SECTION 1. The office of Medicaid shall establish a bundled payment pilot program designed to serve persons with complex conditions and co-morbidities, including behavioral health conditions. Such program shall be designed based on the 4 models of care set forth in the Bundled Payments for Care Improvement Initiative of the federal Centers for Medicare and Medicaid Services and shall provide for:
(a) A bundled payment for an episode of care focused on an acute care inpatient hospitalization, which shall include a discount from the usual hospital inpatient payments.
(b) A bundled payment for an episode of care including an inpatient stay in the acute care hospital and related services provided during the episode, which shall end 30, 60 or 90 days after hospital discharge. The office shall determine the different clinical condition episodes to be covered by the bundled payment.
(c) A bundled payment for an episode of care triggered by an acute care hospital stay and beginning at the initiation of post-acute care services with a participating skilled nursing facility, inpatient rehabilitation facility, long-term hospital or home health agency. The office shall determine the different clinical condition episodes to be covered by the bundled payment.
(d) A single, prospectively determined bundled payment to a hospital to include all services provided during the inpatient stay by the hospital, physicians and other practitioners. The office shall determine the different clinical condition episodes to be covered by the bundled payment.
SECTION 2. In cases under the bundled payment pilot program requiring coordination of different health care services, including behavioral health treatment and services, and assistance in access to and cueing of services, the office shall designate an individual with expertise in providing such services to act as a case counselor for the patient. The case counselor shall have the cultural and linguistic competence appropriate to the patient to which he is assigned. The office shall determine the qualifications of such case counselors and the manner of their selection and appointment.
SECTION 3. The program shall seek to integrate treatment of any accompanying behavioral health conditions as part of the bundled payment and care coordination services provided.
SECTION 4. The program shall address geographic accessibility of services to ensure that patients can obtain all necessary or appropriate services and facilities included in the episode of care.
SECTION 5. The program shall seek to ensure that patients participating in the program have access to culturally and linguistically competent health care services.
SECTION 6. This act shall be effective on January 1, 2016.
The information contained in this website is for general information purposes only. The General Court provides this information as a public service and while we endeavor to keep the data accurate and current to the best of our ability, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information contained on the website for any purpose. Any reliance you place on such information is therefore strictly at your own risk.