Title 43, Public Welfare

(1) The state board of public welfare shall appoint a medical advisory committee consisting of not less than nine (9) nor more than twenty (20) physicians from among nominees made by the Mississippi State Medical Association whose respective tenures of service shall be not less t…

This article shall be entitled and cited as the “Mississippi Medicaid Law.”

For the purpose of affording health care and remedial and institutional services in accordance with the requirements for federal grants and other assistance under Titles XVIII, XIX and XXI of the Social Security Act, as amended, a statewide system of medical assistance is establi…

(a) When used in this article, the following definitions shall apply, unless the context requires otherwise:(a) “Administering agency” means the Division of Medicaid in the Office of the Governor as created by this article.(b) “Division” or “Division of Medicaid” means the Divisi…

(1) The Division of Medicaid is created in the Office of the Governor and established to administer this article and perform such other duties as are prescribed by law. (2) (a) The Governor shall appoint a full-time executive director, with the advice and consent of the Senate, w…

The director, with the approval of the governor and pursuant to the rules and regulations of the state personnel board, may adopt reasonable rules and regulations to provide for an open, competitive or qualifying examination for all employees of the division other than the direct…

Every state health agency, as defined in Section 43-13-105, shall obtain an appropriation of state funds from the state Legislature for all medical assistance programs rendered by the agency and shall organize its programs and budgets in such a manner as to secure maximum federal…

(1) The State Treasurer shall receive on behalf of the state, and execute all instruments incidental thereto, federal and other funds to be used for financing the medical assistance plan or program adopted pursuant to this article, and place all such funds in a special account to…

(1) Recipients of Medicaid shall be the following persons only:(1) Those who are qualified for public assistance grants under provisions of Title IV-A and E of the federal Social Security Act, as amended, including those statutorily deemed to be IV-A and low income families and c…

(1) Ambulatory prenatal care shall be available to a pregnant woman under this article during a presumptive eligibility period in accordance with the provisions of this section. (2) For purposes of this section, the following terms shall be defined as provided in this subsection:…

(1) It shall be the duty of the Division of Medicaid to fully implement and carry out the administrative functions of determining the eligibility of those persons who qualify for medical assistance under Section 43-13-115. (2) In determining Medicaid eligibility, the Division of …

(1) For purposes of this section:(a) “Financial institution” has the meaning given by Sections 81-3-1 and 81-12-3, and shall include, but not be limited to, credit unions, stock brokerages, public or private entities administering retirement, savings, annuities, life insurance an…

(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 appl…

It is the intent of the Legislature to expand access to Medicaid-funded home- and community-based services for eligible nursing facility residents who choose those services. The Executive Director of the Division of Medicaid is authorized to transfer funds allocated for nursing f…

The Division of Medicaid is authorized and directed to study the feasibility of implementing a pilot program to provide chronic disease management of chronic obstructive pulmonary disease (COPD) using private sources of funding in an effort to reduce the financial and clinical bu…

(1) This section shall be known and may be cited as the “Mississippi Pediatric Access to Critical Health Care Protection Act.” (2) The purpose of this section is to promote quality health care and to ensure Mississippi children have access to pediatric inpatient hospital care. (3…

Notwithstanding any other provision of Section 43-13-117, the division shall not authorize payment of part or all of the costs of care and services rendered by any entity that performs nontherapeutic abortions, maintains or operates a facility where nontherapeutic abortions are p…

The Division of Medicaid is authorized to reimburse for services provided to eligible Medicaid beneficiaries by a licensed freestanding psychiatric hospital in a method and manner to be determined by the division in accordance with federal law and federal regulations. The divisio…

(1) The Division of Medicaid may apply to the federal Center for Medicaid Services (CMS) for necessary waivers to provide federal funding under the Medicaid program for providing reimbursement for authorized services to medically frail inmates who qualify for nursing home-level c…

Notwithstanding any other provisions of Section 43-13-117, the division shall not reimburse or provide coverage for gender transition procedures for a person under eighteen (18) years of age. As used in this section, the term “gender transition procedures” means the same as defin…

It shall be the duty of each provider participating in the medical assistance program to keep and maintain books, documents, and other records as prescribed by the division of Medicaid in substantiation of its claim for services rendered Medicaid recipients, and such books, docum…

(1) Any person who is a Medicaid recipient and is receiving medical assistance for services provided in a long-term care facility under the provisions of Section 43-13-117 from the Division of Medicaid in the Office of the Governor, who dies intestate and leaves no known heirs, s…

(1) The division shall administer the Medicaid program under the provisions of this article, and may do the following:(a) Adopt and promulgate reasonable rules, regulations and standards, with approval of the Governor, and in accordance with the Administrative Procedures Law, Sec…

(1) The division is authorize to apply to the Center for Medicare and Medicaid Services of the United States Department of Health and Human Services for waivers and research and demonstration grants. (2) The division is further authorized to accept and expend any grants, donation…

(a) The determination of the method of providing payment of claims under this article shall be made by the division, with approval of the Governor, which methods may be:(a) By contract with insurance companies licensed to do business in the State of Mississippi or with nonprofit …

(1) If Medicaid is provided to a recipient under this article for injuries, disease or sickness caused under circumstances creating a cause of action in favor of the recipient against any person, firm, corporation, political subdivision or other state agency, then the division sh…

(a) As a condition of doing business in the state, health insurers, including self-insured plans, group health plans (as defined in Section 607(1) of the Employee Retirement Income Security Act of 1974), service benefit plans, managed care organizations, pharmacy benefit managers…

(1) Within sixty (60) days after the end of each fiscal year and at each regular session of the Legislature, the division shall make and publish a report to the Governor and to the Legislature, showing for the period of time covered the following:(a) The total number of recipient…

Any person making application for benefits under this article for himself or for another person, and any provider of services, who knowingly makes a false statement or false representation or fails to disclose a material fact to obtain or increase any benefit or payment under thi…

Any person who shall, through intentional misrepresentation, fraud, deceit or unlawful design, either acting individually or in concert with others, influence any recipient to elect any particular provider of services, or any particular type of services, for the purposes and with…

It is the intent of the Legislature that all federal matching funds for medical assistance under Titles V, XVIII and XIX of the federal Social Security Act paid into any state health agency after October 10, 1969, shall be used exclusively to defray the cost of medical assistance…

The division is an agency as defined under Section 25-43-3 and, therefore, must comply in all respects with the Administrative Procedures Law, Section 25-43-1 et seq.

Nothing contained in this article shall be construed to prevent the Governor, in his discretion, from discontinuing or limiting medical assistance to any individuals who are classified or deemed to be within any optional group or optional category of recipients as prescribed unde…

There is created in the State Treasury a special fund to be known as the “Medical Care Fund,” which shall be comprised of monies transferred by public or private health care providers, governing bodies of counties, municipalities, public or community hospitals and other political…

(1) (a) Upon each nursing facility licensed by the State of Mississippi, there is levied an assessment in an amount set by the division, equal to the maximum rate allowed by federal law or regulation, for each licensed and occupied bed of the facility.(b) A nursing facility is ex…

(1) The Mississippi Medicaid Program and the Children’s Health Insurance Program, in consultation with statewide organizations focused on premature infant healthcare, shall:(a) Examine and improve hospital discharge and follow-up care procedures for premature infants born earlier…

This article shall be known and may be cited as the “Medicaid Fraud Control Act.”

(a) As used in this article:(a) “Benefit” means the receipt of money, goods, services or anything of pecuniary value.(b) “False statement” or “false representation” means a statement or representation knowingly and wilfully made by a person knowing of the falsity of the statement…

(1) A person shall not knowingly make or cause to be made a false representation of a material fact in an application for Medicaid benefits. (2) A person shall not knowingly make or cause to be made a false statement of a material fact for use in determining rights to a Medicaid …

A person shall not solicit, offer or receive a kickback or bribe in the furnishing of goods or services for which payment is or may be made in whole or in part pursuant to the Medicaid program, or make or receive any such payment, or receive a rebate of a fee or charge for referr…

A person shall not knowingly and wilfully make, induce or seek to induce the making of a false statement or false representation of a material fact with respect to the conditions or operation of an institution or facility in order that the institution or facility may qualify, upo…

A person shall not enter into an agreement, combination or conspiracy to defraud the state by obtaining or aiding another to obtain the payment or allowance of a false, fictitious or fraudulent claim for Medicaid benefits.

A person shall not make, present or cause to be made or presented a claim for Medicaid benefits, knowing the claim to be false, fictitious or fraudulent.

A person who violates any provision of Sections 43-13-205 through 43-13-213 shall be guilty of a felony, and, upon conviction thereof, shall be punished by imprisonment for not more than five (5) years, or by a fine of not more than Fifty Thousand Dollars ($50,000.00), or both. S…

In any prosecution under this article, it shall not be necessary to show that the person had knowledge of similar acts having been performed in the past on the part of persons acting on his behalf, nor to show that the person had actual notice that the acts by persons acting on h…

There is hereby created within the office of the attorney general a “Medicaid Fraud Control Unit.” The unit shall consist of a director appointed by the attorney general and such attorneys, auditors, investigator and other such personnel as are necessary to conduct the activities…