Budget Amendment ID: FY2016-S3-336

ECO 336

Medicaid ACO Health Pilot

Messrs. Rush, Tarr and McGee, Ms. O'Connor Ives, Messrs. Fattman, Keenan and Lewis, Ms. Gobi, Ms. Forry, Ms. Flanagan, Messrs. Lesser, Hedlund, Ross and deMacedo moved that the proposed new text be amended by inserting, after section __, the following new section:-

“SECTION __.  Notwithstanding any general or special law to the contrary, the office of Medicaid shall establish a prospective, global payment pilot program under which Medicaid contracts with risk-bearing provider organizations for the provision and coordination of health care services for their attributed members beginning not later than September 1, 2016; provided, that such risk-bearing provider organizations shall be able to provide coordinated care through the provider’s network of primary care providers; provided further, that such providers shall have experience and demonstrated capabilities to provide behavioral health services including psychiatric and substance abuse beds; provided further, that Medicaid shall reimburse such providers on a prospective monthly basis; provided further, that such risk-bearing provider organizations that have obtained a risk certificate or a waiver from the Division of Insurance pursuant to section 3 of chapter 176T shall not be required to obtain additional insurance licensure under chapters 175, 176A, 176B, 176G, 176I or 176J of the General Laws; provided further, that the program shall not go into effect until the division of insurance, in conjunction with other health policy agencies, has promulgated regulations providing for risk certificates or procedures for waivers for such risk-bearing provider organizations.”