April 15, 2016
MPHCA spearheaded an effort that resulted in MQHC funding restored to $4,000,000 at close of 2016 legislative session via House Bill 1651
MS Legislature Finalizes/Cuts Budgets Final Recap of 2016 Legislative Session
Adjourns… Special Session Possible
The Mississippi Legislature cut a swath through 2016-17 state budgets over the prior weekend as they prepared to adjourn the legislative session, cutting spending in agencies ranging from the Department of Education to the Department of Health in response to slowing growth in tax collections. As lawmakers adjourned “Sine Die” (without return) – The Senate on Wednesday and House on Thursday - Gov. Phil Bryant immediately announced further cuts in the state budgets this fiscal year; and he suggested calling a special session as early as June to spend the proceeds from the settlement of a lawsuit with BP from the Deepwater Horizon oil spill.
The Budget that lawmakers hammered out in the final hours spends even less than the conservative starting budget with which they walked into this session. More typically, lawmakers start with a conservative budget but increases the amount available to spend in the final days of the Session.
State agency heads were also preparing to adjust to a new funding systems imposed this year in which they don’t necessarily keep all licensing fees or traffic fines that once were dedicated to specific causes; but also no longer face using their budgets to “pay rent” back to the state for office space or computer/information systems use. Regardless, the depth of some cuts were notable: Department of Agriculture is cut 18.7%; Wildlife and Fisheries was cut 7.7%; Corrections 4.2%; Archives and History 17.8%.
Adjournment ended a tumultuous and challenging session ushered in January with newly reelected Republican leadership. House Speaker Philip Gunn found that voters had given his party a three-fifths majority in the 122-member House; and Lt. Gov. Tate Reeves entered his second term as presiding officer in the Senate with a similar numerical advantage in the 52-member Senate. Despite the Republican strength, though, the session was often challenging on a range of issues, with Democrats - mostly in the House- invoking procedural maneuvers to slow the process, including asking that each bill be read aloud as per the Constitution of 1890 allows; and differences in priorities among the new Republican House majority.
In short, these are some of the major issues that dominated the session:
- Tight budget: Economists told the legislative budget leadership that even while the economy continued to grow – it is growing at a very slow pace. As a result, in a rare move, the leadership in the final days revised downward by .4 % their estimate of funds they are likely to have available in the fiscal year beginning July 1. The state’s $6.3 billion state-dollar spending plan includes $5.8 billion in “general funds” from state tax collections as well as other dedicated taxes and $5 million from the state’s rainy day fund (which still has approximately $350 million in reserves).
- Tax Cuts: Republican leadership delivered on campaign promise to cut taxes by implementing a 12-year plan to phase out $415 million in tax cuts, including: 1) Eliminating Mississippi’s 3% individual income tax bracket ($145 million) and raising the threshold for all paying state income taxes to $10,000;2) Phasing out the state’s corporate franchise tax on investments ($260 million), and; 3) Lowering the state’s self-employment tax ($10.2 million). The bulk of the tax cuts don’t begin to phase-in for at least two years, and House budget leaders openly expressed their intent to before that time consider a major overhaul of the state’s tax system that might undue or modify these tax measures. Gov. Bryant told reporters he would “study” the cut, noting his focus was on tax cuts for individuals rather than corporations.
- Workforce training: The MS Works bill is designed to eventually put up to $10 million a year toward job training and focusses on luring new employers and sustaining existing manufacturers and others. Specially, SB 2808 will: 1) Divert the current .2% minimum unemployment experience rate tax to the Mississippi Works Fund; 2) Ensure 75% of funds go toward new job creation and 25% of funds go toward retention and existing jobs; 3) Use the community college system; and bring Mississippi law into conformity with the WIOA.
- Education: After decades of debate, Mississippi lawmakers approved legislation blocking the election of local school district superintendents, saying local school boards should be free to find the best candidate from outside the boundaries of a district. Currently over 50 districts have elected superintendents.
- Gay Marriage: On "social issues", lawmakers ended the Session enacting HB 1523 that supporters said was designed to offer a measure of protection to both churches, faith-based institutions, and public and private sector employees who refused services in support of gay marriage. Critics called the legislation unnecessary at best, and discriminatory at worst; lawmakers and Gov. Phil Bryant found themselves the topic/target of an on-going national discussion on the issue, with some cheering them on and others calling for the legislation's repeal.
- Highway Infrastructure: Efforts to build a consensus around raising new revenues for highway maintenance stalled. The Mississippi Economic Council kicked off the Session calling for an additional $375 million annually to fund highway maintenance. However, legislators said a range of concerns – ranging from opposition to raising taxes to questions about the need for highway repairs, and even where and how the funds would be allocated – stymied a variety of funds-raising scenarios. Lawmakers in both chambers are likely to spend this summer and fall focused on both the challenges with road maintenance and potential funding solutions.
- Campaign Finance: After a flurry of media coverage focusing on use of campaign funds for seemingly personal expenses, the Legislature debated a bill to prohibit the conversion of campaign funds raised after January 1, 2017 for strictly personal use. The bill died, though, during conference committee negotiations.
- Bonds: Lawmakers authorized the borrowing through the sale of bonds of $250 million for projects ranging from building construction on university and community college campuses, to local bridge repairs to dozens of smaller, community projects like walking trails, museums and parks. Lawmakers also dedicated some of the proceeds of settlement of the lawsuit over the BP oil spill to construction, maintenance and other projects in South Mississippi.
Here is an update of high-profile healthcare legislation of interest:
- Medicaid HB 1650. Lawmakers funded this-year’s Medicaid short-fall deficit of $51.5 million in state dollars so the agency can finish the year; and then they authorized a $947 million in state dollars for Medicaid for the fiscal year beginning July 1. Those state dollars are part of Mississippi’s $5 billion state-federal Medicaid budget, and officials estimated the state funding is still below what is needed next year by about $80 million. If so, legislators will again be asked to address that deficit when they return in January, 2017. The appropriations bill increased funding for OBGYN services as well. While the agency wasn’t merged with the Dept. of Human Services (that bill died), the appropriations bill does commission a $250,000 on the operation and performance assessments “to examine potential changes in structure, processes and resources.”
- Solo ER’s: Gov. Phil Bryant signed SB 2297 that authorizes free- standing emergency rooms in rural regions of the state that have lost “critical access hospital” designation from CMS. The legislation authorizes the Dept. of Health to create regulations to award licensure and to govern free-standing ERs, and it prohibits one within 15 miles of any hospital-based ER.
- Health Fees: HB 289 would raise some fees within the Mississippi Department of Health within limits. The department can raise a licensing or registration fee, and other fees, up to twice over the next four years, but neither time may the increase be more than 15%. The bill is headed to the governor’s desk.
- Trauma: HB 298 would redirect traffic fees and other fines collected as part of funding for the state’s subsidized Trauma System to flow through the state’s general fund budget before being reauthorized specifically for the Trauma fund. This is part of a larger look at so-called “special funds,’’ such as licensing fees that now automatically go to fund the agencies that collect them. The leadership has insisted this will not result in a reduction in trauma funding. The bill is on the way to the governor’s desk; the Dept. of Health’s budgeted dollars for Trauma did not to appear to have been immediately impacted.
- MD Licensure: HB 41, which allows Mississippi to enter into reciprocal medical licensing agreements with other states, is on its way to the governor.
Note: The Board of Medical Licensure in response to multiple bills filed to allow APRNs to have independent practice. The 75 mile requirement was the final negotiation. https://www.msbml.ms.gov/msbml/web.nsf/webpageedit/Updates_Filings_4-4-16NP/$FILE/4-4-16NP.pdf?OpenElement
The following are “dead bills”
- Fraud HB 1116 would have enhanced identity verification and asset verification. The legislation was aimed at ensuring Medicaid beneficiaries have not hidden assets and that they are who they say they are. The bill died during conference committee negotiations, though, in part over questions about how to pay for it and how many social service benefits to apply it to.
- Medicaid/DHS: SB 2384, as approved by the Senate, would have merge the Division of Medicaid with the Mississippi Department of Human Services, which currently deals with TANF benefits, child support collections, and other programs. The legislation died in the final days of the session.
- Air EMS: SB 2340 would have required Air EMS operators in Mississippi to be associated with a Level I or Level II Trauma Center. We killed this legislation by discouraging the Public Health and Senate leadership from taking it up for a committee vote. It died by failing to advance on schedule.
- Telemedicine: HB 1178, as approved by the House, would have protected telemedicine practices as currently conducted in the state of Mississippi in statute, requiring telemedicine to be conducted by a licensed Mississippi physician via various modes of communication including telephone, store-and-forward technology, and/or video conferencing. This measure passed out of the House with 108 votes out of the 122-member body; The bill died in a Senate committee.
- Medicaid: HB 898, as introduced and approved by the House, would have required the state through the Division of Medicaid to reimburse OB/GYNs at 100% of Medicare. The Legislation has code sections to allow for expansive Medicaid amendments, and it died in the Senate.
- Procurement: HB 1452 was aimed at exempting medical services and products from IHL oversight and MS bidding laws. UMMC argued that it does a disservice to both patients and training physicians to require lowest-and-best bids; this legislation could potentially be a vehicle for future amendments. The bill died in the Senate.
Mississippi Legislative Report
April 19, 2016
As many of you know Saturday, April 16 was the budget deadline to complete negotiations on the state’s budget via appropriation, tax and bond measures via conference weekend.
Clare Hester reports:
After a long fought battle this weekend - MQHC grant program is restored to $4M. Most budgets have been cut - this has been a major undertaking and a great victory
Governor Bryant’s Rural Health Summit and MS Legislative Report (April 11, 2016)
Based on attendance at the Governor’s Rural Health Summit on April 11th, MPHCA believes we have a tremendous opportunity to aid the plight of struggling hospitals in our state.
Governor Bryant opened the summit with content that he consistently uses from the Blueprint Mississippi document:
- Goal of 2,000 additional physicians in MS by 2025
- Attention to the Economic Impact of 1 physician being approximately $2million to each local economy;
- The MS Rural Physician Program; although proud of there is a need for expanding.
- MS leading the nation in Telemedicine
He added that priorities of supply and demand; healthcare access and quality of patient care should all be priority areas of focus.
Mississippi Legislative Report
Gov. Bryant also referenced House Bill 41 and his expressed support of the Interstate Medical Licensure Compact.
ENACT INTO LAW THE INTERSTATE MEDICAL LICENSURE COMPACT AND PROVIDE THAT THE STATE OF MISSISSIPPI ENTERS THE COMPACT WITH OTHER STATES THAT JOIN IN THE COMPACT.
Senator Terry Burton also spoke and emphasized the following 2 items as priorities:
- Expansion of Telehealth/Telemedicine
- Expansion of Opportunities for Best Practice of Nurse Practitioners after 3-4 years of working with a physician. They should then be able to go into independent practice. He referenced his sponsorship of the Nurse Practitioner bill and the extension from 15 to 75 miles and what this should afford in the ability of NP’s and PA’s to practice what they know, particularly in rural areas.
Other presenters included Tim Moore, President & CEO Mississippi Hospital Association. MHA is still seeking to offer the Governor an option in lieu current Managed Care structure and the absence of Medicaid expansion to allow for a Provider-Sponsored Managed Care Plan.
They have partnered with Evolent https://www.evolenthealth.com/. They are a population-based health management group that will assist them in focusing on population health, ACO activity and Value-based payment options.
Other speakers were from the law firms of Waller, Taggart Rimes & Graham, and the Ochsner Health System talked about the future of change i.e. payment reform in healthcare delivery and the abysmal outlook for hospitals in the acute care business.
FQHCs were referenced by both Mr. Fairman and I during the presentation and Mr. Scott Phillips, Managing Director, Healthcare Management Partners shared the following FQHC/Hospital collaboration as a model with the audience.
Understanding more on Mississippi Hospital Crisis can be access via the following link: www.stateofyourhospital.com
As a follow up, Ms. Sherman has reached out to panel members to continue discussions for potential solutions by FQHCs.
April 11, 2016 (Legislative Update from Capital Resources)
The Final Stretch:
Mississippi lawmakers return to the Capitol Monday prepared to work through the coming weekend to complete business and adjourn the 2016 Regular Legislative Session. Three key deadlines loom:
- Saturday, April 16 is the budget deadline. It is the deadline to complete negotiations on the state’s budget via hundreds of appropriation, tax and bond measures that are now pending in conference committees. This is known as “conference weekend.” Finalizing the appropriation bills and bond bills also paves the way for final deals of scores of general bills.
- Wednesday, April 20 is the general deadline. It is the deadline for first consideration of negotiated deals on conference reports for general bills. Legislation that isn’t approved by this deadline has a slim chance to return.
- Sunday, April 24 is adjournment sine die. Legislators typically complete their business a few days prior to this official adjournment date.
Mississippi Legislative Report
March 28, 2016
Mississippi Legislators have until Wednesday, March 30, to approve pending general legislation before they return their attention to major tax and budget issues. The House and Senate worked last week to either pass general bills originating in the other chamber out of committee or kill them.
- Gov. Phil Bryant announce his appointment of Rep. Herb Frierson (R-Poplarville) as the state’s next Commissioner of the Department of Revenue. Frierson currently serves as chairman of the House Appropriations bill and is a pivotal player in the upcoming budgeting process. He will remain in that role through adjournment of this year’s regular session and will then takeover as Revenue, or Tax, Commissioner July 1.
- Vaccine exemption legislation die. HB 938, which passed the House 65-54 after a contentious debate, would have removed the Department of Health from approving vaccine exemptions for children. Senate leaders said the Department appears to be granting exemptions when requested.
- The federal Centers for Medicare and Medicaid (CMS) approve--for now--Mississippi’s supplemental Medicaid payment plan to hospitals. In a letter dated March 22, CMS told the state the formula for Medicaid supplemental payments to the state’s hospitals can’t remain static and must move toward a value-based system.
- The Mississippi Economic Council unveils a detailed report (found at http://www.msmec.com/images/Excelerate_MS/TRIP_Report_March_23.pdf) showing Mississippians will pay, on average, $640 in increased travel, auto repair, and other costs if the state doesn’t begin to invest more in highway maintenance. The House and Senate leadership are pushing to design a new highway funding package.
The following “dead bills”: (I would only list bill name and highlights) and the “read more” tab.
Air EMS: SB 2340 would have required Air EMS operators in Mississippi to be associated with a Level I or Level II Trauma Center. We killed this legislation by discouraging the Public Health and Senate leadership from taking it up for a committee vote. It died by failing to advance on schedule. We are guarding for possible amendments to other legislation.
Hospitals: HB 267 would have established a grant program administered by the Mississippi
Department of Health to support small and rural hospitals transition to new business models to survive changing economic and healthcare conditions.
Telemedicine: HB 1178, as approved by the House, would have protected telemedicine practices as currently conducted in the state of Mississippi in statute, requiring telemedicine to be conducted by a licensed Mississippi physician via various modes of communication including telephone, store-and-forward technology, and/or video conferencing. This measure passed out of the House with 108 votes out of the 122-member body; Senate committee action could occur as early as this week. There is opposition by UMMC and the state Board of Medical Licensure who intend to either kill the bill, severely limit services to licensed MS physicians who are actual residents of MS, and/or limit the mode of communication to video only. We have worked with existing providers, media, and business groups to shore up support for this legislation, which was filed in response to proposed Board of Medical Licensure rules to severely limit the practice of telemedicine.
Medicaid: HB 898, as introduced and approved by the House, would have required the state through the Division of Medicaid to reimburse OB/GYNs at 100% of Medicare. The Legislation has code sections to allow for expansive Medicaid amendments, and leadership in the Senate is likely to be extraordinarily cautious in dealing with it.
Procurement: HB 1452 was aimed at exempting medical services and products from IHL oversight and MS bidding laws. UMMC argues that it does a disservice to both patients and training physicians to require lowest-and-best bids; this legislation could potentially be a vehicle for future amendments. HB 1452 could potentially be amended to address that, as well, or to expand services for which UMMC would not have to procure.
Mississippi Legislative Report
March 21, 2016
Still Alive in the Legislature:
Mississippi House Bill 898
MS State Legislature page for HB898 (helpful language for drafting future legislation)
An Act To Amend Section 43-13-117, Mississippi Code Of 1972, To Direct The Division Of Medicaid To Reimburse Physicians With A Designation Of Family Medicine, General Internal Medicine, Pediatric Medicine, Obstetrics And Gynecology, Or A Subspecialty Recognized By The Division As Providing Primary Care Services At A Rate Not Less Than One Hundred Percent Of The Current Rate Established Under Medicare; To Provide That Medicaid Managed Care Plans Shall Reimburse For The Same Services In The Same Manner; And For Related Purposes.
Title: Medicaid; require reimbursement of all primary care physicians at 100% of Medicare rate.
Mississippi House Bill 364
An Act To Amend Section 27-65-105, Mississippi Code Of 1972, To Exempt From Sales Taxation Sales Of Tangible Personal Property, Labor, Services Or Products To Schools And School Districts Under A Program That Is Administered By Or Coordinated With An Agency, Commission, Department Or Other Instrumentality Of The United States Government When Payment For The Tangible Personal Property, Labor, Services Or Products Is Made By Or Through A Nonprofit Organization Or Other Entity Established By Or For The Benefit Of The Agency, Commission, Department Or Other Instrumentality Of The United States Government Administering Or Coordinating Such Program; And For Related Purposes.
Senate Bill 2384
(As Passed the Senate)
AN ACT TO ESTABLISH THE MISSISSIPPI DEPARTMENT OF MEDICAID AND HUMAN SERVICES WHICH SHALL CONSIST OF THE PROGRAMS OF THE DIVISION OF MEDICAID IN THE OFFICE OF THE GOVERNOR, THE DEPARTMENT OF HUMAN SERVICES IN THE OFFICE OF THE GOVERNOR WITH CERTAIN EXCEPTIONS AND THE MISSISSIPPI DEPARTMENT OF REHABILITATION SERVICES; TO ESTABLISH THE POSITION OF EXECUTIVE DIRECTOR OF THE MISSISSIPPI DEPARTMENT OF MEDICAID AND HUMAN SERVICES AND EMPOWER THE DIRECTOR TO ADMINISTER THE PROGRAMS OF THE NEW DEPARTMENT; TO TRANSFER THE SAID PROGRAMS TO THE NEW MISSISSIPPI DEPARTMENT OF MEDICAID AND HUMAN SERVICES