 27-65-15 or 27-65-21.

The tax levied by this chapter shall not apply to the following:

(a) Sales of tangible personal property and services to hospitals or infirmaries owned and operated by a corporation or association in which no part of the net earnings inures to the benefit of any private shareholder, group or individual, and which are subject to and governed by Sections 41-7-123 through 41-7-127.

Only sales of tangible personal property or services which are ordinary and necessary to the operation of such hospitals and infirmaries are exempted from tax.

(b) Sales of daily or weekly newspapers, and periodicals or publications of scientific, literary or educational organizations exempt from federal income taxation under Section 501(c)(3) of the Internal Revenue Code of 1954, as it exists as of March 31, 1975, and subscription sales of all magazines.

(d) Sales of tangible personal property for immediate export to a foreign country.

(e) Sales of tangible personal property to an orphanage, old men's or ladies' home, supported wholly or in part by a religious denomination, fraternal nonprofit organization or other nonprofit organization.

(f) Sales of tangible personal property, labor or services taxable under Sections 27-65-17, 27-65-19 and 27-65-23, to a YMCA, YWCA, a Boys' or Girls' Club owned and operated by a corporation or association in which no part of the net earnings inures to the benefit of any private shareholder, group or individual.

(g) Sales to elementary and secondary grade schools, junior and senior colleges owned and operated by a corporation or association in which no part of the net earnings inures to the benefit of any private shareholder, group or individual, and which are exempt from state income taxation, provided that this exemption does not apply to sales of property or services which are not to be used in the ordinary operation of the school, or which are to be resold to the students or the public.

(h) The gross proceeds of retail sales and the use or consumption in this state of drugs and medicines:

(i) Prescribed for the treatment of a human being by a person authorized to prescribe the medicines, and dispensed or prescription filled by a registered pharmacist in accordance with law; or

(ii) Furnished by a licensed physician, surgeon, dentist or podiatrist to his own patient for treatment of the patient; or

(iii) Furnished by a hospital for treatment of any person pursuant to the order of a licensed physician, surgeon, dentist or podiatrist; or

(iv) Sold to a licensed physician, surgeon, podiatrist, dentist or hospital for the treatment of a human being; or

(v) Sold to this state or any political subdivision or municipal corporation thereof, for use in the treatment of a human being or furnished for the treatment of a human being by a medical facility or clinic maintained by this state or any political subdivision or municipal corporation thereof.

"Medicines," as used in this paragraph (h), shall mean and include any substance or preparation intended for use by external or internal application to the human body in the diagnosis, cure, mitigation, treatment or prevention of disease and which is commonly recognized as a substance or preparation intended for such use; "medicines" do not include any auditory, prosthetic, ophthalmic or ocular device or appliance, any dentures or parts thereof or any artificial limbs or their replacement parts, articles which are in the nature of splints, bandages, pads, compresses, supports, dressings, instruments, apparatus, contrivances, appliances, devices or other mechanical, electronic, optical or physical equipment or article or the component parts and accessories thereof, or any alcoholic beverage or any other drug or medicine not commonly referred to as a prescription drug.

Notwithstanding the preceding sentence of this paragraph (h), "medicines" as used in this paragraph (h), shall mean and include sutures, whether or not permanently implanted, bone screws, bone pins, pacemakers and other articles permanently implanted in the human body to assist the functioning of any natural organ, artery, vein or limb and which remain or dissolve in the body.

The exemption provided in this paragraph (h) shall not apply to medical cannabis sold in accordance with the provisions of the Mississippi Medical Cannabis Act and in compliance with rules and regulations adopted thereunder.

"Hospital," as used in this paragraph (h), shall have the meaning ascribed to it in Section 41-9-3.

Insulin furnished by a registered pharmacist to a person for treatment of diabetes as directed by a physician shall be deemed to be dispensed on prescription within the meaning of this paragraph (h).

(i) Retail sales of automobiles, trucks and truck-tractors if exported from this state within forty-eight (48) hours and registered and first used in another state.

(j) Sales of tangible personal property or services to the Salvation Army and the Muscular Dystrophy Association, Inc.

(k) From July 1, 1985, through December 31, 1992, retail sales of "alcohol-blended fuel" as such term is defined in Section 75-55-5. The gasoline-alcohol blend or the straight alcohol eligible for this exemption shall not contain alcohol distilled outside the State of Mississippi.

(l) Sales of tangible personal property or services to the Institute for Technology Development.

(m) The gross proceeds of retail sales of food and drink for human consumption made through vending machines serviced by full-line vendors from and not connected with other taxable businesses.

(n) The gross proceeds of sales of motor fuel.

(o) Retail sales of food for human consumption purchased with food stamps issued by the United States Department of Agriculture, or other federal agency, from and after October 1, 1987, or from and after the expiration of any waiver granted pursuant to federal law, the effect of which waiver is to permit the collection by the state of tax on such retail sales of food for human consumption purchased with food stamps.

(p) Sales of cookies for human consumption by the Girl Scouts of America if no part of the net earnings from those sales inures to the benefit of any private group or individual.

(q) Gifts or sales of tangible personal property or services to public or private nonprofit museums of art.

(r) Sales of tangible personal property or services to alumni associations of state-supported colleges or universities.

(s) Sales of tangible personal property or services to National Association of Junior Auxiliaries, Inc., and chapters of the National Association of Junior Auxiliaries, Inc.

(t) Sales of tangible personal property or services to domestic violence shelters which qualify for state funding under Sections 93-21-101 through 93-21-113.

(u) Sales of tangible personal property or services to the National Multiple Sclerosis Society, Mississippi Chapter.

(v) Retail sales of food for human consumption purchased with food instruments issued the Mississippi Band of Choctaw Indians under the Women, Infants and Children Program (WIC) funded by the United States Department of Agriculture.

(w) Sales of tangible personal property or services to a private company, as defined in Section 57-61-5, which is making such purchases with proceeds of bonds issued under Section 57-61-1 et seq., the Mississippi Business Investment Act.

(x) The gross collections from the operation of self-service, coin-operated car washing equipment and sales of the service of washing motor vehicles with portable high-pressure washing equipment on the premises of the customer.

(y) Sales of tangible personal property or services to the Mississippi Technology Alliance.

(z) Sales of tangible personal property to nonprofit organizations that provide foster care, adoption services and temporary housing for unwed mothers and their children if the organization is exempt from federal income taxation under Section 501(c)(3) of the Internal Revenue Code.

(aa) Sales of tangible personal property to nonprofit organizations that provide residential rehabilitation for persons with alcohol and drug dependencies if the organization is exempt from federal income taxation under Section 501(c)(3) of the Internal Revenue Code.

(ab) (i) Retail sales of an article of clothing or footwear designed to be worn on or about the human body and retail sales of school supplies if the sales price of the article of clothing or footwear or school supply is less than One Hundred Dollars ($100.00) and the sale takes place during a period beginning at 12:01 a.m. on the second Friday in July and ending at 12:00 midnight the following Sunday. This paragraph (ab) shall not apply to:

1. Accessories including jewelry, handbags, luggage, umbrellas, wallets, watches, briefcases, garment bags and similar items carried on or about the human body, without regard to whether worn on the body in a manner characteristic of clothing;

2. The rental of clothing or footwear; and

3. Skis, swim fins, roller blades, skates and similar items worn on the foot.

(ii) For purposes of this paragraph (ab), "school supplies" means items that are commonly used by a student in a course of study. The following is an all-inclusive list:

1. Backpacks;

2. Binder pockets;

3. Binders;

4. Blackboard chalk;

5. Book bags;

6. Calculators;

7. Cellophane tape;

8. Clays and glazes;

9. Compasses;

10. Composition books;

11. Crayons;

12. Dictionaries and thesauruses;

13. Dividers;

14. Erasers;

15. Folders: expandable, pocket, plastic and manila;

16. Glue, paste and paste sticks;

17. Highlighters;

18. Index card boxes;

19. Index cards;

20. Legal pads;

21. Lunch boxes;

22. Markers;

23. Notebooks;

24. Paintbrushes for artwork;

25. Paints: acrylic, tempera and oil;

26. Paper: loose-leaf ruled notebook paper, copy paper, graph paper, tracing paper, manila paper, colored paper, poster board and construction paper;

27. Pencil boxes and other school supply boxes;

28. Pencil sharpeners;

29. Pencils;

30. Pens;

31. Protractors;

32. Reference books;

33. Reference maps and globes;

34. Rulers;

35. Scissors;

36. Sheet music;

37. Sketch and drawing pads;

38. Textbooks;

39. Watercolors;

40. Workbooks; and

41. Writing tablets.

(iii) From and after January 1, 2010, the governing authorities of a municipality, for retail sales occurring within the corporate limits of the municipality, may suspend the application of the exemption provided for in this paragraph (ab) by adoption of a resolution to that effect stating the date upon which the suspension shall take effect. A certified copy of the resolution shall be furnished to the Department of Revenue at least ninety (90) days prior to the date upon which the municipality desires such suspension to take effect.

(ac) The gross proceeds of sales of tangible personal property made for the sole purpose of raising funds for a school or an organization affiliated with a school.

As used in this paragraph (ac), "school" means any public or private school that teaches courses of instruction to students in any grade from kindergarten through Grade 12.

(ad) Sales of durable medical equipment and home medical supplies when ordered or prescribed by a licensed physician for medical purposes of a patient. As used in this paragraph (ad), "durable medical equipment" and "home medical supplies" mean equipment, including repair and replacement parts for the equipment or supplies listed under Title XVIII of the Social Security Act or under the state plan for medical assistance under Title XIX of the Social Security Act, prosthetics, orthotics, hearing aids, hearing devices, prescription eyeglasses, oxygen and oxygen equipment. Payment does not have to be made, in whole or in part, by any particular person to be eligible for this exemption. Purchases of home medical equipment and supplies by a provider of home health services or a provider of hospice services are eligible for this exemption if the purchases otherwise meet the requirements of this paragraph.

(ae) Sales of tangible personal property or services to Mississippi Blood Services.

(af) (i) Subject to the provisions of this paragraph (af), retail sales of firearms, ammunition and hunting supplies if sold during the annual Mississippi Second Amendment Weekend holiday beginning at 12:01 a.m. on the last Friday in August and ending at 12:00 midnight the following Sunday. For the purposes of this paragraph (af), "hunting supplies" means tangible personal property used for hunting, including, and limited to, archery equipment, firearm and archery cases, firearm and archery accessories, hearing protection, holsters, belts and slings. Hunting supplies does not include animals used for hunting.

(ii) This paragraph (af) shall apply only if one or more of the following occur:

1. Title to and/or possession of an eligible item is transferred from a seller to a purchaser; and/or

2. A purchaser orders and pays for an eligible item and the seller accepts the order for immediate shipment, even if delivery is made after the time period provided in subparagraph (i) of this paragraph (af), provided that the purchaser has not requested or caused the delay in shipment.

(ag) Sales of nonperishable food items to charitable organizations that are exempt from federal income taxation under Section 501(c)(3) of the Internal Revenue Code and operate a food bank or food pantry or food lines.

(ah) Sales of tangible personal property or services to the United Way of the Pine Belt Region, Inc.

(ai) Sales of tangible personal property or services to the Mississippi Children's Museum or any subsidiary or affiliate thereof operating a satellite or branch museum within this state.

(aj) Sales of tangible personal property or services to the Jackson Zoological Park.

(ak) Sales of tangible personal property or services to the Hattiesburg Zoo.

(al) Gross proceeds from sales of food, merchandise or other concessions at an event held solely for religious or charitable purposes at livestock facilities, agriculture facilities or other facilities constructed, renovated or expanded with funds for the grant program authorized under Section 18, Chapter 530, Laws of 1995.

(am) Sales of tangible personal property and services to the Diabetes Foundation of Mississippi and the Mississippi Chapter of the Juvenile Diabetes Research Foundation.

(an) Sales of potting soil, mulch, or other soil amendments used in growing ornamental plants which bear no fruit of commercial value when sold to commercial plant nurseries that operate exclusively at wholesale and where no retail sales can be made.

(ao) Sales of tangible personal property or services to the University of Mississippi Medical Center Research Development Foundation.

(ap) Sales of tangible personal property or services to Keep Mississippi Beautiful, Inc., and all affiliates of Keep Mississippi Beautiful, Inc.

(aq) Sales of tangible personal property or services to the Friends of Children's Hospital.

(ar) Sales of tangible personal property or services to the Pinecrest Weekend Snackpacks for Kids located in Corinth, Mississippi.

(as) Sales of hearing aids when ordered or prescribed by a licensed physician, audiologist or hearing aid specialist for the medical purposes of a patient.

(at) Sales exempt under the Facilitating Business Rapid Response to State Declared Disasters Act of 2015 (Sections 27-113-1 through 27-113-9).

(au) Sales of tangible personal property or services to the Junior League of Jackson.

(av) Sales of tangible personal property or services to the Mississippi's Toughest Kids Foundation for use in the construction, furnishing and equipping of buildings and related facilities and infrastructure at Camp Kamassa in Copiah County, Mississippi. This paragraph (av) shall stand repealed on July 1, 2028.

(aw) Sales of tangible personal property or services to MS Gulf Coast Buddy Sports, Inc.

(ax) Sales of tangible personal property or services to Biloxi Lions, Inc.

(ay) Sales of tangible personal property or services to Lions Sight Foundation of Mississippi, Inc.

(az) Sales of tangible personal property and services to the Goldring/Woldenberg Institute of Southern Jewish Life (ISJL).

(ba) Sales of coins, currency, and bullion. For the purposes of this paragraph (ba), the following words and phrases shall have the meanings ascribed in this paragraph (ba) unless the context clearly indicates otherwise:

(i) "Bullion" means a bar, ingot, or coin:

1. Manufactured, in whole or in part, of gold, silver, platinum, or palladium;

2. That was or is used solely as a medium of exchange, security, or commodity by any state, the United States Government, or a foreign nation; and

3. Sold based on the intrinsic value of the bar, ingot, or coin as a precious metal or collectible item rather than its form or representative value as a medium of exchange.

(ii) "Coin or currency" means a coin or currency:

1. Manufactured, in whole or in part, of gold, silver, other metal, or paper;

2. That was or is used solely as a medium of exchange, security, or commodity by any state, the United States Government, or a foreign nation; and

3. Sold based on the intrinsic value of the coin or currency as a precious metal or collectible item rather than its form or representative value as a medium of exchange.

"Coin or currency" does not include a coin or currency that has been incorporated into jewelry.

(bb) Sales of:

(i) Children's diapers, including single-use diapers, reusable diapers and reusable diaper inserts;

(ii) Diaper bags, diaper rash cream, baby wipes, and baby powder; and

(iii) Baby formula.

SECTION 57. Nothing in Section 56 of this act shall affect or defeat any claim, assessment, appeal, suit, right or cause of action for taxes due or accrued under the sales tax laws before the date on which this act becomes effective, whether such claims, assessments, appeals, suits or actions have been begun before the date on which this act becomes effective or are begun thereafter; and the provisions of the sales tax laws are expressly continued in full force, effect and operation for the purpose of the assessment, collection and enrollment of liens for any taxes due or accrued and the execution of any warrant under such laws before the date on which this act becomes effective, and for the imposition of any penalties, forfeitures or claims for failure to comply with such laws.

SECTION 58. Section 43-13-117, Mississippi Code of 1972, is amended as follows:

43-13-117. (A) Medicaid as authorized by this article shall include payment of part or all of the costs, at the discretion of the division, with approval of the Governor and the Centers for Medicare and Medicaid Services, of the following types of care and services rendered to eligible applicants who have been determined to be eligible for that care and services, within the limits of state appropriations and federal matching funds:

(1) Inpatient hospital services.

(a) The division is authorized to implement an All Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement methodology for inpatient hospital services.

(b) No service benefits or reimbursement limitations in this subsection (A)(1) shall apply to payments under an APR-DRG or Ambulatory Payment Classification (APC) model or a managed care program or similar model described in subsection (H) of this section unless specifically authorized by the division.

(2) Outpatient hospital services.

(a) Emergency services.

(b) Other outpatient hospital services. The division shall allow benefits for other medically necessary outpatient hospital services (such as chemotherapy, radiation, surgery and therapy), including outpatient services in a clinic or other facility that is not located inside the hospital, but that has been designated as an outpatient facility by the hospital, and that was in operation or under construction on July 1, 2009, provided that the costs and charges associated with the operation of the hospital clinic are included in the hospital's cost report. In addition, the Medicare thirty-five-mile rule will apply to those hospital clinics not located inside the hospital that are constructed after July 1, 2009. Where the same services are reimbursed as clinic services, the division may revise the rate or methodology of outpatient reimbursement to maintain consistency, efficiency, economy and quality of care.

(c) The division is authorized to implement an Ambulatory Payment Classification (APC) methodology for outpatient hospital services. The division shall give rural hospitals that have fifty (50) or fewer licensed beds the option to not be reimbursed for outpatient hospital services using the APC methodology, but reimbursement for outpatient hospital services provided by those hospitals shall be based on one hundred one percent (101%) of the rate established under Medicare for outpatient hospital services. Those hospitals choosing to not be reimbursed under the APC methodology shall remain under cost-based reimbursement for a two-year period.

(d) No service benefits or reimbursement limitations in this subsection (A)(2) shall apply to payments under an APR-DRG or APC model or a managed care program or similar model described in subsection (H) of this section unless specifically authorized by the division.

(3) Laboratory and x-ray services.

(4) Nursing facility services.

(a) The division shall make full payment to nursing facilities for each day, not exceeding forty-two (42) days per year, that a patient is absent from the facility on home leave. Payment may be made for the following home leave days in addition to the forty-two-day limitation: Christmas, the day before Christmas, the day after Christmas, Thanksgiving, the day before Thanksgiving and the day after Thanksgiving.

(b) From and after July 1, 1997, the division shall implement the integrated case-mix payment and quality monitoring system, which includes the fair rental system for property costs and in which recapture of depreciation is eliminated. The division may reduce the payment for hospital leave and therapeutic home leave days to the lower of the case-mix category as computed for the resident on leave using the assessment being utilized for payment at that point in time, or a case-mix score of 1.000 for nursing facilities, and shall compute case-mix scores of residents so that only services provided at the nursing facility are considered in calculating a facility's per diem.

(d) On or after January 1, 2015, the division shall update the case-mix payment system resource utilization grouper and classifications and fair rental reimbursement system. The division shall develop and implement a payment add-on to reimburse nursing facilities for ventilator-dependent resident services.

(e) The division shall develop and implement, not later than January 1, 2001, a case-mix payment add-on determined by time studies and other valid statistical data that will reimburse a nursing facility for the additional cost of caring for a resident who has a diagnosis of Alzheimer's or other related dementia and exhibits symptoms that require special care. Any such case-mix add-on payment shall be supported by a determination of additional cost. The division shall also develop and implement as part of the fair rental reimbursement system for nursing facility beds, an Alzheimer's resident bed depreciation enhanced reimbursement system that will provide an incentive to encourage nursing facilities to convert or construct beds for residents with Alzheimer's or other related dementia.

(f) The division shall develop and implement an assessment process for long-term care services. The division may provide the assessment and related functions directly or through contract with the area agencies on aging.

The division shall apply for necessary federal waivers to assure that additional services providing alternatives to nursing facility care are made available to applicants for nursing facility care.

(5) Periodic screening and diagnostic services for individuals under age twenty-one (21) years as are needed to identify physical and mental defects and to provide health care treatment and other measures designed to correct or ameliorate defects and physical and mental illness and conditions discovered by the screening services, regardless of whether these services are included in the state plan. The division may include in its periodic screening and diagnostic program those discretionary services authorized under the federal regulations adopted to implement Title XIX of the federal Social Security Act, as amended. The division, in obtaining physical therapy services, occupational therapy services, and services for individuals with speech, hearing and language disorders, may enter into a cooperative agreement with the State Department of Education for the provision of those services to handicapped students by public school districts using state funds that are provided from the appropriation to the Department of Education to obtain federal matching funds through the division. The division, in obtaining medical and mental health assessments, treatment, care and services for children who are in, or at risk of being put in, the custody of the Mississippi Department of Human Services may enter into a cooperative agreement with the Mississippi Department of Human Services for the provision of those services using state funds that are provided from the appropriation to the Department of Human Services to obtain federal matching funds through the division.

(6) Physician services. Fees for physician's services that are covered only by Medicaid shall be reimbursed at ninety percent (90%) of the rate established on January 1, 2018, and as may be adjusted each July thereafter, under Medicare. The division may provide for a reimbursement rate for physician's services of up to one hundred percent (100%) of the rate established under Medicare for physician's services that are provided after the normal working hours of the physician, as determined in accordance with regulations of the division. The division may reimburse eligible providers, as determined by the division, for certain primary care services at one hundred percent (100%) of the rate established under Medicare. The division shall reimburse obstetricians and gynecologists for certain primary care services as defined by the division at one hundred percent (100%) of the rate established under Medicare.

(7) (a) Home health services for eligible persons, not to exceed in cost the prevailing cost of nursing facility services. All home health visits must be precertified as required by the division. In addition to physicians, certified registered nurse practitioners, physician assistants and clinical nurse specialists are authorized to prescribe or order home health services and plans of care, sign home health plans of care, certify and recertify eligibility for home health services and conduct the required initial face-to-face visit with the recipient of the services.

(b) [Repealed]

(8) Emergency medical transportation services as determined by the division.

(9) Prescription drugs and other covered drugs and services as determined by the division.

The division shall establish a mandatory preferred drug list. Drugs not on the mandatory preferred drug list shall be made available by utilizing prior authorization procedures established by the division.

The division may seek to establish relationships with other states in order to lower acquisition costs of prescription drugs to include single-source and innovator multiple-source drugs or generic drugs. In addition, if allowed by federal law or regulation, the division may seek to establish relationships with and negotiate with other countries to facilitate the acquisition of prescription drugs to include single-source and innovator multiple-source drugs or generic drugs, if that will lower the acquisition costs of those prescription drugs.

The division may allow for a combination of prescriptions for single-source and innovator multiple-source drugs and generic drugs to meet the needs of the beneficiaries.

The executive director may approve specific maintenance drugs for beneficiaries with certain medical conditions, which may be prescribed and dispensed in three-month supply increments.

Drugs prescribed for a resident of a psychiatric residential treatment facility must be provided in true unit doses when available. The division may require that drugs not covered by Medicare Part D for a resident of a long-term care facility be provided in true unit doses when available. Those drugs that were originally billed to the division but are not used by a resident in any of those facilities shall be returned to the billing pharmacy for credit to the division, in accordance with the guidelines of the State Board of Pharmacy and any requirements of federal law and regulation. Drugs shall be dispensed to a recipient and only one (1) dispensing fee per month may be charged. The division shall develop a methodology for reimbursing for restocked drugs, which shall include a restock fee as determined by the division not exceeding Seven Dollars and Eighty-two Cents ($7.82).

Except for those specific maintenance drugs approved by the executive director, the division shall not reimburse for any portion of a prescription that exceeds a thirty-one-day supply of the drug based on the daily dosage.

The division is authorized to develop and implement a program of payment for additional pharmacist services as determined by the division.

All claims for drugs for dually eligible Medicare/Medicaid beneficiaries that are paid for by Medicare must be submitted to Medicare for payment before they may be processed by the division's online payment system.

The division shall develop a pharmacy policy in which drugs in tamper-resistant packaging that are prescribed for a resident of a nursing facility but are not dispensed to the resident shall be returned to the pharmacy and not billed to Medicaid, in accordance with guidelines of the State Board of Pharmacy.

The division shall develop and implement a method or methods by which the division will provide on a regular basis to Medicaid providers who are authorized to prescribe drugs, information about the costs to the Medicaid program of single-source drugs and innovator multiple-source drugs, and information about other drugs that may be prescribed as alternatives to those single-source drugs and innovator multiple-source drugs and the costs to the Medicaid program of those alternative drugs.

Notwithstanding any law or regulation, information obtained or maintained by the division regarding the prescription drug program, including trade secrets and manufacturer or labeler pricing, is confidential and not subject to disclosure except to other state agencies.

The dispensing fee for each new or refill prescription, including nonlegend or over-the-counter drugs covered by the division, shall be not less than Three Dollars and Ninety-one Cents ($3.91), as determined by the division.

The division shall not reimburse for single-source or innovator multiple-source drugs if there are equally effective generic equivalents available and if the generic equivalents are the least expensive.

It is the intent of the Legislature that the pharmacists providers be reimbursed for the reasonable costs of filling and dispensing prescriptions for Medicaid beneficiaries.

The division shall allow certain drugs, including physician-administered drugs, and implantable drug system devices, and medical supplies, with limited distribution or limited access for beneficiaries and administered in an appropriate clinical setting, to be reimbursed as either a medical claim or pharmacy claim, as determined by the division.

It is the intent of the Legislature that the division and any managed care entity described in subsection (H) of this section encourage the use of Alpha-Hydroxyprogesterone Caproate (17P) to prevent recurrent preterm birth.

(10) Dental and orthodontic services to be determined by the division.

The division shall increase the amount of the reimbursement rate for diagnostic and preventative dental services for each of the fiscal years 2022, 2023 and 2024 by five percent (5%) above the amount of the reimbursement rate for the previous fiscal year. The division shall increase the amount of the reimbursement rate for restorative dental services for each of the fiscal years 2023, 2024 and 2025 by five percent (5%) above the amount of the reimbursement rate for the previous fiscal year. It is the intent of the Legislature that the reimbursement rate revision for preventative dental services will be an incentive to increase the number of dentists who actively provide Medicaid services. This dental services reimbursement rate revision shall be known as the "James Russell Dumas Medicaid Dental Services Incentive Program."

The Medical Care Advisory Committee, assisted by the Division of Medicaid, shall annually determine the effect of this incentive by evaluating the number of dentists who are Medicaid providers, the number who and the degree to which they are actively billing Medicaid, the geographic trends of where dentists are offering what types of Medicaid services and other statistics pertinent to the goals of this legislative intent. This data shall annually be presented to the Chair of the Senate Medicaid Committee and the Chair of the House Medicaid Committee.

The division shall include dental services as a necessary component of overall health services provided to children who are eligible for services.

(11) Eyeglasses for all Medicaid beneficiaries who have (a) had surgery on the eyeball or ocular muscle that results in a vision change for which eyeglasses or a change in eyeglasses is medically indicated within six (6) months of the surgery and is in accordance with policies established by the division, or (b) one (1) pair every five (5) years and in accordance with policies established by the division. In either instance, the eyeglasses must be prescribed by a physician skilled in diseases of the eye or an optometrist, whichever the beneficiary may select.

(12) Intermediate care facility services.

(a) The division shall make full payment to all intermediate care facilities for individuals with intellectual disabilities for each day, not exceeding sixty-three (63) days per year, that a patient is absent from the facility on home leave. Payment may be made for the following home leave days in addition to the sixty-three-day limitation: Christmas, the day before Christmas, the day after Christmas, Thanksgiving, the day before Thanksgiving and the day after Thanksgiving.

(b) All state-owned intermediate care facilities for individuals with intellectual disabilities shall be reimbursed on a full reasonable cost basis.

(c) Effective January 1, 2015, the division shall update the fair rental reimbursement system for intermediate care facilities for individuals with intellectual disabilities.

(13) Family planning services, including drugs, supplies and devices, when those services are under the supervision of a physician or nurse practitioner.

(14) Clinic services. Preventive, diagnostic, therapeutic, rehabilitative or palliative services that are furnished by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. Clinic services include, but are not limited to:

(a) Services provided by ambulatory surgical centers (ASCs) as defined in Section 41-75-1(a); and

(b) Dialysis center services.

(15) Home- and community-based services for the elderly and disabled, as provided under Title XIX of the federal Social Security Act, as amended, under waivers, subject to the availability of funds specifically appropriated for that purpose by the Legislature.

(16) Mental health services. Certain services provided by a psychiatrist shall be reimbursed at up to one hundred percent (100%) of the Medicare rate. Approved therapeutic and case management services (a) provided by an approved regional mental health/intellectual disability center established under Sections 41-19-31 through 41-19-39, or by another community mental health service provider meeting the requirements of the Department of Mental Health to be an approved mental health/intellectual disability center if determined necessary by the Department of Mental Health, using state funds that are provided in the appropriation to the division to match federal funds, or (b) provided by a facility that is certified by the State Department of Mental Health to provide therapeutic and case management services, to be reimbursed on a fee for service basis, or (c) provided in the community by a facility or program operated by the Department of Mental Health. Any such services provided by a facility described in subparagraph (b) must have the prior approval of the division to be reimbursable under this section.

(17) Durable medical equipment services and medical supplies. Precertification of durable medical equipment and medical supplies must be obtained as required by the division. The Division of Medicaid may require durable medical equipment providers to obtain a surety bond in the amount and to the specifications as established by the Balanced Budget Act of 1997. A maximum dollar amount of reimbursement for noninvasive ventilators or ventilation treatments properly ordered and being used in an appropriate care setting shall not be set by any health maintenance organization, coordinated care organization, provider-sponsored health plan, or other organization paid for services on a capitated basis by the division under any managed care program or coordinated care program implemented by the division under this section. Reimbursement by these organizations to durable medical equipment suppliers for home use of noninvasive and invasive ventilators shall be on a continuous monthly payment basis for the duration of medical need throughout a patient's valid prescription period.

(18) (a) Notwithstanding any other provision of this section to the contrary, as provided in the Medicaid state plan amendment or amendments as defined in Section 43-13-145(10), the division shall make additional reimbursement to hospitals that serve a disproportionate share of low-income patients and that meet the federal requirements for those payments as provided in Section 1923 of the federal Social Security Act and any applicable regulations. It is the intent of the Legislature that the division shall draw down all available federal funds allotted to the state for disproportionate share hospitals. However, from and after January 1, 1999, public hospitals participating in the Medicaid disproportionate share program may be required to participate in an intergovernmental transfer program as provided in Section 1903 of the federal Social Security Act and any applicable regulations.

(b) (i) 1. The division may establish a Medicare Upper Payment Limits Program, as defined in Section 1902(a)(30) of the federal Social Security Act and any applicable federal regulations, or an allowable delivery system or provider payment initiative authorized under 42 CFR 438.6(c), for hospitals, nursing facilities and physicians employed or contracted by hospitals.

2. The division shall establish a Medicaid Supplemental Payment Program, as permitted by the federal Social Security Act and a comparable allowable delivery system or provider payment initiative authorized under 42 CFR 438.6(c), for emergency ambulance transportation providers in accordance with this subsection (A)(18)(b).

(ii) The division shall assess each hospital, nursing facility, and emergency ambulance transportation provider for the sole purpose of financing the state portion of the Medicare Upper Payment Limits Program or other program(s) authorized under this subsection (A)(18)(b). The hospital assessment shall be as provided in Section 43-13-145(4)(a), and the nursing facility and the emergency ambulance transportation assessments, if established, shall be based on Medicaid utilization or other appropriate method, as determined by the division, consistent with federal regulations. The assessments will remain in effect as long as the state participates in the Medicare Upper Payment Limits Program or other program(s) authorized under this subsection (A)(18)(b). In addition to the hospital assessment provided in Section 43-13-145(4)(a), hospitals with physicians participating in the Medicare Upper Payment Limits Program or other program(s) authorized under this subsection (A)(18)(b) shall be required to participate in an intergovernmental transfer or assessment, as determined by the division, for the purpose of financing the state portion of the physician UPL payments or other payment(s) authorized under this subsection (A)(18)(b).

(iii) Subject to approval by the Centers for Medicare and Medicaid Services (CMS) and the provisions of this subsection (A)(18)(b), the division shall make additional reimbursement to hospitals, nursing facilities, and emergency ambulance transportation providers for the Medicare Upper Payment Limits Program or other program(s) authorized under this subsection (A)(18)(b), and, if the program is established for physicians, shall make additional reimbursement for physicians, as defined in Section 1902(a)(30) of the federal Social Security Act and any applicable federal regulations, provided the assessment in this subsection (A)(18)(b) is in effect.

(iv) Notwithstanding any other provision of this article to the contrary, effective upon implementation of the Mississippi Hospital Access Program (MHAP) provided in subparagraph (c)(i) below, the hospital portion of the inpatient Upper Payment Limits Program shall transition into and be replaced by the MHAP program. However, the division is authorized to develop and implement an alternative fee-for-service Upper Payment Limits model in accordance with federal laws and regulations if necessary to preserve supplemental funding. Further, the division, in consultation with the hospital industry shall develop alternative models for distribution of medical claims and supplemental payments for inpatient and outpatient hospital services, and such models may include, but shall not be limited to the following: increasing rates for inpatient and outpatient services; creating a low-income utilization pool of funds to reimburse hospitals for the costs of uncompensated care, charity care and bad debts as permitted and approved pursuant to federal regulations and the Centers for Medicare and Medicaid Services; supplemental payments based upon Medicaid utilization, quality, service lines and/or costs of providing such services to Medicaid beneficiaries and to uninsured patients. The goals of such payment models shall be to ensure access to inpatient and outpatient care and to maximize any federal funds that are available to reimburse hospitals for services provided. Any such documents required to achieve the goals described in this paragraph shall be submitted to the Centers for Medicare and Medicaid Services, with a proposed effective date of July 1, 2019, to the extent possible, but in no event shall the effective date of such payment models be later than July 1, 2020. The Chairmen of the Senate and House Medicaid Committees shall be provided a copy of the proposed payment model(s) prior to submission. Effective July 1, 2018, and until such time as any payment model(s) as described above become effective, the division, in consultation with the hospital industry, is authorized to implement a transitional program for inpatient and outpatient payments and/or supplemental payments (including, but not limited to, MHAP and directed payments), to redistribute available supplemental funds among hospital providers, provided that when compared to a hospital's prior year supplemental payments, supplemental payments made pursuant to any such transitional program shall not result in a decrease of more than five percent (5%) and shall not increase by more than the amount needed to maximize the distribution of the available funds.

(v) 1. To preserve and improve access to ambulance transportation provider services, the division shall seek CMS approval to make ambulance service access payments as set forth in this subsection (A)(18)(b) for all covered emergency ambulance services rendered on or after July 1, 2022, and shall make such ambulance service access payments for all covered services rendered on or after the effective date of CMS approval.

2. The division shall calculate the ambulance service access payment amount as the balance of the portion of the Medical Care Fund related to ambulance transportation service provider assessments plus any federal matching funds earned on the balance, up to, but not to exceed, the upper payment limit gap for all emergency ambulance service providers.

3. a. Except for ambulance services exempt from the assessment provided in this paragraph (18)(b), all ambulance transportation service providers shall be eligible for ambulance service access payments each state fiscal year as set forth in this paragraph (18)(b).

b. In addition to any other funds paid to ambulance transportation service providers for emergency medical services provided to Medicaid beneficiaries, each eligible ambulance transportation service provider shall receive ambulance service access payments each state fiscal year equal to the ambulance transportation service provider's upper payment limit gap. Subject to approval by the Centers for Medicare and Medicaid Services, ambulance service access payments shall be made no less than on a quarterly basis.

c. As used in this paragraph (18)(b)(v), the term "upper payment limit gap" means the difference between the total amount that the ambulance transportation service provider received from Medicaid and the average amount that the ambulance transportation service provider would have received from commercial insurers for those services reimbursed by Medicaid.

4. An ambulance service access payment shall not be used to offset any other payment by the division for emergency or nonemergency services to Medicaid beneficiaries.

(c) (i) Not later than December l, 2015, the division shall, subject to approval by the Centers for Medicare and Medicaid Services (CMS), establish, implement and operate a Mississippi Hospital Access Program (MHAP) for the purpose of protecting patient access to hospital care through hospital inpatient reimbursement programs provided in this section designed to maintain total hospital reimbursement for inpatient services rendered by in-state hospitals and the out-of-state hospital that is authorized by federal law to submit intergovernmental transfers (IGTs) to the State of Mississippi and is classified as Level I trauma center located in a county contiguous to the state line at the maximum levels permissible under applicable federal statutes and regulations, at which time the current inpatient Medicare Upper Payment Limits (UPL) Program for hospital inpatient services shall transition to the MHAP.

(ii) Subject to approval by the Centers for Medicare and Medicaid Services (CMS), the MHAP shall provide increased inpatient capitation (PMPM) payments to managed care entities contracting with the division pursuant to subsection (H) of this section to support availability of hospital services or such other payments permissible under federal law necessary to accomplish the intent of this subsection.

(iii) The intent of this subparagraph (c) is that effective for all inpatient hospital Medicaid services during state fiscal year 2016, and so long as this provision shall remain in effect hereafter, the division shall to the fullest extent feasible replace the additional reimbursement for hospital inpatient services under the inpatient Medicare Upper Payment Limits (UPL) Program with additional reimbursement under the MHAP and other payment programs for inpatient and/or outpatient payments which may be developed under the authority of this paragraph.

(iv) The division shall assess each hospital as provided in Section 43-13-145(4)(a) for the purpose of financing the state portion of the MHAP, supplemental payments and such other purposes as specified in Section 43-13-145. The assessment will remain in effect as long as the MHAP and supplemental payments are in effect.

(19) (a) Perinatal risk management services. The division shall promulgate regulations to be effective from and after October 1, 1988, to establish a comprehensive perinatal system for risk assessment of all pregnant and infant Medicaid recipients and for management, education and follow-up for those who are determined to be at risk. Services to be performed include case management, nutrition assessment/counseling, psychosocial assessment/counseling and health education. The division shall contract with the State Department of Health to provide services within this paragraph (Perinatal High Risk Management/Infant Services System (PHRM/ISS)). The State Department of Health shall be reimbursed on a full reasonable cost basis for services provided under this subparagraph (a).

(b) Early intervention system services. The division shall cooperate with the State Department of Health, acting as lead agency, in the development and implementation of a statewide system of delivery of early intervention services, under Part C of the Individuals with Disabilities Education Act (IDEA). The State Department of Health shall certify annually in writing to the executive director of the division the dollar amount of state early intervention funds available that will be utilized as a certified match for Medicaid matching funds. Those funds then shall be used to provide expanded targeted case management services for Medicaid eligible children with special needs who are eligible for the state's early intervention system. Qualifications for persons providing service coordination shall be determined by the State Department of Health and the Division of Medicaid.

(20) Home- and community-based services for physically disabled approved services as allowed by a waiver from the United States Department of Health and Human Services for home- and community-based services for physically disabled people using state funds that are provided from the appropriation to the State Department of Rehabilitation Services and used to match federal funds under a cooperative agreement between the division and the department, provided that funds for these services are specifically appropriated to the Department of Rehabilitation Services.

(21) Nurse practitioner services. Services furnished by a registered nurse who is licensed and certified by the Mississippi Board of Nursing as a nurse practitioner, including, but not limited to, nurse anesthetists, nurse midwives, family nurse practitioners, family planning nurse practitioners, pediatric nurse practitioners, obstetrics-gynecology nurse practitioners and neonatal nurse practitioners, under regulations adopted by the division. Reimbursement for those services shall not exceed ninety percent (90%) of the reimbursement rate for comparable services rendered by a physician. The division may provide for a reimbursement rate for nurse practitioner services of up to one hundred percent (100%) of the reimbursement rate for comparable services rendered by a physician for nurse practitioner services that are provided after the normal working hours of the nurse practitioner, as determined in accordance with regulations of the division.

(22) Ambulatory services delivered in federally qualified health centers, rural health centers and clinics of the local health departments of the State Department of Health for individuals eligible for Medicaid under this article based on reasonable costs as determined by the division. Federally qualified health centers shall be reimbursed by the Medicaid prospective payment system as approved by the Centers for Medicare and Medicaid Services. The division shall recognize federally qualified health centers (FQHCs), rural health clinics (RHCs) and community mental health centers (CMHCs) as both an originating and distant site provider for the purposes of telehealth reimbursement. The division is further authorized and directed to reimburse FQHCs, RHCs and CMHCs for both distant site and originating site services when such services are appropriately provided by the same organization.

(23) Inpatient psychiatric services.

(a) Inpatient psychiatric services to be determined by the division for recipients under age twenty-one (21) that are provided under the direction of a physician in an inpatient program in a licensed acute care psychiatric facility or in a licensed psychiatric residential treatment facility, before the recipient reaches age twenty-one (21) or, if the recipient was receiving the services immediately before he or she reached age twenty-one (21), before the earlier of the date he or she no longer requires the services or the date he or she reaches age twenty-two (22), as provided by federal regulations. From and after January 1, 2015, the division shall update the fair rental reimbursement system for psychiatric residential treatment facilities. Precertification of inpatient days and residential treatment days must be obtained as required by the division. From and after July 1, 2009, all state-owned and state-operated facilities that provide inpatient psychiatric services to persons under age twenty-one (21) who are eligible for Medicaid reimbursement shall be reimbursed for those services on a full reasonable cost basis.

(b) The division may reimburse for services provided by a licensed freestanding psychiatric hospital to Medicaid recipients over the age of twenty-one (21) in a method and manner consistent with the provisions of Section 43-13-117.5.

(24) [Deleted]

(25) [Deleted]

(26) Hospice care. As used in this paragraph, the term "hospice care" means a coordinated program of active professional medical attention within the home and outpatient and inpatient care that treats the terminally ill patient and family as a unit, employing a medically directed interdisciplinary team. The program provides relief of severe pain or other physical symptoms and supportive care to meet the special needs arising out of physical, psychological, spiritual, social and economic stresses that are experienced during the final stages of illness and during dying and bereavement and meets the Medicare requirements for participation as a hospice as provided in federal regulations.

(27) Group health plan premiums and cost-sharing if it is cost-effective as defined by the United States Secretary of Health and Human Services.

(28) Other health insurance premiums that are cost-effective as defined by the United States Secretary of Health and Human Services. Medicare eligible must have Medicare Part B before other insurance premiums can be paid.

(29) The Division of Medicaid may apply for a waiver from the United States Department of Health and Human Services for home- and community-based services for developmentally disabled people using state funds that are provided from the appropriation to the State Department of Mental Health and/or funds transferred to the department by a political subdivision or instrumentality of the state and used to match federal funds under a cooperative agreement between the division and the department, provided that funds for these services are specifically appropriated to the Department of Mental Health and/or transferred to the department by a political subdivision or instrumentality of the state.

(30) Pediatric skilled nursing services as determined by the division and in a manner consistent with regulations promulgated by the Mississippi State Department of Health.

(31) Targeted case management services for children with special needs, under waivers from the United States Department of Health and Human Services, using state funds that are provided from the appropriation to the Mississippi Department of Human Services and used to match federal funds under a cooperative agreement between the division and the department.

(32) Care and services provided in Christian Science Sanatoria listed and certified by the Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc., rendered in connection with treatment by prayer or spiritual means to the extent that those services are subject to reimbursement under Section 1903 of the federal Social Security Act.

(33) Podiatrist services.

(34) Assisted living services as provided through home- and community-based services under Title XIX of the federal Social Security Act, as amended, subject to the availability of funds specifically appropriated for that purpose by the Legislature.

(35) Services and activities authorized in Sections 43-27-101 and 43-27-103, using state funds that are provided from the appropriation to the Mississippi Department of Human Services and used to match federal funds under a cooperative agreement between the division and the department.

(36) Nonemergency transportation services for Medicaid-eligible persons as determined by the division. The PEER Committee shall conduct a performance evaluation of the nonemergency transportation program to evaluate the administration of the program and the providers of transportation services to determine the most cost-effective ways of providing nonemergency transportation services to the patients served under the program. The performance evaluation shall be completed and provided to the members of the Senate Medicaid Committee and the House Medicaid Committee not later than January 1, 2019, and every two (2) years thereafter.

(37) [Deleted]

(38) Chiropractic services. A chiropractor's manual manipulation of the spine to correct a subluxation, if x-ray demonstrates that a subluxation exists and if the subluxation has resulted in a neuromusculoskeletal condition for which manipulation is appropriate treatment, and related spinal x-rays performed to document these conditions. Reimbursement for chiropractic services shall not exceed Seven Hundred Dollars ($700.00) per year per beneficiary.

(39) Dually eligible Medicare/Medicaid beneficiaries. The division shall pay the Medicare deductible and coinsurance amounts for services available under Medicare, as determined by the division. From and after July 1, 2009, the division shall reimburse crossover claims for inpatient hospital services and crossover claims covered under Medicare Part B in the same manner that was in effect on January 1, 2008, unless specifically authorized by the Legislature to change this method.

(40) [Deleted]

(41) Services provided by the State Department of Rehabilitation Services for the care and rehabilitation of persons with spinal cord injuries or traumatic brain injuries, as allowed under waivers from the United States Department of Health and Human Services, using up to seventy-five percent (75%) of the funds that are appropriated to the Department of Rehabilitation Services from the Spinal Cord and Head Injury Trust Fund established under Section 37-33-261 and used to match federal funds under a cooperative agreement between the division and the department.

(42) [Deleted]

(43) The division shall provide reimbursement, according to a payment schedule developed by the division, for smoking cessation medications for pregnant women during their pregnancy and other Medicaid-eligible women who are of child-bearing age.

(44) Nursing facility services for the severely disabled.

(a) Severe disabilities include, but are not limited to, spinal cord injuries, closed-head injuries and ventilator-dependent patients.

(b) Those services must be provided in a long-term care nursing facility dedicated to the care and treatment of persons with severe disabilities.

(45) Physician assistant services. Services furnished by a physician assistant who is licensed by the State Board of Medical Licensure and is practicing with physician supervision under regulations adopted by the board, under regulations adopted by the division. Reimbursement for those services shall not exceed ninety percent (90%) of the reimbursement rate for comparable services rendered by a physician. The division may provide for a reimbursement rate for physician assistant services of up to one hundred percent (100%) or the reimbursement rate for comparable services rendered by a physician for physician assistant services that are provided after the normal working hours of the physician assistant, as determined in accordance with regulations of the division.

(46) The division shall make application to the federal Centers for Medicare and Medicaid Services (CMS) for a waiver to develop and provide services for children with serious emotional disturbances as defined in Section 43-14-1(1), which may include home- and community-based services, case management services or managed care services through mental health providers certified by the Department of Mental Health. The division may implement and provide services under this waivered program only if funds for these services are specifically appropriated for this purpose by the Legislature, or if funds are voluntarily provided by affected agencies.

(47) (a) The division may develop and implement disease management programs for individuals with high-cost chronic diseases and conditions, including the use of grants, waivers, demonstrations or other projects as necessary.

(b) Participation in any disease management program implemented under this paragraph (47) is optional with the individual. An individual must affirmatively elect to participate in the disease management program in order to participate, and may elect to discontinue participation in the program at any time.

(48) Pediatric long-term acute care hospital services.

(a) Pediatric long-term acute care hospital services means services provided to eligible persons under twenty-one (21) years of age by a freestanding Medicare-certified hospital that has an average length of inpatient stay greater than twenty-five (25) days and that is primarily engaged in providing chronic or long-term medical care to persons under twenty-one (21) years of age.

(b) The services under this paragraph (48) shall be reimbursed as a separate category of hospital services.

(49) The division may establish copayments and/or coinsurance for any Medicaid services for which copayments and/or coinsurance are allowable under federal law or regulation.

(50) Services provided by the State Department of Rehabilitation Services for the care and rehabilitation of persons who are deaf and blind, as allowed under waivers from the United States Department of Health and Human Services to provide home- and community-based services using state funds that are provided from the appropriation to the State Department of Rehabilitation Services or if funds are voluntarily provided by another agency.

(51) Upon determination of Medicaid eligibility and in association with annual redetermination of Medicaid eligibility, beneficiaries shall be encouraged to undertake a physical examination that will establish a base-line level of health and identification of a usual and customary source of care (a medical home) to aid utilization of disease management tools. This physical examination and utilization of these disease management tools shall be consistent with current United States Preventive Services Task Force or other recognized authority recommendations.

For persons who are determined ineligible for Medicaid, the division will provide information and direction for accessing medical care and services in the area of their residence.

(52) Notwithstanding any provisions of this article, the division may pay enhanced reimbursement fees related to trauma care, as determined by the division in conjunction with the State Department of Health, using funds appropriated to the State Department of Health for trauma care and services and used to match federal funds under a cooperative agreement between the division and the State Department of Health. The division, in conjunction with the State Department of Health, may use grants, waivers, demonstrations, enhanced reimbursements, Upper Payment Limits Programs, supplemental payments, or other projects as necessary in the development and implementation of this reimbursement program.

(53) Targeted case management services for high-cost beneficiaries may be developed by the division for all services under this section.

(54) [Deleted]

(55) Therapy services. The plan of care for therapy services may be developed to cover a period of treatment for up to six (6) months, but in no event shall the plan of care exceed a six-month period of treatment. The projected period of treatment must be indicated on the initial plan of care and must be updated with each subsequent revised plan of care. Based on medical necessity, the division shall approve certification periods for less than or up to six (6) months, but in no event shall the certification period exceed the period of treatment indicated on the plan of care. The appeal process for any reduction in therapy services shall be consistent with the appeal process in federal regulations.

(56) Prescribed pediatric extended care centers services for medically dependent or technologically dependent children with complex medical conditions that require continual care as prescribed by the child's attending physician, as determined by the division.

(57) No Medicaid benefit shall restrict coverage for medically appropriate treatment prescribed by a physician and agreed to by a fully informed individual, or if the individual lacks legal capacity to consent by a person who has legal authority to consent on his or her behalf, based on an individual's diagnosis with a terminal condition. As used in this paragraph (57), "terminal condition" means any aggressive malignancy, chronic end-stage cardiovascular or cerebral vascular disease, or any other disease, illness or condition which a physician diagnoses as terminal.

(58) Treatment services for persons with opioid dependency or other highly addictive substance use disorders. The division is authorized to reimburse eligible providers for treatment of opioid dependency and other highly addictive substance use disorders, as determined by the division. Treatment related to these conditions shall not count against any physician visit limit imposed under this section.

(59) The division shall allow beneficiaries between the ages of ten (10) and eighteen (18) years to receive vaccines through a pharmacy venue. The division and the State Department of Health shall coordinate and notify OB-GYN providers that the Vaccines for Children program is available to providers free of charge.

(60) Border city university-affiliated pediatric teaching hospital.

(a) Payments may only be made to a border city university-affiliated pediatric teaching hospital if the Centers for Medicare and Medicaid Services (CMS) approve an increase in the annual request for the provider payment initiative authorized under 42 CFR Section 438.6(c) in an amount equal to or greater than the estimated annual payment to be made to the border city university-affiliated pediatric teaching hospital. The estimate shall be based on the hospital's prior year Mississippi managed care utilization.

(b) As used in this paragraph (60), the term "border city university-affiliated pediatric teaching hospital" means an out-of-state hospital located within a city bordering the eastern bank of the Mississippi River and the State of Mississippi that submits to the division a copy of a current and effective affiliation agreement with an accredited university and other 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 (5) different 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) years.

(c) The cost of providing services to Mississippi Medicaid beneficiaries under the age of twenty-one (21) years 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.

(d) It is the intent of the Legislature that payments shall not result in any in-state hospital receiving payments lower than they would otherwise receive if not for the payments made to any border city university-affiliated pediatric teaching hospital.

(e) This paragraph (60) shall stand repealed on July 1, 2024.

(61) Services described in Section 41-140-3 that are provided by certified community health workers employed and supervised by a Medicaid provider. Reimbursement for these services shall be provided only if the division has received approval from the Centers for Medicare and Medicaid Services for a state plan amendment, waiver or alternative payment model for services delivered by certified community health workers.

(62) Coverage for the services described in Sections 16 through 21, 33 and 48 through 55 of this act.

(B) Planning and development districts participating in the home- and community-based services program for the elderly and disabled as case management providers shall be reimbursed for case management services at the maximum rate approved by the Centers for Medicare and Medicaid Services (CMS).

(C) The division may pay to those providers who participate in and accept patient referrals from the division's emergency room redirection program a percentage, as determined by the division, of savings achieved according to the performance measures and reduction of costs required of that program. Federally qualified health centers may participate in the emergency room redirection program, and the division may pay those centers a percentage of any savings to the Medicaid program achieved by the centers' accepting patient referrals through the program, as provided in this subsection (C).

(D) (1) As used in this subsection (D), the following terms shall be defined as provided in this paragraph, except as otherwise provided in this subsection:

(a) "Committees" means the Medicaid Committees of the House of Representatives and the Senate, and "committee" means either one of those committees.

(b) "Rate change" means an increase, decrease or other change in the payments or rates of reimbursement, or a change in any payment methodology that results in an increase, decrease or other change in the payments or rates of reimbursement, to any Medicaid provider that renders any services authorized to be provided to Medicaid recipients under this article.

(2) Whenever the Division of Medicaid proposes a rate change, the division shall give notice to the chairmen of the committees at least thirty (30) calendar days before the proposed rate change is scheduled to take effect. The division shall furnish the chairmen with a concise summary of each proposed rate change along with the notice, and shall furnish the chairmen with a copy of any proposed rate change upon request. The division also shall provide a summary and copy of any proposed rate change to any other member of the Legislature upon request.

(3) If the chairman of either committee or both chairmen jointly object to the proposed rate change or any part thereof, the chairman or chairmen shall notify the division and provide the reasons for their objection in writing not later than seven (7) calendar days after receipt of the notice from the division. The chairman or chairmen may make written recommendations to the division for changes to be made to a proposed rate change.

(4) (a) The chairman of either committee or both chairmen jointly may hold a committee meeting to review a proposed rate change. If either chairman or both chairmen decide to hold a meeting, they shall notify the division of their intention in writing within seven (7) calendar days after receipt of the notice from the division, and shall set the date and time for the meeting in their notice to the division, which shall not be later than fourteen (14) calendar days after receipt of the notice from the division.

(b) After the committee meeting, the committee or committees may object to the proposed rate change or any part thereof. The committee or committees shall notify the division and the reasons for their objection in writing not later than seven (7) calendar days after the meeting. The committee or committees may make written recommendations to the division for changes to be made to a proposed rate change.

(5) If both chairmen notify the division in writing within seven (7) calendar days after receipt of the notice from the division that they do not object to the proposed rate change and will not be holding a meeting to review the proposed rate change, the proposed rate change will take effect on the original date as scheduled by the division or on such other date as specified by the division.

(6) (a) If there are any objections to a proposed rate change or any part thereof from either or both of the chairmen or the committees, the division may withdraw the proposed rate change, make any of the recommended changes to the proposed rate change, or not make any changes to the proposed rate change.

(b) If the division does not make any changes to the proposed rate change, it shall notify the chairmen of that fact in writing, and the proposed rate change shall take effect on the original date as scheduled by the division or on such other date as specified by the division.

(c) If the division makes any changes to the proposed rate change, the division shall notify the chairmen of its actions in writing, and the revised proposed rate change shall take effect on the date as specified by the division.

(7) Nothing in this subsection (D) shall be construed as giving the chairmen or the committees any authority to veto, nullify or revise any rate change proposed by the division. The authority of the chairmen or the committees under this subsection shall be limited to reviewing, making objections to and making recommendations for changes to rate changes proposed by the division.

(E) Notwithstanding any provision of this article, no new groups or categories of recipients and new types of care and services may be added without enabling legislation from the Mississippi Legislature, except that the division may authorize those changes without enabling legislation when the addition of recipients or services is ordered by a court of proper authority.

(F) The executive director shall keep the Governor advised on a timely basis of the funds available for expenditure and the projected expenditures. Notwithstanding any other provisions of this article, if current or projected expenditures of the division are reasonably anticipated to exceed the amount of funds appropriated to the division for any fiscal year, the Governor, after consultation with the executive director, shall take all appropriate measures to reduce costs, which may include, but are not limited to:

(1) Reducing or discontinuing any or all services that are deemed to be optional under Title XIX of the Social Security Act;

(2) Reducing reimbursement rates for any or all service types;

(3) Imposing additional assessments on health care providers; or

(4) Any additional cost-containment measures deemed appropriate by the Governor.

To the extent allowed under federal law, any reduction to services or reimbursement rates under this subsection (F) shall be accompanied by a reduction, to the fullest allowable amount, to the profit margin and administrative fee portions of capitated payments to organizations described in paragraph (1) of subsection (H).

Beginning in fiscal year 2010 and in fiscal years thereafter, when Medicaid expenditures are projected to exceed funds available for the fiscal year, the division shall submit the expected shortfall information to the PEER Committee not later than December 1 of the year in which the shortfall is projected to occur. PEER shall review the computations of the division and report its findings to the Legislative Budget Office not later than January 7 in any year.

(G) Notwithstanding any other provision of this article, it shall be the duty of each provider participating in the Medicaid program to keep and maintain books, documents and other records as prescribed by the Division of Medicaid in accordance with federal laws and regulations.

(H) (1) Notwithstanding any other provision of this article, the division is authorized to implement (a) a managed care program, (b) a coordinated care program, (c) a coordinated care organization program, (d) a health maintenance organization program, (e) a patient-centered medical home program, (f) an accountable care organization program, (g) provider-sponsored health plan, or (h) any combination of the above programs. As a condition for the approval of any program under this subsection (H)(1), the division shall require that no managed care program, coordinated care program, coordinated care organization program, health maintenance organization program, or provider-sponsored health plan may:

(a) Pay providers at a rate that is less than the Medicaid All Patient Refined Diagnosis Related Groups (APR-DRG) reimbursement rate;

(b) Override the medical decisions of hospital physicians or staff regarding patients admitted to a hospital for an emergency medical condition as defined by 42 US Code Section 1395dd. This restriction (b) does not prohibit the retrospective review of the appropriateness of the determination that an emergency medical condition exists by chart review or coding algorithm, nor does it prohibit prior authorization for nonemergency hospital admissions;

(c) Pay providers at a rate that is less than the normal Medicaid reimbursement rate. It is the intent of the Legislature that all managed care entities described in this subsection (H), in collaboration with the division, develop and implement innovative payment models that incentivize improvements in health care quality, outcomes, or value, as determined by the division. Participation in the provider network of any managed care, coordinated care, provider-sponsored health plan, or similar contractor shall not be conditioned on the provider's agreement to accept such alternative payment models;

(d) Implement a prior authorization and utilization review program for medical services, transportation services and prescription drugs that is more stringent than the prior authorization processes used by the division in its administration of the Medicaid program. Not later than December 2, 2021, the contractors that are receiving capitated payments under a managed care delivery system established under this subsection (H) shall submit a report to the Chairmen of the House and Senate Medicaid Committees on the status of the prior authorization and utilization review program for medical services, transportation services and prescription drugs that is required to be implemented under this subparagraph (d);

(e) [Deleted]

(f) Implement a preferred drug list that is more stringent than the mandatory preferred drug list established by the division under subsection (A)(9) of this section;

(g) Implement a policy which denies beneficiaries with hemophilia access to the federally funded hemophilia treatment centers as part of the Medicaid Managed Care network of providers.

Each health maintenance organization, coordinated care organization, provider-sponsored health plan, or other organization paid for services on a capitated basis by the division under any managed care program or coordinated care program implemented by the division under this section shall use a clear set of level of care guidelines in the determination of medical necessity and in all utilization management practices, including the prior authorization process, concurrent reviews, retrospective reviews and payments, that are consistent with widely accepted professional standards of care. Organizations participating in a managed care program or coordinated care program implemented by the division may not use any additional criteria that would result in denial of care that would be determined appropriate and, therefore, medically necessary under those levels of care guidelines.

(2) Notwithstanding any provision of this section, the recipients eligible for enrollment into a Medicaid Managed Care Program authorized under this subsection (H) may include only those categories of recipients eligible for participation in the Medicaid Managed Care Program as of January 1, 2021, the Children's Health Insurance Program (CHIP), and the CMS-approved Section 1115 demonstration waivers in operation as of January 1, 2021. No expansion of Medicaid Managed Care Program contracts may be implemented by the division without enabling legislation from the Mississippi Legislature.

(3) (a) Any contractors receiving capitated payments under a managed care delivery system established in this section shall provide to the Legislature and the division statistical data to be shared with provider groups in order to improve patient access, appropriate utilization, cost savings and health outcomes not later than October 1 of each year. Additionally, each contractor shall disclose to the Chairmen of the Senate and House Medicaid Committees the administrative expenses costs for the prior calendar year, and the number of full-equivalent employees located in the State of Mississippi dedicated to the Medicaid and CHIP lines of business as of June 30 of the current year.

(b) The division and the contractors participating in the managed care program, a coordinated care program or a provider-sponsored health plan shall be subject to annual program reviews or audits performed by the Office of the State Auditor, the PEER Committee, the Department of Insurance and/or independent third parties.

(i) The financial benefit to the State of Mississippi of the managed care program,

(ii) The difference between the premiums paid to the managed care contractors and the payments made by those contractors to health care providers,

(iii) Compliance with performance measures required under the contracts,

(iv) Administrative expense allocation methodologies,

(v) Whether nonprovider payments assigned as medical expenses are appropriate,

(vi) Capitated arrangements with related party subcontractors,

(vii) Reasonableness of corporate allocations,

(viii) Value-added benefits and the extent to which they are used,

(ix) The effectiveness of subcontractor oversight, including subcontractor review,

(x) Whether health care outcomes have been improved, and

(xi) The most common claim denial codes to determine the reasons for the denials.

The audit reports shall be considered public documents and shall be posted in their entirety on the division's website.

(4) All health maintenance organizations, coordinated care organizations, provider-sponsored health plans, or other organizations paid for services on a capitated basis by the division under any managed care program or coordinated care program implemented by the division under this section shall reimburse all providers in those organizations at rates no lower than those provided under this section for beneficiaries who are not participating in those programs.

(5) No health maintenance organization, coordinated care organization, provider-sponsored health plan, or other organization paid for services on a capitated basis by the division under any managed care program or coordinated care program implemented by the division under this section shall require its providers or beneficiaries to use any pharmacy that ships, mails or delivers prescription drugs or legend drugs or devices.

(6) (a) Not later than December 1, 2021, the contractors who are receiving capitated payments under a managed care delivery system established under this subsection (H) shall develop and implement a uniform credentialing process for providers. Under that uniform credentialing process, a provider who meets the criteria for credentialing will be credentialed with all of those contractors and no such provider will have to be separately credentialed by any individual contractor in order to receive reimbursement from the contractor. Not later than December 2, 2021, those contractors shall submit a report to the Chairmen of the House and Senate Medicaid Committees on the status of the uniform credentialing process for providers that is required under this subparagraph (a).

(b) If those contractors have not implemented a uniform credentialing process as described in subparagraph (a) by December 1, 2021, the division shall develop and implement, not later than July 1, 2022, a single, consolidated credentialing process by which all providers will be credentialed. Under the division's single, consolidated credentialing process, no such contractor shall require its providers to be separately credentialed by the contractor in order to receive reimbursement from the contractor, but those contractors shall recognize the credentialing of the providers by the division's credentialing process.

(c) The division shall require a uniform provider credentialing application that shall be used in the credentialing process that is established under subparagraph (a) or (b). If the contractor or division, as applicable, has not approved or denied the provider credentialing application within sixty (60) days of receipt of the completed application that includes all required information necessary for credentialing, then the contractor or division, upon receipt of a written request from the applicant and within five (5) business days of its receipt, shall issue a temporary provider credential/enrollment to the applicant if the applicant has a valid Mississippi professional or occupational license to provide the health care services to which the credential/enrollment would apply. The contractor or the division shall not issue a temporary credential/enrollment if the applicant has reported on the application a history of medical or other professional or occupational malpractice claims, a history of substance abuse or mental health issues, a criminal record, or a history of medical or other licensing board, state or federal disciplinary action, including any suspension from participation in a federal or state program. The temporary credential/enrollment shall be effective upon issuance and shall remain in effect until the provider's credentialing/enrollment application is approved or denied by the contractor or division. The contractor or division shall render a final decision regarding credentialing/enrollment of the provider within sixty (60) days from the date that the temporary provider credential/enrollment is issued to the applicant.

(d) If the contractor or division does not render a final decision regarding credentialing/enrollment of the provider within the time required in subparagraph (c), the provider shall be deemed to be credentialed by and enrolled with all of the contractors and eligible to receive reimbursement from the contractors.

(7) (a) Each contractor that is receiving capitated payments under a managed care delivery system established under this subsection (H) shall provide to each provider for whom the contractor has denied the coverage of a procedure that was ordered or requested by the provider for or on behalf of a patient, a letter that provides a detailed explanation of the reasons for the denial of coverage of the procedure and the name and the credentials of the person who denied the coverage. The letter shall be sent to the provider in electronic format.

(b) After a contractor that is receiving capitated payments under a managed care delivery system established under this subsection (H) has denied coverage for a claim submitted by a provider, the contractor shall issue to the provider within sixty (60) days a final ruling of denial of the claim that allows the provider to have a state fair hearing and/or agency appeal with the division. If a contractor does not issue a final ruling of denial within sixty (60) days as required by this subparagraph (b), the provider's claim shall be deemed to be automatically approved and the contractor shall pay the amount of the claim to the provider.

(c) After a contractor has issued a final ruling of denial of a claim submitted by a provider, the division shall conduct a state fair hearing and/or agency appeal on the matter of the disputed claim between the contractor and the provider within sixty (60) days, and shall render a decision on the matter within thirty (30) days after the date of the hearing and/or appeal.

(8) It is the intention of the Legislature that the division evaluate the feasibility of using a single vendor to administer pharmacy benefits provided under a managed care delivery system established under this subsection (H). Providers of pharmacy benefits shall cooperate with the division in any transition to a carve-out of pharmacy benefits under managed care.

(9) The division shall evaluate the feasibility of using a single vendor to administer dental benefits provided under a managed care delivery system established in this subsection (H). Providers of dental benefits shall cooperate with the division in any transition to a carve-out of dental benefits under managed care.

(10) It is the intent of the Legislature that any contractor receiving capitated payments under a managed care delivery system established in this section shall implement innovative programs to improve the health and well-being of members diagnosed with prediabetes and diabetes.

(11) It is the intent of the Legislature that any contractors receiving capitated payments under a managed care delivery system established under this subsection (H) shall work with providers of Medicaid services to improve the utilization of long-acting reversible contraceptives (LARCs). Not later than December 1, 2021, any contractors receiving capitated payments under a managed care delivery system established under this subsection (H) shall provide to the Chairmen of the House and Senate Medicaid Committees and House and Senate Public Health Committees a report of LARC utilization for State Fiscal Years 2018 through 2020 as well as any programs, initiatives, or efforts made by the contractors and providers to increase LARC utilization. This report shall be updated annually to include information for subsequent state fiscal years.

(12) The division is authorized to make not more than one (1) emergency extension of the contracts that are in effect on July 1, 2021, with contractors who are receiving capitated payments under a managed care delivery system established under this subsection (H), as provided in this paragraph (12). The maximum period of any such extension shall be one (1) year, and under any such extensions, the contractors shall be subject to all of the provisions of this subsection (H). The extended contracts shall be revised to incorporate any provisions of this subsection (H).

(I) [Deleted]

(J) There shall be no cuts in inpatient and outpatient hospital payments, or allowable days or volumes, as long as the hospital assessment provided in Section 43-13-145 is in effect. This subsection (J) shall not apply to decreases in payments that are a result of: reduced hospital admissions, audits or payments under the APR-DRG or APC models, or a managed care program or similar model described in subsection (H) of this section.

(K) In the negotiation and execution of such contracts involving services performed by actuarial firms, the Executive Director of the Division of Medicaid may negotiate a limitation on liability to the state of prospective contractors.

(L) The Division of Medicaid shall reimburse for services provided to eligible Medicaid beneficiaries by a licensed birthing center in a method and manner to be determined by the division in accordance with federal laws and federal regulations. The division shall seek any necessary waivers, make any required amendments to its State Plan or revise any contracts authorized under subsection (H) of this section as necessary to provide the services authorized under this subsection. As used in this subsection, the term "birthing centers" shall have the meaning as defined in Section 41-77-1(a), which is a publicly or privately owned facility, place or institution constructed, renovated, leased or otherwise established where nonemergency births are planned to occur away from the mother's usual residence following a documented period of prenatal care for a normal uncomplicated pregnancy which has been determined to be low risk through a formal risk-scoring examination.

(M) This section shall stand repealed on July 1, 2028.

SECTION 59. This act shall take effect and be in force from and after July 1, 2026.