(1)To improve
health outcomes and lower health-care costs, the state department may develop
payments to providers that are based on quantifiable performance or measures of
quality of care. These performance-based payments may include, but are not
limited to, payments to:
(a)Primary care providers;
(b)Federally qualified health centers;
(c)Providers of long-term care services and supports; and
(d)Behavioral health providers, including, but not limited to:
(II)Behavioral health safety net providers, as defined in section 27-50-101;
and
(III)Entities contracted with the state department to administer the
statewide system of community behavioral health care established in section 25.5-5-402.
(2)(a) Prior to implementing performance-based payments in the medi
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(1) To improve
health outcomes and lower health-care costs, the state department may develop
payments to providers that are based on quantifiable performance or measures of
quality of care. These performance-based payments may include, but are not
limited to, payments to:
(a) Primary care providers;
(b) Federally qualified health centers;
(c) Providers of long-term care services and supports; and
(d) Behavioral health providers, including, but not limited to:
(I) Repealed.
(II) Behavioral health safety net providers, as defined in section 27-50-101;
and
(III) Entities contracted with the state department to administer the
statewide system of community behavioral health care established in section 25.5-5-402.
(2) (a) Prior to implementing performance-based payments in the medicaid
program pursuant to this article 4 and articles 5 and 6 of this title 25.5, including
performance-based payments set forth in this section, the state department shall
submit to the joint budget committee:
(I) (A) Evidence that the performance-based payments are designed to
achieve budget savings; or
(B) A budget request for costs associated with the performance-based
payments;
(II) The estimated performance-based payments compared to total
reimbursements for the affected service; and
(III) A description of the stakeholder engagement process for developing the
performance-based payments, including the participants in the process and a
summary of the stakeholder feedback, and the state department's response to
stakeholder feedback.
(b) The information required pursuant to subsection (2)(a) of this section
must be provided on or before November 1 for performance-based payments that
will take effect in the following fiscal year unless the state department includes
with its submission an explanation of the need for faster implementation of the
payment. If faster implementation is requested, the state department shall provide
the information at least three months prior to the implementation of the
performance-based payments unless compliance with federal law necessitates
shorter notice.
(3) On or before November 1, 2017, and on or before November 1 each year
thereafter, the state department shall submit a report to the joint budget
committee, the public health care and human services committee of the house of
representatives, and the health and human services committee of the senate, or any
successor committees, describing rules adopted by the state board and contract
provisions approved by the federal centers for medicare and medicaid services in
the preceding calendar year that authorize payments to providers based on
performance. Notwithstanding the provisions of section 24-1-136 (11)(a)(I), the
report required pursuant to this subsection (3) continues indefinitely. The report
must include, at a minimum:
(a) A description of performance-based payments included in state board
rules, including which performance standards are targeted with each performance-based payment;
(b) A description of the goals and objectives of the performance-based
payments, and how those goals and objectives align with other quality improvement
initiatives;
(c) A summary of the research-based evidence for the performance-based
payments, to the extent such evidence is available;
(d) A summary of the anticipated impact and clinical and nonclinical
outcomes of implementing the performance-based payments;
(e) A description of how the impact or outcomes will be evaluated;
(f) An explanation of steps taken by the state department to limit the
administrative burden on providers;
(g) A summary of the stakeholder engagement process with respect to each
performance-based payment, including major concerns raised through the
stakeholder process and how those concerns were remediated;
(h) When available, evaluation results for performance-based payments that
were implemented in prior years; and
(i) A description of proposed modifications to current performance-based
payments.