MHA's Legislative Liaison

Legislative update: Final Medicaid bill

Governor Barbour signed House Bill 71 into law on June 30 around 9:30 p.m. Attached is an Executive Summary of the major provisions in the statute, with a link for you to download the actual bill.

Download Executive Summary of HB71

Bill passes, sent to Governor to sign

The House and Senate today passed HB 71 (Medicaid Technical Amendments and Reauthorization of DoM) on June 30. The measure is being transmitted to the Governor’s Office for his signature. 

MHA will be sending out details of the new statute to members today.

Update on Medicaid agreement

Today, the Mississippi Hospital Association held a press conference asking legislators to support HB 71 with no amendments. Sam Cameron's statement during the press conference is available online here.

MHA Legislative Update: Barbour says he won't call Special Session

Just after 5 p.m. on June 22, Governor Barbour’s office released the statement attached below. Shortly thereafter, Lt. Governor Bryant’s office released a statement, also attached. 

In his statement, Barbour rejects the Medicaid technical amendments bill drafted and agreed to by House and Senate negotiators and endorsed last night by Lt. Governor Bryant.

The Governor points to that part of current law that requires him to make cuts when he “reasonably foresees” that Medicaid expenditures exceed appropriated funds. The statute states the Governor must first cut all optional services prior to making cuts in mandatory services. Barbour has interpreted this statute differently and obviously wants to begin cutting hospitals on July 2. One of MHA’s “protections” would prevent him from cutting hospital reimbursement rates, days of service, or volumes as long as the new assessment is in effect.

The Governor says in his statement, “At the demand of the Mississippi Hospital Association, the House of Representatives has insisted on gutting this very important law. . . .”. He adds, “I appreciate the senators and Lieutenant Governor Phil Bryant who have resisted this proposal and continue to oppose it.” (The proposal, you’ll recall, was negotiated and approved by Senate Public Health and Welfare Chairman Hob Bryan on behalf of the Senate and upon instructions from Lt. Governor Bryant.)

Lt. Governor Bryant says, “ I agree with the Governor that this authority should not be removed.” and “stresses the importance of Governor Barbour to have continued budgeting authority over the Division of Medicaid.”

The Governor further states, “I will fight the proposal with all my might,” and concludes "Obviously, there is no need to call a Special Session when such enormous Medicaid issues remain unresolved." 

MHA has met with House leaders, who are both astounded and perplexed. We will keep you updated daily as we get more information.

Gov. Barbour's statement: Download GHB Statement on Medicaid

Lt. Gov. Bryant's statement: Download Phil Bryant Statement

MHA Legislative Update: House & Senate budget agreement reached

House and Senate budget leaders completed their revisions of the proposed FY2010 budget last night and held a joint press conference at the Capitol. Included in the agreement is the Medicaid Technical amendments bill. Following are the major provisions of the Medicaid bill as it has been sent to the Governor as part of the overall budget recommendations:

Assessments

A new tax of $60 Million is imposed on hospitals and will remain in effect until July, 2012. The assessment can escalate to $90 Million during that period (depending on changes in the FMAP) but cannot be escalated more than $1.5 Million per quarter in each of the nine quarters beginning January 1, 2011. Total liability for hospitals would, therefore, be $69 Million if the FMAP returns to pre-ARRA levels. Also, if CMS does not approve the lower-of-logic provision, the amount of the assessment will be reduced $7.5 Million.

Protections

- Services provided at “off-campus” outpatient facilities in existence or under construction as of July 1, 2009, will be reimbursed at outpatient rates;

- UPL assessments will be used for the sole purpose of financing the UPL program;

- Subject to CMS approval (via a state plan amendment) crossover claims for inpatient services and those covered under Medicare Part B will be reimbursed in the manner in effect January 1, 2008; (

- Prohibits any changes in payment methodologies used to determine reimbursement rates for inpatient and outpatient services;

- Allows implementation of “managed care” in July, 2010, BUT it: (1) limits the program to 15 percent of the Medicaid population; (2) allows a 30-day “opt-out” option for all beneficiaries; (3) requires all payments to the managed care companies to be considered regular Medicaid payments for purposes of the UPL and DSH programs; (4) requires DoM to request and be granted a CMS waiver on all of the above provisions before it can implement any form of managed care program; and (5) requires all managed care companies to reimburse all providers at rates no lower than those provided those who do not participate in the managed care program;

- Allows DoM to implement a DRG system after July 1, 2010, provided the system uses the prevailing corresponding Medicare DRG rate (or a closely related Medicare DRG rate) and applies rates to all hospitals based on the highest federal wage index currently used in the state;

- Provides there shall be no cuts in inpatient and outpatient hospital payments or allowable days or volumes as long as the assessment is in place;

- Codifies the Scheer Plan;

- Requires maximization of DSH and UPL;

- Requires timely payments of DSH and UPL;

- Requires that hospitals will receive the Medicare published market basket inflationary index payment increase.

Status

The House and Senate have agreed to this legislation. Governor Barbour has said he will not convene the Special Session on the entire state budget until he is presented an agreement that assesses hospitals $90 million with no protections. We commend Lt. Governor Bryant and Speaker McCoy for their leadership in crafting both a balanced budget for fiscal 2010 and this resolution to the Medicaid funding challenge.

We will advise you via Member Updates on further discussions between the legislative and executive branches.

MHA Legislative Update: Regular Legislative Session Ends

Lawmakers left the Capitol at midnight on June 3 with no resolution to Medicaid funding or the state budget. Adjournment came after four unsuccessful attempts in the House and one unsuccessful attempt in the Senate to extend the session. Lawmakers will now be summoned back to the Capitol by Gov. Haley Barbour in Special Session.

Negotiators on SB 2928 (Medicaid Technical Amendments/Hospital Tax) reportedly reached compromise around 7:30 p.m. The agreement contained taxes on nonparticipating cigarette manufacturers, a $60/$60/$60 Million hospital assessment with all of MHA’s protections, and reauthorization of Medicaid. The deal was reportedly rejected by Barbour before Sen. Nunnelee delivered word to Lt. Governor Bryant that the compromise had been accepted. Senate leaders then removed the compromise from the table.

Date and timing of topics for the Special Session remain unknown to everyone except Barbour and his staff. 

Legislative Update: May 22, 2009

 

House and Senate conferees on SB 2928 (Medicaid Technical Amendments/Hospital Tax) agreed on May 22 to discontinue their negotiations.

Chairmen Stringer and Nunnelee agreed that further discussions of a hospital tax would be pointless. They adjourned the conference committee and began developing state budgets for fiscal 2010, without any new taxes levied on hospitals.

Senate and House leaders reportedly agreed behind closed doors to extend the Division of Medicaid for one year. House conferees have already signed a conference report achieving that task; Senate conferees are yet to sign it.

Legislative Update - May 13, 2009

 

House and Senate conferees on SB 2928 (Medicaid Technical Amendments) met on May 12 and 13 with little progress on or discussion of Medicaid. The majority of the focus has been on trying to resolve differences in state budget proposals for FY 2009-2011. While the hospital tax debate is critical to those budgets, conferees are currently deadlocked over other issues.

Regarding hospitals, Sen. Nunnelee continues to seek leverage on the House for either a $60 or $90 million hospital tax. His budget plans for FY 2010-2011 call for the hospital tax proceeds to be placed in a Medicaid “Rainy Day Fund.” The taxes hospitals would pay for two years would then be used to offset costs when stimulus funds are no longer available.

MHA and the House conferees have objected to that proposal for several reasons (not the least of those is our belief that such a scheme violates federal law). We also mutually and strongly object to taxing hospitals today for state budgets yet to be written.

Also “on the table” for the conferees is the question of reauthorizing the Division of Medicaid. Sen. Nunnelee is also trying to leverage MHA and the House with the threat of a Gov. Haley Barbour-run Medicaid program. Again, Sen. Nunnelee is trying to force us into higher taxes and fewer protections.

Attorney General Jim Hood on May 13 released an official opinion on the Governor running the Division of Medicaid by Executive Order. The essence of the opinion is that the Governor cannot recreate by Executive Order an agency terminated by act of the Legislature. He can run Medicaid by Executive Order BUT he would do so without an Executive Director and staff. He would have to abide by all restrictions currently in the law and would not have access to any of Medicaid's current funding sources. To have access to Medicaid funds, like the UPL program, the legislature would have to appropriate the money directly to the Governor. The House is very unlikely do agree to that.

Legislative Update - May 7, 2009

The 2009 Regular Session reconvened May 6 at 1:00 p.m. Earlier that morning, Gov. Haley Barbour held a public hearing on his revised Executive Budget Recommendation. Then, after both chambers came into session, Barbour called a Special Session that convened at 9:00 a.m. on May 7 to address three issues. (One of the issues was the DeSoto County certificate of need bill. The measure passed the Senate after considerable amendment on the Senate floor and died in the House with no action taken on it.) 

Governor Barbour’s revised budget recommendation includes an additional tax of $90 Million on hospitals. His remarks regarding the need for the hospital tax were both passionate and pointed.

In regular session on May 7, both chambers approved a 50 cent per pack increase in the excise tax on cigarettes. All but $5 million of the projected increase will be allocated to the Car Tag Fund.

On May 7, Senate Appropriations Chairman Alan Nunnelee presented his revised FY10 budget to members of the Senate. His budget includes the cigarette tax increase, no additional hospital assessment, and 10 percent cuts to all state agencies. His posturing is intended to make our unwillingness to pay the $90 million the sole purpose for making the state agency cuts.

House Appropriations Committee Chairman Johnny Stringer presented his revised budget on May 7 also. The House budget proposal doesn’t include any hospital assessments and fully funds K-12 education. It is Chairman Stringer’s belief that the FY10 budget can be balanced without the hospital tax.

Conferees on all appropriations bills are expected to begin meeting on May 8 to resolve their differences. Lawmakers are expected to work Saturday and could then recess again for a week.

Needless to say, funding Medicaid is now the central focus of the remaining days of the session. Gov. Barbour and the Senate leadership are trying to invoke every state agency and interest group to be vocal against hospitals. MHA will be responding with direct media and grassroots solicitations within a few days, so stay tuned.

Senate and House Pass Cigarette Tax

On May 6, the Senate and House took up HB 364 and both chambers passed a 68 cent cigarette tax that will provide much needed revenue for the state while leading to a reduction in youth smoking and general consumption.

House Ways and Means Committee Chairman Percy Watson, D-Hattiesburg, said the tax was expected to generate nearly $113 million next fiscal year.

The Senate voted 40-4 and the House 102-18 to approve the bill to boost the state’s excise tax from 18 cents to 68 cents per pack. The tax has remained unchanged since 1985 and is the third lowest in the country.  Click here to see how your legislators voted.