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H.B. 138 VETOES
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(iii) Arrangements agreed upon between a payor and a health care
practitioner.
(d) (1) (i) The Commission may make an effort, through voluntary and
cooperative arrangements between the Commission and the appropriate health care
practitioner specialty group, to bring that health care practitioner specialty group
into compliance with the health care cost goals of the Commission if the Commission
determines that:
1. Certain health care services are significantly contributing
to unreasonable increases in the overall volume and cost of health care services;
2. Health care practitioners in a specialty area have attained
unreasonable levels of reimbursable services under a specific code in comparison to
health care practitioners in another specialty area for the same code;
3. . Health care practitioners in a specialty area have attained
unreasonable levels of reimbursement, in terms of total compensation, in comparison
to health care practitioners in another specialty area;
4. There are significant increases in the cost of providing
health care services; or
5. Costs in a particular health care specialty vary
significantly from the health care cost annual adjustment goal established under
subsection (f) of this section.
(ii) If the Commission determines that voluntary and cooperative
efforts between the Commission and appropriate health care practitioners have been
unsuccessful in bringing the appropriate health care practitioners into compliance
with the health care cost goals of the Commission, the Commission may adjust the
conversion modifier.
(2) If the Commission adjusts the conversion modifier under this
subsection for a particular specialty group, a health care practitioner in that specialty
group may not be reimbursed more than an amount equal to the amount determined
according to the factors set forth in subsection (b)(3)(i) and (ii) of this section and the
conversion modifier established by the Commission.
(e) (1) On an annual basis, the Commission shall publish:
(i) The total reimbursement for all health care services over a
12-month period;
(ii) The total reimbursement for each health care specialty over a
12-month period;
(iii) The total reimbursement for each code over a 12-month period;
and
(iv) The annual rate of change in reimbursement for health services
by health care specialties and by code.
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- 4294 -
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