Bill Text: IA SF2031 | 2013-2014 | 85th General Assembly | Introduced


Bill Title: A bill for an act relating to corrections system health care costs.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2014-01-23 - Subcommittee, Hogg, Courtney, and Schneider. S.J. 117. [SF2031 Detail]

Download: Iowa-2013-SF2031-Introduced.html
Senate File 2031 - Introduced SENATE FILE 2031 BY SODDERS A BILL FOR An Act relating to corrections system health care costs. 1 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 2 TLSB 5593XS (5) 85 pf/nh
S.F. 2031 Section 1. LEGISLATIVE FINDINGS AND INTENT. The general 1 assembly finds that other states have saved millions of dollars 2 by implementing solutions to eliminate and recover health 3 care overpayments in the corrections system. Similarly, 4 states have significantly reduced such health care costs by 5 billing the Medicaid program for eligible inpatient health care 6 costs. Therefore, it is the intent of the general assembly 7 to implement automated payment detection, prevention, and 8 recovery solutions to reduce health care overpayments and to 9 ensure that Medicaid is billed for eligible inpatient hospital 10 and professional services for individuals in the corrections 11 system. 12 Sec. 2. NEW SECTION . 904.321 Health care cost containment. 13 1. The department, in consultation with the department 14 of human services, shall do all of the following in regard 15 to state correctional health care systems and services and 16 state-contracted managed correctional health care services: 17 a. Implement state-of-the-art clinical code editing 18 technology solutions to further automate health care claims 19 resolution and enhance health care cost containment through 20 improved claim accuracy and appropriate code correction. The 21 technology shall identify and prevent errors or potential 22 overbilling based on widely accepted and referenced protocols 23 such as the American medical association and the centers for 24 Medicare and Medicaid services protocols. The edits shall 25 be applied automatically before claims are adjudicated to 26 speed processing and reduce the number of pending or rejected 27 claims and to ensure a smoother, more consistent, and more 28 open adjudication process and fewer delays in provider 29 reimbursement. 30 b. Implement health care claims audit and recovery services 31 to identify improper payments due to nonfraudulent issues, 32 audit claims, obtain health care provider sign-off on the audit 33 results, and recover validated overpayments. Postpayment 34 reviews shall ensure that the diagnoses and procedure codes 35 -1- LSB 5593XS (5) 85 pf/nh 1/ 3
S.F. 2031 are accurate and valid based on the supporting physician 1 documentation within the medical records. Core categories of 2 reviews may include but are not limited to coding compliance 3 diagnosis related group reviews, transfers, readmissions, cost 4 outlier reviews, outpatient seventy-two-hour rule reviews, 5 payment errors, and billing errors. 6 c. Implement automated payment detection, prevention, 7 and recovery solutions to ensure that the Medicaid program 8 is billed for eligible inpatient hospital and professional 9 services. 10 2. a. The department may contract for the services 11 specified in this section. 12 b. To the maximum extent possible, any savings generated 13 from the measures implemented pursuant to this section shall 14 be used for the continued administration of the technology 15 services implemented under this section. 16 c. Reimbursement of any contractor may be contracted 17 on the basis of a percentage of achieved savings model, a 18 per-beneficiary-per-month model, a per-transaction model, a 19 case-rate model, or any blended model of such methodologies. 20 Reimbursement of any contractor may also include models based 21 on performance guarantees of the contractor to ensure that the 22 savings generated under this section exceed program costs. 23 EXPLANATION 24 The inclusion of this explanation does not constitute agreement with 25 the explanation’s substance by the members of the general assembly. 26 This bill relates to health care cost containment in the 27 corrections system. 28 The bill provides that the general assembly finds that 29 other states have saved millions of dollars by implementing 30 solutions to eliminate and recover health care overpayments 31 in the corrections system and that states have significantly 32 reduced such health care costs by billing the Medicaid program 33 for eligible inpatient health care costs. The intent of the 34 general assembly is to implement automated payment detection, 35 -2- LSB 5593XS (5) 85 pf/nh 2/ 3
S.F. 2031 prevention, and recovery solutions to reduce health care 1 overpayments and to ensure that Medicaid is billed for eligible 2 inpatient hospital and professional services for individuals in 3 the corrections system. 4 The bill directs the department of corrections, in 5 consultation with the department of human services, to 6 implement state-of-the-art clinical code editing technology 7 solutions to further automate health care claims resolution 8 and enhance health care cost containment through improved 9 claim accuracy and appropriate code correction; implement 10 health care claims audit and recovery services to identify 11 improper payments due to nonfraudulent issues, audit claims, 12 obtain health care provider sign-off on the audit results, and 13 recover validated overpayments; and implement automated payment 14 detection, prevention, and recovery solutions to ensure that 15 the Medicaid program is billed for eligible inpatient hospital 16 and professional services. The department is authorized 17 to contract for the services specified, and to the maximum 18 extent possible, any savings generated from the measured 19 implemented under the bill shall be used for the continued 20 administration of the services used in administering the bill. 21 The department is also authorized to reimburse any contractor 22 on the basis of a percentage of achieved savings model, a 23 per-beneficiary-per-month model, a per-transaction model, a 24 case-rate model, or any blended model of such methodologies. 25 Reimbursement of any contractor may also include models based 26 on performance guarantees of the contractor to ensure that 27 the savings generated under the bill exceed program costs. 28 The provisions of the bill apply to state correctional health 29 care systems and services and to state-contracted managed 30 correctional health care services. 31 -3- LSB 5593XS (5) 85 pf/nh 3/ 3
feedback