SB340 Summary

• Establishes regional care organizations (RCOs) to deliver comprehensive Medicaid benefits to beneficiaries on a managed care basis through risk contracts with capitated payments.

• RCOs must have governing boards with 12 risk-bearing participant representatives, 5 medical professionals (3 primary care physicians, 1 optometrist, 1 pharmacist), and 3 community representatives, with Medicaid Agency approval.

• Requires RCOs to maintain minimum financial reserves of $250,000 or 25% of average monthly expenditures (whichever is greater) and capital/surplus of $2,500,000, or provide performance bonds as alternatives.

• Creates a quality assurance committee to identify objective outcome and quality measures for ambulatory care, inpatient care, mental health, dental, and other services, with measures incorporated into RCO contracts.

• Permits Medicaid Agency to contract with alternate care providers only after failed attempts to secure RCO contracts, with implementation timeline requiring organizations to achieve probationary certification by October 1, 2014, and full certification by October 1, 2016.