2012 Session

Budget Amendments - SB30 (Member Request)

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Chief Patron: Newman
Care Coordination of High Need Medicaid Recipients (language only)

Item 307 #28s

Item 307 #28s

Health And Human Resources
Medical Assistance Services, Department of

Page 235, strike lines 31 through 33 and insert:
"aged, blind and disabled (ABD) recipients not otherwise addressed in this Item and individuals dually eligible for services under  both Medicare and Medicaid. The department will establish a stakeholder advisory committee to support successful implementation of ABD and dual-eligible care coordination systems.  This advisory committee will support the department with the ABD and dual-eligible  initiative by identifying care coordination and quality improvement priorities, assisting in securing analytic and care management support resources (from the Centers for Medicaid and Medicare Innovation Center demonstration programs, private grants and other sources) and helping design and communicate performance reports.  Given the difference in patient needs between and among the ABD and dual-eligible patient populations, as well as variations in health plan and provider system capabilities, the models implemented may well vary by region and/or population served.  The ABD and dual-eligible stakeholder committee will include balanced representation from health systems, health plans, long-term care providers, health policy researchers, physicians and others with expertise in serving the ABD and dual-eligible populations.  Nominations for members of the stakeholder advisory committee will be made by associations or groups representing these stakeholders. In designing the ABD and dual-eligible care coordination programs the department may incorporate a managed fee-for-service option, in regions outside of those considered for a capitated managed care model, where local provider coalitions or systems demonstrate a willingness and capacity to work collaboratively and be held accountable for desired outcomes.  In regions where the capitated model is applied, the department will encourage participating plans to either:  (a) engage in shared risk arrangements with participating local provider systems or coalitions who agree to be held accountable for quality outcomes; or (b) embed the practice management and care coordination resources necessary to achieve the improved outcomes in local settings.  For these complex patient populations, the department and stakeholder advisory committee will consider including the practice management and care coordination resources that evidence shows can lead to improved outcomes and lower overall costs, such as:  (i) case managers to help coordinate services, (ii) doctors of pharmacy to assist with medication management; (iii) psychiatrists to assist in mental health integration; and (iv) palliative care coordinators.  The advisory committee will assist the department in developing options for securing such practice management and care coordination resources via federal demonstration programs, shared risk arrangements or other means.  The department shall have the authority to promulgate emergency regulations to implement this amendment within 280 days or less from the enactment of this act."

(This amendment adds language to assist the Department of Medical Assistance Services with developing and implementing innovative care coordination models for high-need Medicaid recipients, especially those dually eligible for Medicare and Medicaid. Successful care coordination is expected to increase quality and lower costs for both the Medicare and Medicaid programs.)