Amendment #337 to H4100

Pediatric Complex Care

Mr. Walsh of Lynn moves to amend the bill by inserting at the end the following new section:—

Section XX:   Notwithstanding any general or special law to the contrary, the Executive Office of Health and Human Services (EOHHS) shall conduct a procurement to select an entity or entities to conduct an analysis of the children with complex care needs in the MassHealth program.  The goal of the procurement shall be to identify a suitable vendor to partner with the Executive Office to identify all children with complex care needs in the MassHealth program, understand the services, service providers and medical resources utilized and current costs of serving these children; and to analyze the suitability of their current primary or majority care settings relative to the goals of the Commonwealth’s Patient-Centered Medical Home Initiative and the goal of providing the highest quality care most efficiently by managing care and utilization of services. The analysis conducted pursuant to the procurement shall group the patients by primary diagnosis, including mental health diagnoses, and/ or other clinical profile characteristics and assess the current medical home capabilities of primary care providers for the relevant patients in each category, by geographic region.  EOHHS shall not award any money or other compensation with the contract.  The request for proposals shall be released by October 1, 2012 and the vendor shall be selected by November 30, 2012.

The chosen entity or entities shall produce a report of its findings to the Executive Office of Health and Human Services, the Division of Insurance, the Joint Committee on Health Care Finance, the House and Senate Committees on Ways and Means and the House and Senate clerks, for public availability, no later than August 31, 2013.  Such report shall include the following: a) recommendations for how children with complex care needs could be served in keeping with the goals of the Commonwealth’s Patient Centered Medical Home Initiative; b) recommendations for appropriate quality benchmarks for their care or recommendations regarding the development of such metrics; c) an analysis of potential federal and external funding sources; and d) an analysis of care models and financial arrangements used for complex children in other states.