THE SENATE

S.B. NO.

205

TWENTY-SEVENTH LEGISLATURE, 2013

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to correctional health care.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


     SECTION 1.  The legislature finds that states have saved millions of dollars by incorporating solutions to eliminate and recover correctional health care overpayments.  Similarly, states have significantly reduced correctional health care costs by ensuring that medicaid is only billed for eligible inpatient hospital and professional services.

     Therefore, it is the intent of the legislature to incorporate automated payment detection, prevention, and recovery solutions to reduce overpayments and ensure that medicaid is only billed for eligible inpatient hospital and professional services.  It is the further intent of the legislature that the State shall contract for the foregoing services and that the savings achieved shall more than cover the costs of implementation and administration of this Act.

     SECTION 2.  Unless otherwise stated, this Act shall specifically apply to state correctional health care systems and services, and state-contracted correctional health care services.

     SECTION 3.  The State shall incorporate 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 identify and prevent errors or potential overbilling based on widely accepted and referenceable protocols such as those of the American Medical Association and the Centers for Medicare and Medicaid Services.  The code-editing shall be applied automatically before claims are adjudicated to: speed processing; reduce the number of pending or rejected claims; ensure a smoother, more consistent, and more open adjudication process; and reduce delays in provider reimbursement.

     SECTION 4.  The State shall incorporate correctional health care claims audit and recovery services to: identify improper payments due to non-fraudulent related issues; audit claims; obtain provider sign-off on the audit results; and recover validated overpayments.  Post-payment reviews shall ensure that the diagnoses and procedure codes are accurate and valid based on the supporting physician documentation within the medical records.  Core categories of reviews may include: coding compliance diagnosis related group reviews; transfers; readmissions; cost outlier reviews; outpatient seventy-two-hour rule reviews; payment errors; and billing errors.

     SECTION 5.  The State shall incorporate automated payment detection, prevention, and recovery solutions to ensure that medicaid is only billed for eligible inpatient hospital and professional services.

     SECTION 6.  To the extent possible, technology services used in carrying out this Act shall be secured using the savings generated by the program, whereby the State's only direct cost will be funded through the actual savings achieved.  To further enable this model, reimbursement to the contractor may be contracted on the basis of a percentage of achieved savings model, a per beneficiary per month model, a peer transaction model, a case-rate model, or any blended model of the aforementioned methodologies.  Reimbursement models with the contractor may also include performance guarantees of the contractor to ensure savings identified exceed program costs.

     SECTION 7.  This Act shall take effect upon its approval.

 

INTRODUCED BY:

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Report Title:

Correctional Health Care; Medicaid; Technology; Waste

 

Description:

Requires the State to implement certain cost-savings programs and technologies to eliminate and recover correctional health care overpayments and ensure medicaid is only billed for eligible inpatient hospital and professional services.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.