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  • Summary date: Apr 5 2023 - View Summary

    Identical to S 586, filed 4/4/23.

    Requires the Department of Health and Human Services, Division of Health Benefits (DHB), to set and adjust rates for new services provided by licensed ambulatory surgical centers so that these services are reimbursed at 95% of the Medicare Ambulatory Surgical Centers fee schedule in effect as of January 1 of each year. Requires the following of the new Healthcare Common Procedure Coding System (HCPCS) procedure code G0330, which was adopted by DHB as of January 1, 2023, and incorporated into the Medicaid Clinical Coverage Policy 4A: Dental Services: (1) DHB must not reimburse ambulatory surgical centers based solely on the length of the procedure and requires reimbursement, as of July 1, 2023, so that services billed under procedure code G0330 are reimbursed at 95% of the total payment rate listed on the Medicare Part B Hospital Outpatient Prospective Payment System (OPPS), in effect as of January 1, 2023, and requires the rates to be updated annually starting January 1, 2024, so that services are reimbursed at 95% of the Medicare Part B OPPS payment rate, in effect as of January 1, for that procedure code and (2) all standard benefit plans and BH IDD tailored plans must be required to cover procedures billed under procedure code G0330.

    Appropriates $500,000 in recurring funds for each year of the 2023-25 biennium from the General Fund to DHB to implement the act. Specifies that the funds are to provide a State match for the $950,000 in recurring federal funds and appropriates those federal funds to DHB to implement this act.