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In this subsection, “care coordination” includes coordination of outpatient medical care, specialty care, inpatient care, dental care, and mental health care and medical case management.
The department shall develop a proposal to increase medical assistance reimbursement to each provider that receives a grant under s. 252.12 (2) (a) 8. and to which at least one of the following applies: 1. The provider is recognized by the National Committee on Quality Assurance as a Patient-Centered Medical Home. 2. The secretary determines that the provider performs well with respect to all of the following aspects of care: a. Adoption of written standards for patient access and patient communication. b. Use of data to show that standards for patient access and patient communication are satisfied. c. Use of paper or electronic charting tools to organize clinical information. d. Use of data to identify diagnoses and conditions among the provider’s patients that have a lasting detrimental effect on health. e. Adoption and implementation of guidelines that are based on evidence for treatment and management of HIV-related conditions. f. Active support of patient self-management. g. Systematic tracking of patient test results and systematic identification of abnormal patient test results. h. Systematic tracking of referrals using a paper or electronic system. i. Measuring the quality of the performance of the provider and of individuals who perform services on behalf of the provider, including with respect to provision of clinical services, patient outcomes, and patient safety. j. Reporting to employees and contractors of the provider and to other persons on the quality of the performance of the provider and of individuals who perform services on behalf of the provider.
The provider is recognized by the National Committee on Quality Assurance as a Patient-Centered Medical Home.
The secretary determines that the provider performs well with respect to all of the following aspects of care: a. Adoption of written standards for patient access and patient communication. b. Use of data to show that standards for patient access and patient communication are satisfied. c. Use of paper or electronic charting tools to organize clinical information. d. Use of data to identify diagnoses and conditions among the provider’s patients that have a lasting detrimental effect on health. e. Adoption and implementation of guidelines that are based on evidence for treatment and management of HIV-related conditions. f. Active support of patient self-management. g. Systematic tracking of patient test results and systematic identification of abnormal patient test results. h. Systematic tracking of referrals using a paper or electronic system. i. Measuring the quality of the performance of the provider and of individuals who perform services on behalf of the provider, including with respect to provision of clinical services, patient outcomes, and patient safety. j. Reporting to employees and contractors of the provider and to other persons on the quality of the performance of the provider and of individuals who perform services on behalf of the provider.
Adoption of written standards for patient access and patient communication.
Use of data to show that standards for patient access and patient communication are satisfied.
Use of paper or electronic charting tools to organize clinical information.
Use of data to identify diagnoses and conditions among the provider’s patients that have a lasting detrimental effect on health.
Adoption and implementation of guidelines that are based on evidence for treatment and management of HIV-related conditions.
Active support of patient self-management.
Systematic tracking of patient test results and systematic identification of abnormal patient test results.
Systematic tracking of referrals using a paper or electronic system.
Measuring the quality of the performance of the provider and of individuals who perform services on behalf of the provider, including with respect to provision of clinical services, patient outcomes, and patient safety.
Reporting to employees and contractors of the provider and to other persons on the quality of the performance of the provider and of individuals who perform services on behalf of the provider.
The department’s proposal under par. (b) shall specify increases in reimbursement rates for providers that satisfy the conditions under par. (b), and shall provide for payment of a monthly per-patient care coordination fee to those providers. The department shall set the increases in reimbursement rates and the monthly per-patient care coordination fee so that together they provide sufficient incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall specify effective dates for the increases in reimbursement rates and the monthly per-patient care coordination fee that are no sooner than January 1, 2011.
The department shall, subject to approval by the U.S. department of health and human services of any required waiver of federal law relating to medical assistance and any required amendment to the state plan for medical assistance under 42 USC 1396a, implement the proposal under par. (b) beginning January 1, 2011.