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US Laws | Affordable Health Care Act (HR3950F)
TITLE II--ROLE OF PUBLIC PROGRAMS
Subtitle I--Improving the Quality of Medicaid for Patients and Providers

(f) Authorization of Appropriations- There are authorized to be appropriated such sums as are necessary to carry out this section. (3025)

SEC. 2706. PEDIATRIC ACCOUNTABLE CARE ORGANIZATION DEMONSTRATION PROJECT. (3026)(Text)

(a) Authority To Conduct Demonstration- (3027)

(1) IN GENERAL- The Secretary of Health and Human Services (referred to in this section as the "Secretary") shall establish the Pediatric Accountable Care Organization Demonstration Project to authorize a participating State to allow pediatric medical providers that meet specified requirements to be recognized as an accountable care organization for purposes of receiving incentive payments (as described under subsection (d)), in the same manner as an accountable care organization is recognized and provided with incentive payments under section 1899 of the Social Security Act (as added by section 3022). (3028)

(2) DURATION- The demonstration project shall begin on January 1, 2012, and shall end on December 31, 2016. (3029)

(b) Application- A State that desires to participate in the demonstration project under this section shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require. (3030)

(c) Requirements- (3031)

(1) PERFORMANCE GUIDELINES- The Secretary, in consultation with the States and pediatric providers, shall establish guidelines to ensure that the quality of care delivered to individuals by a provider recognized as an accountable care organization under this section is not less than the quality of care that would have otherwise been provided to such individuals. (3032)

(2) SAVINGS REQUIREMENT- A participating State, in consultation with the Secretary, shall establish an annual minimal level of savings in expenditures for items and services covered under the Medicaid program under title XIX of the Social Security Act and the CHIP program under title XXI of such Act that must be reached by an accountable care organization in order for such organization to receive an incentive payment under subsection (d). (3033)

(3) MINIMUM PARTICIPATION PERIOD- A provider desiring to be recognized as an accountable care organization under the demonstration project shall enter into an agreement with the State to participate in the project for not less than a 3-year period. (3034)

(d) Incentive Payment- An accountable care organization that meets the performance guidelines established by the Secretary under subsection (c)(1) and achieves savings greater than the annual minimal savings level established by the State under subsection (c)(2) shall receive an incentive payment for such year equal to a portion (as determined appropriate by the Secretary) of the amount of such excess savings. The Secretary may establish an annual cap on incentive payments for an accountable care organization. (3035)

(e) Authorization of Appropriations- There are authorized to be appropriated such sums as are necessary to carry out this section. (3036)

SEC. 2707. MEDICAID EMERGENCY PSYCHIATRIC DEMONSTRATION PROJECT. (3037)(Text)

(a) Authority To Conduct Demonstration Project- The Secretary of Health and Human Services (in this section referred to as the "Secretary") shall establish a demonstration project under which an eligible State (as described in subsection (c)) shall provide payment under the State Medicaid plan under title XIX of the Social Security Act to an institution for mental diseases that is not publicly owned or operated and that is subject to the requirements of section 1867 of the Social Security Act (42 U.S.C. 1395dd) for the provision of medical assistance available under such plan to individuals who-- (3038)

(1) have attained age 21, but have not attained age 65; (3039)

(2) are eligible for medical assistance under such plan; and (3040)

(3) require such medical assistance to stabilize an emergency medical condition. (3041)

(b) Stabilization Review- A State shall specify in its application described in subsection (c)(1) establish a mechanism for how it will ensure that institutions participating in the demonstration will determine whether or not such individuals have been stabilized (as defined in subsection (h)(5)). This mechanism shall commence before the third day of the inpatient stay. States participating in the demonstration project may manage the provision of services for the stabilization of medical emergency conditions through utilization review, authorization, or management practices, or the application of medical necessity and appropriateness criteria applicable to behavioral health. (3042)

(c) Eligible State Defined- (3043)

(1) IN GENERAL- An eligible State is a State that has made an application and has been selected pursuant to paragraphs (2) and (3). (3044)

(2) APPLICATION- A State seeking to participate in the demonstration project under this section shall submit to the Secretary, at such time and in such format as the Secretary requires, an application that includes such information, provisions, and assurances, as the Secretary may require. (3045)

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