2000 Session

Budget Amendments - HB30 (Member Request)

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Chief Patron: Baskerville
Medicaid HMO Contracts (language only)

Item 319 #44h

Item 319 #44h

Health And Human Resources
Medical Assistance Services, Department of

Page 250, after line 8, insert:
"X. The Department of Medical Assistance Services shall revise the current HMO contracting standards regarding the composition of HMO provider networks to mandate that any HMO contracting to provide services under the Medallion II Medicaid HMO plan include in its provider networks any hospital which, in the fiscal year immediately prior to implementation of the Medallion II HMO, (i) provided  25 percent or more of the Medicaid care in either psychiatric or medical services in the geographic market serviced by the HMO, according to Medicaid patient discharge data report in the HCIA standard Hospital Report, and (ii) had a payor mix within such hospital composed of not less than 20 percent Medicaid, according to patient discharge data compiled in the HCIA standard Hospital Report.  Inclusion of such hospitals in the HMO's provider network shall be on terms not less favorable than other hospitals' terms  in the HMO's provider network."

(This amendment requires the Department of Medical Assistance Services to revise its HMO contracts to require HMOs to include in their networks hospitals that had served large numbers of Medicaid recipients prior to the implementation of the Medallion II HMO contracts.)