Senator proposes alternative to Medicaid expansion

Twentieth District State Sen. Bill Stanley (R-Moneta) introduced several pieces of legislation in the Special Session of the General Assembly Friday. The legislative proposals focus on creating solutions for the efficient delivery of quality health care for all Virginians as a comprehensive alternative to the expansion of Medicaid.

Senator Stanley has patroned the following legislation:

• Senate Bill (SB) 5001: Establishment of a Patient-Centered Medical Home Advisory Council.

The Council will advise and make recommendations to the Department of Medical Assistance Services on reforms to the commonwealth's program of medical assistance that would increase the quality of care while containing costs through the use of a patient-centered medical home system. A patient-centered medical home is a physician-led team approach to providing health care that: (i) originates in a primary care setting; (ii) fosters a partnership among the patient, the personal provider and other health care professionals, and where appropriate, the patient's family; (iii) utilizes the partnership to access all medical health-related services and nonmedical health-related services needed by the patient to achieve maximum health potential; and (iv) maintains a centralized, comprehensive record of all health-related services to promote continuity of care.

• SB 5007: Medicaid accountable care organizations; this bill directs the Department of Medical Assistance Services to establish a health care delivery system under which a majority of the commonwealth's Medicaid beneficiaries will receive benefits through accountable care organizations.

Accountable care organizations are corporations that provide health care services through their member health care providers and receive Medicaid payments through innovative payment methodologies, which include capitated payments, gainsharing payment arrangements, pay-for-performance, quality-based payments, and other payment arrangements to generate savings from greater coordination and efficiency in service delivery. A portion of these cost savings are to be distributed among the health care providers participating in the accountable care organizations. Prior to contracting with the department, a proposed accountable care organizations shall obtain a certification of authority issued by the State Corporation Commission, which can be issued if the accountable care organizations satisfies requirements regarding working capital and reserves. The commission and the attorney general are further required to determine (i) whether a proposed accountable care organizations is likely to reduce competition in a market for health care services and (ii) that the accountable care organization's pro-competitive benefits are likely to substantially outweigh the anticompetitive effects of any increase in market power. The department is directed to apply for federal waivers required for implementation of the program.

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