208.950. Plans required--participant enrollment--survey to assess health and wellness outcomes--health risk assessments required.
Plans required--participant enrollment--survey to assess health andwellness outcomes--health risk assessments required.
208.950. 1. The department of social services shall, with the adviceand approval of the Mo HealthNet oversight committee established undersection 208.955, create health improvement plans for all participants in MoHealthNet. Such health improvement plans shall include but not be limitedto, risk-bearing coordinated care plans, administrative servicesorganizations, and coordinated fee-for-service plans. Development of theplans and enrollment into such plans shall begin July 1, 2008, and shall becompleted by July 1, 2011, and shall take into account the appropriatenessof enrolling particular participants into the specific plans and the timeline for enrollment. For risk-bearing care coordination plans andadministrative services organization plans, the contract shall require thatthe contracted per diem be reduced or other financial penalty occur if thequality targets specified by the department are not met. For purposes ofthis section, "quality targets specified by the department" shall include,but not be limited to, rates at which participants whose care is beingmanaged by such plans seek to use hospital emergency department servicesfor nonemergency medical conditions.
2. Every participant shall be enrolled in a health improvement planand be provided a health care home. All health improvement plans arerequired to help participants remain in the least restrictive level of carepossible, use domestic-based call centers and nurse help lines, and reporton participant and provider satisfaction information annually. All healthimprovement plans shall use best practices that are evidence-based. Thedepartment of social services shall evaluate and compare all healthimprovement plans on the basis of cost, quality, health improvement, healthoutcomes, social and behavioral outcomes, health status, customersatisfaction, use of evidence-based medicine, and use of best practices andshall report such findings to the oversight committee.
3. When creating a health improvement plan for participants, thedepartment shall ensure that the rules and policies are promulgatedconsistent with the principles of transparency, personal responsibility,prevention and wellness, performance-based assessments, and achievement ofimproved health outcomes, increasing access, and cost-effective deliverythrough the use of technology and coordination of care.
4. No provisions of any state law shall be construed as to requireany aged, blind, or disabled person to enroll in a risk-bearingcoordination plan.
5. The department of social services shall, by July 1, 2008,commission an independent survey to assess health and wellness outcomes ofMO HealthNet participants by examining key health care delivery systemindicators, including but not limited to disease-specific outcome measures,provider network demographic statistics including but not limited to thenumber of providers per unit population broken down by specialty,subspecialty, and multidisciplinary providers by geographic areas of thestate in comparison side-by-side with like indicators of providersavailable to the state-wide population, and participant and providerprogram satisfaction surveys. In counting the number of providersavailable, the study design shall use a definition of provider availabilitysuch that a provider that limits the number of MO HealthNet recipients seenin a unit of time is counted as a partial provider in the determination ofavailability. The department may contract with another organization inorder to complete the survey, and shall give preference to Missouri-basedorganizations. The results of the study shall be completed within sixmonths and be submitted to the general assembly, the governor, and theoversight committee.
6. The department of social services shall engage in a public processfor the design, development, and implementation of the health improvementplans and other aspects of MO HealthNet. Such public process shall allowfor but not be limited to input from consumers, health advocates,disability advocates, providers, and other stakeholders.
7. By July 1, 2008, all health improvement plans shall conduct ahealth risk assessment for enrolled participants and develop a plan of carefor each enrolled participant with health status goals achievable throughhealthy lifestyles, and appropriate for the individual based on theparticipant's age and the results of the participant's health riskassessment.
8. For any necessary contracts related to the purchase of products orservices required to administer the MO HealthNet program, there shall becompetitive requests for proposals consistent with state procurementpolicies of chapter 34, RSMo, or through other existing state procurementprocesses specified in chapter 630, RSMo.
(L. 2007 S.B. 577)