Purpose

This bill aims to create a demonstration project to test a coordinated service model for disability services providers. The model focuses on integrating medical assistance and Medicare services, addressing health-related social needs, and prioritizing the preferences of enrollees.

Main Provisions

• Project Establishment: A demonstration project will test a provider-led model to coordinate services for people with disabilities.
• Provider Collaboration: The project encourages partnerships between home and community-based providers, health care providers, and managed care plans.
• Enrollment Criteria: Participants must be dual-eligible for medical and Medicare assistance and receiving specific waiver services.
• Service Coordination: The project seeks to integrate a wide range of services, including primary care, dental, pharmacy, and community-based services.
• Quality and Cost Accountability: Organizations must maintain standards for quality care and demonstrate cost savings.
• Funding and Payments: A population-based payment model will apply, which includes risk-adjusted payments to acknowledge care complexity. Providers will also focus on achieving quality and performance targets to receive incentive payments.
• Innovation Grants: Grants will be available to help organizations cover initial costs and improve coordination efforts.

Significant Changes

• Innovative Care Delivery: Encourages the use of new methods like telehealth and community health workers.
• Federal Support: Seeks federal approval and funding participation.
• Financial Structure: Establishes a value-based financial arrangement to share savings and risks among participating organizations.

Relevant Terms

coordinated services organization, demonstration project, provider-led model, dual-eligible, integration, waiver services, quality standards, partnership, managed care, population-based payment, risk-adjusted, innovation grants, telehealth, Medicare, medical assistance.