General Assembly Raised Bill No. 6583
January Session, 2013 LCO No. 4024
*04024_______JUD*
Referred to Committee on JUDICIARY
Introduced by:
(JUD)
General Assembly
Raised Bill No. 6583
January Session, 2013
LCO No. 4024
*04024_______JUD*
Referred to Committee on JUDICIARY
Introduced by:
(JUD)
AN ACT CONCERNING THE CONTAINMENT OF CORRECTIONAL HEALTH CARE COSTS.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. (NEW) (Effective October 1, 2013) (a) The Commissioner of Administrative Services shall contract with one or more entities to:
(1) Provide clinical code editing technologies for the Department of Correction inmate health services program to (A) automate the review of claims and the correction of clinical codes for medical or dental treatment provided under such program, in order to increase accuracy and promote cost containment, (B) identify and prevent errors or potential overbilling, based on widely accepted and referenceable protocols, which may include those developed by the American Medical Society or the Centers for Medicare and Medicaid Services, (C) correct any erroneous claim prior to the adjudication of such claim, and (D) identify and prevent payments for medical or dental treatment that is eligible for Medicaid reimbursement; and
(2) Provide claims audit and recovery services for the Department of Correction inmate health services program to (A) identify improper payments made by the Department of Correction for medical or dental treatment provided to inmates and recover such payments, (B) audit claims under said program and obtain provider approval of such audit results, and (C) recover validated overpayments and payments made by the Department of Correction for medical or dental treatment that is eligible for payment under Medicaid and ensure that such claims are submitted to Medicaid for payment. Any postpayment review of claims shall ensure that codes for diagnoses and procedures are accurate and valid, based on supporting medical or dental record documentation by the treating provider as set forth in the medical records.
(b) To ensure, to the extent possible, that the costs of providing such technologies and services set forth in subsection (a) of this section shall be paid for by the savings generated by the use of such technologies and services and by prepayment and postpayment claims reviews, any contract entered into pursuant to subsection (a) of this section may (1) provide that payments to the contractor be made on the basis of (A) a percentage of the savings achieved model, (B) a per beneficiary per month model, (C) a per transaction model, (D) a case-rate model, or (E) a combination of any of such models, and (2) include performance guarantees by the contractor to ensure that savings exceed the costs of providing the technologies and services.
This act shall take effect as follows and shall amend the following sections:
Section 1 October 1, 2013 New section
This act shall take effect as follows and shall amend the following sections:
Section 1
October 1, 2013
New section
Statement of Purpose:
To contain correctional health care costs by implementing clinical code editing technologies and claims audit and recovery services for the Department of Correction inmate health services program in order to increase medical and dental treatment claims accuracy, identify and prevent errors and recover overpayments and payments for such claims and ensure that eligible claims are submitted to Medicaid for reimbursement.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]