2004 Special Session I

Budget Amendments - HB5001 (Committee Approved)

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DMAS Authority to Analyze HMO Encounter Data (language only)

Item 326 #14h

Item 326 #14h

Health And Human Resources
Medical Assistance Services, Department of

Page 264, after line 47, insert:
"BBB. Out of the amounts appropriated for the Medical Assistance Services program, the Department is authorized to expend up to $300,000 from the general fund in fiscal year 2005 to collect and analyze encounter data from Medicaid managed care organizations in order to set managed care capitation rates on an actuarial basis that reflects the relative risk associated with each plan's enrolled members, and to conduct utilization review and quality assurance requirements for the Medicaid program."

(This amendment authorizes the Department of Medical Assistance Services to use a portion of its funding to collect and analyze managed care encounter data in order to better set capitation rates on a sound actuarial basis for Medicaid managed care organizations. The Medicaid program spent approximately $769.7 million to reimburse managed care organizations for services provided to Medicaid-eligible individuals in fiscal year 2003. The funding will also assist the department in conducting required utilization review and quality assurance for the Medicaid program.)