Controlling Medicaid Costs

Accountable care collaborative - information to providers - claims review - cost-control strategies - report and evaluation - appropriation. The act directs the department of health care policy and financing (department) to provide information to providers participating in the accountable care collaborative regarding:

• Cost and quality of medical services provided by hospitals and other medicaid providers; and
• Cost and quality of available pharmaceuticals prescribed by medicaid providers.

The department may make the same information available to other medicaid providers.

The department shall automatically review claims to identify and correct improper coding prior to payment and may obtain commercial technology to conduct the reviews.

The department is authorized to pursue cost-control strategies, value-based payments, and other approaches to reduce the rate of expenditure growth in the medicaid program. The department shall allow recipients, providers, and stakeholders an opportunity to comment and shall report to the joint budget committee prior to implementing any strategies or measures. The department is required to contract for an independent evaluation of any measures pursued and to provide reports to the joint budget committee on the evaluations.

Subject to federal approval, the act also directs the department to design and implement an evidence-based hospital review program to ensure that utilization of hospital services is based on a recipient's need for care. Prior to implementing any changes, the department shall allow recipients, providers, and stakeholders an opportunity to comment and shall report to the joint budget committee. The act requires the department to report to the joint budget committee on the estimated savings from the changes and to report to its committees of reference at its SMART act hearings on the savings and impact on recipients.

The act appropriates $2,737,764 to the department of health care policy and financing.

(Note: This summary applies to this bill as enacted.)