Correctional healthcare costs.

WORKING DRAFT
2014
STATE OF
WYOMING
14LSO-0393

SENATE FILE
NO.
SF0120

Correctional health
care costs.

Sponsored by:
Senator(s)
Hastert
, Craft and Von Flatern and Representative(s) Barlow, Coleman, Connolly, Filer, Harvey
, Throne
and Zwonitzer, Dn.

A BILL

for

AN ACT relating to
medical assistance and services;

providing for the implementation of
a
clinical code editing
system
and an audit and recovery service for correctional healthcare services; providing for contracts for the provision of services;
and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section 1.

W.S. 42
‑
4
‑
122 is created to read:

42
‑
4
‑
122.

C
orrectional healthcare services.

(a)

This section shall apply to:

(i)

State correctional
healthcare systems and services; and

(ii)

State contracted managed correctional healthcare services.

(b)

The department of health
shall implement
a
clinical c
ode editing
system
to automate claims resolution and enhance cost containment through improved claim accuracy and appropriate code correction. The
system
shall identify and prevent errors or potential overbilling based on widely accep
ted protocols.
The
code
edits shall be applied automatically before claims are adjudicated t
o speed processing,
reduce the number o
f pending
or rejected claims,
ensure
a
consistent and open adjudication process and
reduce
delays in provider reimbursement.

(c)

The
department of health
shall implement
a
correctional healthcare c
laims audit and recovery service
to

audit claims
,

identify improper payment
s due to nonfraudulent issues,
obtain provider
approval
on audit results and recover validated overpayments.
The purpose of the service is to
ensure that the diagnoses and procedure codes are accurate and valid based on the supporting physician documentat
ion within the medical records.

The service may include, without limitation, the review of
coding compliance, transfers, readmissions, cost
s
, payment errors and billing errors
.

(d)

The
department of health
shall implement
an
automated payment detection, prevention and recovery
system
to assure that Medicaid is billed for eligible inpatient hospital and professional services.

(e)

T
he state department of health shall
contract for the
services
required under
subsection
s
(b), (c) and (d) of
this section
. T
he savings achieved
under this section
shall
be used to fund
any
direct cost
s
necessary to implement this section
.
R
eimbur
sement to the contractor may be calculated
on the basis of a per
centage of achieved savings
,
per beneficiary per month,
per trans
action, by case rate
or
by
any
combination of those
methodologies. The reimbursement agreement
may include performance guarantees of the contractor to ensure that the savings
achieved under this section exceed

the costs of the services.

(f)

The department of corrections shall cooperate with the department of health t
o the extent
required to implement the program as specified under this section.

Section 2.

This act is effective immediately upon completion of all acts necessary for a bill to become law as provided by Article 4, Section 8 of the Wyoming Constitution.

(END)

1
SF0120