Section 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