performance compared to the State average.
Section 534-A. [Value-based models] Performance-based financial
incentives and penalties.
(a) Establishment.--After the implementation of the
reporting system under section 532-A, the department shall
[evaluate value-based models that will support managed care
organizations in reducing rates of potentially avoidable
admissions, readmissions and emergency visits.] establish
performance-based financial incentives and penalties for managed
care organizations based on whether the managed care
organization reduced avoidable admissions, readmissions,
emergency visits or complications. Financial incentives and
penalties under this subsection shall include:
(1) Positive or negative changes in the annual capitated
rates for managed care organization.
(2) Adjustment of the percentage of Medicaid program
enrollees automatically assigned a plan by the department to
a managed care organization based on the managed care
organization's performance and health outcomes under the
Managed Care Organization Outcomes Program.
(b) Adjustments to annual capitated rate.--The department
shall adjust a managed care organization's annual capitated rate
for providing service under the Medicaid program. A
determination of the adjustment of a managed care organization's
capitated rate shall include, but not be limited, to the
following factors:
(1) A retrospective review of the managed care
organization's performance in reducing avoidable admissions,
readmissions, emergency visits or complications. The review
under this paragraph shall be applied to the managed care
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