September 2, 2014

HB 12-1281: Creation of the Medicaid Payment Reform and Innovation Pilot Project

On February 7, 2012, Rep. Dave Young introduced HB 12-1281 – Concerning a Pilot Program Establishing New Payment Methodologies in Medicaid. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

The bill directs the department of health care policy and financing to facilitate collaboration among Medicaid providers, clients, advocates, and payors that is designed to improve health outcomes and patient satisfaction and support the financial sustainability of the Medicaid program. The executive director of the state department may promulgate rules relating to the collaborative process.

The bill creates the Medicaid payment reform and innovation pilot program in the state department for the purpose of implementing payment reform projects in Medicaid within the framework of the accountable care collaborative. Regional care collaborative organizations (RCCOs) may submit payment proposals to the state department for the pilot program. A RCCO shall work with providers and managed care entities in the RCCO to develop the payment project. Payment projects may include but are not limited to global payments, risk adjustment, risk sharing, and aligned payment incentives. The state department shall select payment projects for inclusion in the pilot program based upon certain criteria and shall give preference to those payment projects that propose global payments. The state department shall respond to RCCOs concerning payment projects that are not selected for the pilot program, stating the reason why the payment projects were not selected and shall copy the response to certain committees of the general assembly. Payment projects shall be implemented for 2 to 5 years, and certain provisions apply to payments under the pilot program. The state department shall seek any federal authorization necessary to implement the pilot program. The state department shall report to certain committees of the general assembly concerning the design, implementation, and outcome of the pilot program.

The bill requires the state department to report concerning the state department’s recommendations for streamlining and simplifying the administrative structure for managing contracts relating to Medicaid managed care.

On February 21, the Health and Environment Committee referred the unamended bill to the Appropriations Committee.

Since this summary, the House Appropriations Committee amended the bill and referred it to the House Committee of the Whole.

Summaries of other featured bills can be found here.