Bill > A4339

Introduced Session

This bill establishes a bundled payments pilot program in the Medicaid program, operated by the Division of Medical Assistance and Health Services in the Department of Human Services. The program would be designed to serve individuals with complex health conditions, including behavioral health conditions. The program would be designed based on the four models of care set forth in the Bundled Payments for Care Improvement Initiative for the federal Centers for Medicare & Medicaid Services. These models of care are: · Model 1: a retrospective bundled payment for an episode of care focused on an acute care inpatient hospitalization, which includes a discount from the usual fee-for-service hospital inpatient payments; · Model 2: a retrospective bundled payment for an episode of care where actual expenditures are reconciled against a target price. The episode of care in Model 2 includes an inpatient stay in an acute care hospital and post-acute care, including related services provided during the episode, which ends 30, 60, or 90 days after discharge from the hospital. · Model 3: similar to Model 2, except that an episode of care is triggered at the initiation of post-acute care services with a participating skilled nursing facility, inpatient rehabilitation facility, long-term care hospital, or home health agency. · Model 4: a single, prospectively determined bundled payment to a hospital to include all services provided during the inpatient stay by the hospital, physicians, and other health care professionals. In cases requiring coordination of different health care providers, the division would designate a case counselor for the patient, who would have expertise in health care coordination, the cultural and linguistic competence appropriate to the patient, and other qualifications as determined by the division. The pilot program would seek to integrate the treatment of a patient's physical and behavioral health conditions as part of the bundled payment and any care coordination services. The pilot program would address geographic accessibility of services to ensure that patients can reasonably access all necessary and appropriate services, providers, and facilities included in the episode of care. The division would be required to report to the Governor and the Legislature on the pilot program two years after the initiation of the program, and make any recommendations it deems appropriate to revise, restrict, or expand the program.

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Troy Singleton (D)*, 

Introduced, Referred to Assembly Health and Senior Services Committee (on 11/21/2016)