The bill amends Section 56-265 of the Idaho Code to establish specific requirements for value care organizations within the Medicaid program. 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. Additionally, the bill emphasizes the department's authority to enter into agreements with providers that focus on value-based payments, which are designed to be cost-neutral or cost-saving compared to traditional payment methodologies.

The bill also outlines various reimbursement rates for different types of hospitals, including critical access, out-of-state, and state-owned hospitals, while requiring the department to work with Idaho hospitals to develop value-based payment methods for inpatient and outpatient services. Furthermore, it mandates that budgets for hospital payments be subject to legislative approval and establishes a quality payment program for adjustment payments based on hospital service quality measures. The act declares an emergency, making it effective on July 1, 2025.

Statutes affected:
Bill Text: 56-265