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THE SENATE |
S.B. NO. |
2314 |
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TWENTY-SEVENTH LEGISLATURE, 2014 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to Health Care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that costs associated with health care and corrections is putting serious pressure on state budgets. Medicaid has been the fastest-growing part of state expenditures over the past two decades, with corrections coming in just behind it.
The legislature further finds that states have saved millions of dollars by implementing solutions to eliminate and recover correctional health care overpayments. Similarly, states have significantly reduced correctional health care costs by billing medicaid for eligible inpatient health care costs.
The savings achieved through improved correctional health care billing will more than cover the cost of the implementation and administration of automated health care technology. Contractors hired for these services may be reimbursed on the basis of a percentage of achieved savings model, per beneficiary per month model, per transaction model, case-rate model, or any combination thereof. Reimbursement models with the contractor may include performance guarantees by the contractor to ensure that the savings identified exceed program costs.
The purpose of this Act is to implement automated payment detection, prevention, and recovery solutions to reduce correctional health care overpayments and to assure that medicaid is billed for eligible inpatient hospital and professional services.
SECTION 2. Section 353C-4.5, Hawaii Revised Statutes, is amended to read as follows:
"[[]§353C-4.5[]]
Correctional health care program. (a) There is established a
correctional health care program within the department. The administrator of
the correctional health care program and physicians who provide care to inmates
shall be appointed by the director without regard to [[]chapter 76[]].
(b) The department 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 identify and prevent errors or potential overbilling based on widely accepted and referenced protocols such as those established by the American Medical Association and the Centers for Medicare and Medicaid Services. The edits shall be applied automatically before claims are adjudicated to speed processing and reduce the number of pending or rejected claims and help ensure a smoother, more consistent, and more open adjudication process and fewer delays in provider reimbursement.
(c) The department shall implement correctional health care claims audit and recovery services to identify improper payments due to non-fraudulent issues, audit claims, obtain provider sign-off on the audit results, and recover validated overpayments. The department shall conduct post payment reviews to ensure that the diagnoses and procedure codes are accurate and valid based on the supporting physician documentation within the medical records.
(d) The department shall implement automated payment detection, prevention, and recovery solutions to assure that medicaid is billed for eligible inpatient hospital and professional services.
(e) The department shall contract for the technology services necessary to carry out this section, and the savings achieved through this section shall be used to pay for implementation and administration of programs implemented pursuant to this section."
SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 4. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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Report Title:
Correctional Health Care Program; Medicaid; Overpayment
Description:
Requires the department of public safety to implement state of the art clinical code editing technology solutions to the correctional health care program in order to prevent errors and potential overbilling. Requires the department to implement correctional health care claims audit and recovery services to identify improper payments. Requires the department to ensure that medicaid is 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.