H2355B3511A06104 AJB:JSL 06/08/20 #90 A06104
AMENDMENTS TO HOUSE BILL NO. 2355
Sponsor: REPRESENTATIVE SCHLOSSBERG
Printer's No. 3511
Amend Bill, page 1, lines 4 and 5, by striking out "duties of
medical assistance managed care organizations" and inserting
medical assistance managed care organization rate setting
Amend Bill, page 1, lines 11 through 19; pages 2 and 3, lines
1 through 30; page 4, lines 1 through 7; by striking out all of
said lines on said pages and inserting
Section 449.1. Medical Assistance Managed Care Organization
Rate Setting.--(a) The department shall annually adjust the
medical assistance managed care organization financial reporting
that is used as the basis of rate setting by the value of
provider-preventable conditions in no less than facility place
of service paid by the medical assistance managed care
organization to ensure that Federal and State funds are not used
to pay for improper payments.
(b) The department shall annually report the value of
adjustments by the medical assistance managed care organization
under subsection (a) as part of the reports required under
Article V-A.
Amend Bill, page 4, line 8, by striking out "(h)" and
inserting
(c)
Amend Bill, page 4, lines 16 through 22, by striking out all
of said lines and inserting
"Provider-preventable conditions" means any conditions
occurring in a health care setting that meet the following
criteria:
(1) Is identified in the State plan in line with the fee-
for-service model.
(2) Has been found by the Commonwealth, based upon a review
of medical literature by qualified professionals, to be
reasonably preventable through the application of procedures
2020/90AJB/HB2355A06104 - 1 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
supported by evidence-based guidelines.
(3) Has a negative consequence for the patient.
(4) Is auditable.
(5) Includes, at a minimum, any of the following:
(i) A wrong surgical or other invasive procedure performed
on a patient.
(ii) A surgical or other invasive procedure performed on the
wrong body part.
(iii) A surgical or other invasive procedure performed on
the wrong patient.
2020/90AJB/HB2355A06104 - 2 -
1
2
3
4
5
6
7
8
9
10
See A06104 in
the context
of HB2355