In order to encourage and facilitate collaboration between Mississippi Medicaid providers and managed care entities contracting on a capitated basis with the Division of Medicaid pursuant to Section 43-13-117(H), to align incentives in support of integrated and coordinated health care delivery, and to encourage the development of appropriate population or community health strategies to better […]
As used in this article, “Provider-Sponsored Health Plan” means a Mississippi not-for-profit corporation formed for the purposes of operating a not-for-profit health plan or managed care entity, with its principal place of business within the State of Mississippi, and which is owned and governed exclusively by (a) not-for-profit Mississippi hospital or physician industry or trade […]
Before offering or providing services to persons residing in this state, the Department of Insurance shall certify that any entity applying to operate in this state as a provider-sponsored health plan meets the definition provided in Section 83-5-603 and has been licensed as either a health maintenance organization pursuant to Section 83-41-1 et seq., or […]
Provider-sponsored health plans shall: Demonstrate ownership or substantial representation in governance and operations by licensed Mississippi hospitals and physicians that participate in the Mississippi Medicaid Program. Notwithstanding any other provision of law to the contrary, for the purpose of meeting this requirement, hospitals owned by the state and hospitals owned by local governmental entities are […]
The purpose of this article is to: Provide the Commissioner of Insurance a summary of an insurer or insurance group’s corporate governance structure, policies and practices to permit the commissioner to gain and maintain an understanding of the insurer’s corporate governance framework. Outline the requirements for completing a corporate governance annual disclosure with the Commissioner […]
As used in this article, unless the context requires otherwise: “Commissioner” means the Commissioner of Insurance of the State of Mississippi. “Corporate Governance Annual Disclosure (CGAD)” means a confidential report filed by the insurer or insurance group made in accordance with the requirements of this article. “Insurance group” means those insurers and affiliates included within […]
The commissioner may, upon notice and opportunity for all interested persons to be heard, issue such rules, regulations and orders as shall be necessary to carry out the provisions of this article. Laws of 2019, ch. 343, § 10, effective January 1, 2020, provides: “SECTION 10. This act shall take effect and be in force […]
Documents, materials or other information including the CGAD, in the possession or control of the Department of Insurance that are obtained by, created by or disclosed to the commissioner or any other person under this article, are recognized by this state as being proprietary and to contain trade secrets. All such documents, materials or other […]
The commissioner may retain, at the insurer’s expense, third-party consultants, including attorneys, actuaries, accountants and other experts not otherwise a part of the commissioner’s staff as may be reasonably necessary to assist the commissioner in reviewing the CGAD and related information or the insurer’s compliance with this article. Any persons retained under subsection (1) of […]
Any insurer failing, without just cause, to timely file the CGAD as required in this article shall be required, after notice and hearing, to pay a penalty of One Hundred Dollars ($100.00) for each day’s delay, to be recovered by the commissioner and the penalty so recovered shall be paid into the State General Fund. […]
