HOUSE DOCKET, NO. 1483        FILED ON: 1/18/2017

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 594

The Commonwealth of Massachusetts

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PRESENTED BY:

Jennifer E. Benson

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act relative to a bundled payment pilot program.

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PETITION OF:

HOUSE DOCKET, NO. 1483        FILED ON: 1/18/2017

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 594

[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 968 OF 2015-2016.]

The Commonwealth of Massachusetts

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In the One Hundred and Ninetieth General Court
(2017-2018)

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An Act relative to a bundled payment pilot program.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

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, 2018.