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House of Representatives
Session of 2021 - 2022 Regular Session


Posted: December 2, 2020 01:29 PM
From: Representative Seth M. Grove
To: All House members
Subject: Improving Healthcare Outcomes
In the near future, I plan to introduce legislation to expand on the healthcare outcome programs established as part of the 2018 omnibus welfare code.  While the legislature intended for the Department of Human Services to use the program to improve healthcare outcomes and reduce costs, the department, to date, has not fully implemented the program.

While Pennsylvania has yet to implement this program other states such as Texas have used identical programs to not only save tens of millions of taxpayer dollars, they also improved healthcare outcomes.  Under the proposed bill, the department would provide financial incentives to hospitals and Medicaid Managed Care Organizations (MCO’s) for reducing potentially avoidable events as defined in current law.

The incentives proposed in the legislation include positive or negative changes in the hospital reimbursement rates under Medicaid.  Incentives offered to MCO’s include positive and negative changes in the MCO’s capitation rate for the next fiscal year.  Additionally, MCO will be incentivized by the opportunity to receive a larger share of the automatically assigned population under Medicaid.   Under current law, the department assigns Medicaid enrollees who fail to choose their own plan into a Medicaid plan.  This proposal would amend the process used for auto assignment to reward MCO’s who reduce a potentially avoidable event with a larger share of the automatically assigned population.

The legislation not only provides an incentive for hospitals and MCO’s to improve healthcare outcomes under Medicaid, the bill also establishes cost reduction targets for the department.  The first year, following enactment of the legislation, the department would be tasked with reducing costs to the Medicaid program by $40 million.

Please join me and co-sponsor this legislation to save taxpayer money and incentivize healthcare providers to improve outcomes for those enrolled under Medicaid. 

Introduced as HB44