Medicaid-pay for performance.

WORKING DRAFT
2007
STATE OF
WYOMING
07LSO-0069

HOUSE BILL
NO.
HB0166

Medicaid-pay for performance.

Sponsored by:
Representative(s) Lubnau and Senator(s) Decaria, Scott and Sessions

A BILL

for

AN ACT relating to the Wyoming Medical Assistance and Services Act; providing for a system of pay for performance to encourage improvement in the quality of health care under the Medicaid program as specified; granting rulemaking authority;
providing a sunset;
requiring
a
report; and providing for an effective date.

Be It Enacted by the Legislature of the State of
Wyoming
:

Section 1.
W.S. 42
‑
4
‑
121 is created to read:

42
‑
4
‑
121.

Pay for performance.

(a)

The department shall develop and implement a pay-for-performance system to provide performance payments to medical service providers that meet quality standards and improve the care of qualified recipients of services under this
chapter
.

(b)

The department is directed to negotiate the terms and conditions of the performance payment plan with the
United States
secretary of health and human services as necessary to implement this section. If determined necessary to implement the plan,
the
department shall apply for a waiver under Section 1115, 1915(b) or 1915(c) of the Social Security Act. The performance payments
shall
be made in accordance with the formula and qualifying criteria set forth in the state plan, and shall be for medical care specified in subsection (d) of this section provided after July 1, 2008.

(c)

No p
erformance payment under this section shall exceed two percent (2%) of the amount that would otherwise be payable for services under this
chapter
.

(d)

The pay for performance plan under this section shall provide incentives for well baby care and well child care, appropriate cervical, breast and colorectal cancer screening and prompt administration of aspirin for acute myocardial infarction. Health care providers participating in the pay for performance shall be required to provide the department with such outcome measures and other performance data as the department shall prescribe by rule and regulation.

(e)

This section is repealed effective June 30, 2011.

Section 2.
The department shall report to the joint labor, health and social services interim committee and the joint appropriations
interim
committee on the status of the pay for performance system required by Section 1 of this act no later than November 1, 2007.

Section 3.

This act is effective July 1, 2007.

(END)

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HB0166