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
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(5)
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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
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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
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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
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