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M.S.A. §256B.0755

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Health Care Delivery Systems Demonstration Project

The Commissioner of Human Services must develop and authorize alternate and innovative health care delivery systems, such as accountable care organizations to be used to provide services to individuals eligible for medical assistance or enrolled in Medicaid.  The Commissioner must obtain requests for proposals for participation in the demonstration projects from a variety of entities. 

The Commissioner must also develop uniform utilization and cost of care forecasting tools, identify performance indicators to be used to measure cost savings, encourage coordination with local and county agencies, and establish quality standards.

In order to participate in the demonstration project, the health care delivery system must meet the following requirements:

  1. Provide required covered services and coordinated care to the recipients;
  2. Establish a process to monitor enrollment and health care quality;
  3. Coordinate care delivery with existing social services programs;
  4. Adopt innovative and cost effective ways of delivering care.

The law also lays out who may participate in the health care delivery demonstration project.  Possible participants include providers in group practices, networks of individual practices, hospitals, or managed care plans.  

The payment system for the demonstration projects must be based on a cost benchmark and risk/gain payment sharing model.  The payment system may include incentive payments to providers who meet or exceed annual quality and performance targets.

Related Laws:  M.S.A. §256B.021

Current as of June 2015