The bill amends Section 56-265 of the Idaho Code to establish specific requirements for value care organizations within the Medicaid framework. It introduces new provisions that mandate agreements between the department and value care organizations to include a stop-loss threshold, which will be set at $250,000 for the performance year starting July 1, 2026, $500,000 for the year starting July 1, 2027, and $1,000,000 for the year starting July 1, 2028, and for all subsequent performance years. This aims to ensure that the agreements are designed to be cost-neutral or cost-saving compared to other payment methodologies.

Additionally, the bill emphasizes the department's authority to pursue waiver agreements with the federal government to support value-based payment arrangements, including fully capitated provider-based managed care. It also outlines the reimbursement rates for various types of hospitals and mandates the department to work with Idaho hospitals to establish value-based payment methods and a quality payment program for inpatient and outpatient services. The bill declares an emergency, making it effective from July 1, 2025.

Statutes affected:
Bill Text: 56-265