Bill Text: MO HB1155 | 2014 | Regular Session | Introduced
Bill Title: Requires the department of corrections to implement various correctional health care system changes to provide cost savings and improve claims payment
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2014-01-09 - Referred: Special Standing Committee on Urban Issues(H) [HB1155 Detail]
Download: Missouri-2014-HB1155-Introduced.html
SECOND REGULAR SESSION
97TH GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE HUBBARD.
4700L.01I D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To amend chapter 217, RSMo, by adding thereto one new section relating to health care systems for correctional facilities.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 217, RSMo, is amended by adding thereto one new section, to be known as section 217.232, to read as follows:
217.232. 1. Unless otherwise provided in this section, the provisions of this section shall apply to:
(1) All state correctional health care systems and services; and
(2) All state contracted managed correctional health care services.
2. The department of corrections shall implement state-of-the-art clinical code editing technology solutions to further automate claims resolution and enhance cost containment through improved claim accuracy and appropriate code correction. The technology shall be designed to identify and prevent errors or potential overbilling based on widely accepted and referenceable protocols, such as the American Medical Association and the Centers for Medicare and Medicaid Services. Such edits shall be applied automatically before claims are adjudicated to speed processing, reduce the number of pending or rejected claims, and help ensure a smoother and more consistent and open adjudication process with fewer delays in provider reimbursement.
3. The department shall implement correctional health care claims audit and recovery services to identify improper payments due to nonfraudulent issues, audit claims, obtain provider acknowledgment of audit results, and recover validated overpayments. Post-payment reviews shall verify that the diagnosis and procedure codes are accurate and valid based on the supporting physician documentation within the relevant medical records. Core categories of reviews may include, but not be limited to, coding compliance diagnosis related group (DRG) reviews, transfers, readmissions, cost outlier reviews, outpatient 72-hour rule reviews, payment errors, and billing errors.
4. The department shall implement automated payment detection, prevention, and recovery solutions to identify and submit claims for reimbursement under the MO HealthNet program for eligible inpatient hospital and professional services.
5. It is the intent of the general assembly that the department shall contract for such services and the resulting savings achieved under this section will be more than sufficient to cover the costs of implementation and administration. To the extent possible, technology services used in implementing the provisions of this section shall be funded through the actual savings achieved under this section. Reimbursement to the contractor may be contracted on the basis of a percentage of an achieved savings model, a per-beneficiary per-month model, a per- transaction model, a case-rate model, or any blended model of such methodologies. Reimbursement models with the contractor may also include performance guarantees of the contractor to ensure savings identified exceed program costs.
6. The department may promulgate rules to implement the provisions of this section. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2014, shall be invalid and void.
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