This bill amends Section 56-265 of the Idaho Code to revise the payment structure for Medicaid providers. It establishes that payments for primary care procedure codes may reach up to 100% of the current Medicare rate, while payments for all other procedure codes will be set at 90% of the Medicare rate. The bill introduces new provisions for home and community-based services without a Medicare equivalent, requiring annual cost surveys with a minimum of 15% of responses audited. It mandates that providers allocate funds to direct care worker wages and employee-related expenses, with potential corrective actions for non-compliance. Additionally, the Department of Health and Welfare is tasked with summarizing the cost survey results in a publicly available report by December 31 each year.

Furthermore, the bill declares certain administrative rules in IDAPA 16.03.26 as null and void after July 1, 2026, and emphasizes the need for value-based payment agreements with providers, which should be cost-neutral or cost-saving. It outlines reimbursement rates for various types of hospitals and mandates equitable reductions in net reimbursements to meet budgetary goals. The Department is also directed to collaborate with Idaho hospitals to establish quality payment programs and value-based payment methods, with legislative approval required for budget changes related to hospital payments. An emergency clause is included, allowing the act to take effect immediately upon passage and approval.

Statutes affected:
Bill Text: 56-265