AB 871

This bill requires the Department of Health Services to create a program to

reimburse hospitals and health care systems for intensive care coordination services

provided to Medical Assistance recipients. Subject to some limitations, DHS must

develop a process for selecting hospitals and health care systems that submit an

application including a description of their programs as specified in the bill,

including a statement that the hospital or health care system will use emergency

department utilization data to identify Medical Assistance recipients to receive

intensive care coordination to reduce use of the emergency department.

Under the bill, DHS reimburses a hospital or health care system participating

in the program $250 initially for each Medical Assistance recipient who is not a

Medicare recipient who is enrolled in intensive care coordination for six months. If

the participant demonstrates progress in reducing emergency department visits for

at least half of its enrollee population, the participant receives an additional $250 per

enrollee. The program participant may enroll each Medical Assistance recipient in

the program for an additional six months for an additional initial reimbursement of

$250 per enrollee and, if the participant demonstrates progress in reducing

emergency department visits for at least half of its enrollee population, $250 per

enrollee at the end of the additional six months.

Annually, each hospital and health care system that is eligible for

reimbursement shall submit a report containing certain information, as specified in

the bill, from which DHS must calculate the costs saved to the Medical Assistance

program by avoiding emergency department visits. If DHS calculates a cost savings,

DHS must distribute savings to the hospital or health care system as specified in the

bill. The bill requires DHS to obtain any necessary approval from the federal

Department of Health and Human Services to implement the reimbursement

program. DHS may implement any part of the program if the federal department

disapproves. The bill requires DHS to implement at least two pilot programs for

intensive care coordination by a deadline specified in the bill.