House Journal: Page 944: Wednesday, April 2, 2003
Page 10
1 If inappropriate usage is identified, the department
2 shall implement procedures necessary to restrict
3 utilization.
4 2. The department of human services shall conduct
5 a review of selected medical assistance services
6 categories and providers for state fiscal years
7 beginning July 1, 2001, July 1, 2002, and July 1,
8 2003. The review shall include intense data analysis
9 to test compliance with rules, regulations, and
10 policies and selected on-site audits.
11 3. The review required under subsection 2 shall
12 attempt to identify any incorrectly paid billings or
13 claims for the state medical assistance program. If
14 inappropriate payments are identified, provider
15 billings shall be adjusted accordingly. If there is
16 substantiated evidence to suggest fraudulent activity,
17 the department shall submit the audit data regarding
18 the medical assistance provider or recipient to the
19 department of inspections and appeals for further
20 action.
21 4. The department of human services may procure a
22 sole source contract to implement the provisions of
23 this section.
24 5. Any savings realized under this section may be
25 used to the extent necessary to pay the costs
26 associated with implementation of this section prior
27 to reversion to the medical assistance program. The
28 department shall report the amount of any savings
29 realized and the amount of any costs paid to the
30 chairpersons of the joint appropriations subcommittee
31 on health and human services.
32 Sec. . MEDICAL ASSISTANCE - CERTAIN PUBLICLY
33 OWNED HOSPITALS - PHYSICIAN SUPPLEMENTAL PAYMENTS.
34 1. For the fiscal year beginning July 1, 2003, and
35 for each fiscal year thereafter, the department of
36 human services shall institute a supplemental payment
37 adjustment applicable to physician services provided
38 to medical assistance recipients at publicly owned
39 acute care teaching hospitals. The adjustment shall
40 generate supplemental payments to physicians which are
41 equal to the difference between the physician's charge
42 and the physician's fee schedule under the medical
43 assistance program. To the extent of the supplemental
44 payments, a qualifying hospital shall, after receipt
45 of the payments, transfer to the department of human
46 services an amount equal to the actual supplemental
47 payments that were made in that month. The department
48 of human services shall deposit these payments in the
49 department's medical assistance account. The
50 department of human services shall amend the medical
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League of Women Voters of Iowa
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