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F I S C A L   I M P A C T   R E P O R T

 

 

 

SPONSOR:

Beffort

 

DATE TYPED:

03/06/03

 

HB

 

 

SHORT TITLE:

Review Medicaid Reimbursement Policies

 

SB

SJM 67

 

 

ANALYST:

Weber

 

APPROPRIATION

 

Appropriation Contained

Estimated Additional Impact

Recurring

or Non-Rec

Fund

Affected

FY03

FY04

FY03

FY04

 

 

 

 

 

NFI

 

 

 

 

 

 

 

 

(Parenthesis ( ) Indicate Expenditure Decreases)

 

SOURCES OF INFORMATION

 

Responses Received From

 

SUMMARY

 

     Synopsis of Bill

 

Senate Joint Memorial 67 states the following:

 

  1. costs of providing services under the Medicaid program are projected to rise;
  2. the Department of Health (DOH) and the Human Services Department (HSD) each administer portions of the Medicaid program;
  3. DOH, HSD, and the Medicaid Fraud Control Unit of the Attorney General’s Office each participate in Medicaid fraud detection efforts;
  4. Medicaid service providers may inadvertertently permit billing for services neither necessary nor rendered;
  5. software programs edits to claims and reimbursement information systems can reduce or eliminate excessive Medicaid payments;
  6. timely information may assist in the detection of detection of Medicaid overpayments; and
  7. a review of Medicaid program reimbursement procedures will lead to suggestions for improved delivery services to Medicaid recipients and reducing unnecessary payments.

 

Therefore, be it resolved by the Legislature that:

 

  1. DOH and HSD conduct a comprehensive review of rules, policies etc for reimbursement to Medicaid providers for non-emergency transportation services, personal care option program services, developmentally disabled residential facilities and out patient prescription drugs; and
  2. the departments give a joint report on their respective reviews and any legislative recommendations to the Legislative Finance Committee.

    

     Significant Issues

 

HSD does have rules, policies, instructions, reporting requirements and procedures for reimbursement to Medicaid providers for non-emergency transportation services, personal care option program services, developmentally disabled residential facilities and outpatient prescription drugs.  DOH does not reimburse Medicaid providers for these services with the exception of developmentally disabled residential services funded through the Medicaid waiver for individuals with developmental disabilities. 

 

The Medicaid program is in the process of reviewing outpatient prescription drug services and personal care option services.  Non-emergency transportation services can also be reviewed.  HSD and DOH can discuss reviews of Medicaid reimbursement for their respective developmentally disabled residential services.

 

MW/njw:sb