364-L - Chronic illness demonstration projects.
* § 364-l. Chronic illness demonstration projects. 1. The legislature finds that medicaid beneficiaries with multiple co-morbidities are among the most medically complicated and most costly, accounting for twenty percent of all medicaid beneficiaries, but seventy-five percent of all medicaid costs. Because these individuals require services across multiple delivery systems, licensed by multiple agencies, their care is often fragmented, uncoordinated and at times duplicative. The legislature further finds that through targeted interventions the care of these individuals can be improved and the costs of that care reduced. 2. To the extent of funds appropriated for this purpose, the commissioner of health is authorized to fund demonstrations that develop and evaluate interventions targeted at medicaid beneficiaries who are otherwise exempt or excluded from mandatory medicaid managed care and who have multiple co-morbidities. Such interventions shall seek to increase the coordination of care, ensure that care is delivered in the most appropriate setting, improve health outcomes and reduce the cost of that care. 3. Demonstrations established pursuant to this section may test models of care and models of reimbursement, including shared savings, that are intended to advance the goals described in subdivision two of this section. 4. Service providers eligible to apply for roles as demonstration service coordinators include: hospitals, diagnostic and treatment centers, nursing homes, certified home health agencies, licensed home care services agencies, long term home health care programs, managed care plans, managed long term care plans, and providers licensed by or funded by the office of mental health or the office of alcohol and substance abuse services. The commissioner of health shall approve chronic illness demonstration programs which are geographically diverse. A participating service provider must establish, to the satisfaction of the commissioner of health, its capacity to enroll and serve sufficient numbers of enrollees to demonstrate the cost-effectiveness of the demonstration program. 5. Nothing in this section shall be construed as requiring any medicaid beneficiary to participate in a demonstration project established pursuant to this section; participation shall be voluntary. Participation in a demonstration project pursuant to this section shall not diminish or impair the services to which a participant is otherwise entitled under this chapter. 6. Prior to establishing any demonstration project authorized by this section, the commissioner shall consult with the commissioners of the office of mental health and the office of alcohol and substance abuse services. 7. This section shall not apply unless all necessary approvals under federal law and regulation have been obtained to receive federal financial participation in the costs of health care services provided pursuant to this section. The commissioner of health is authorized to submit one or more applications for waivers of the federal social security act as may be necessary to obtain such federal financial participation. 8. The commissioner of health shall provide a report to the governor and the legislature no later than January first, two thousand ten. The report shall include findings as to the demonstration projects' effectiveness in managing the care needs and improving the health of program participants, an evaluation as to the programs' cost-effectiveness as measured against traditional medicaid care models, and recommendations as to whether the programs should be extended, modified, eliminated, or made permanent.* NB Repealed March 31, 2013