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<section article="ghg" article_name="Health - General" number="13-4904" effective_note="EFFECTIVE UNTIL NOVEMBER 30, 2027 PER CHAPTERS 290, 291, AND 369 OF 2023" title_number="13" title_name="Miscellaneous Health Care Programs" subtitle_number="49" subtitle_name="Behavioral Health Care Coordination Value-Based Purchasing Pilot Program. [Effective Until December 1, 2027]">
  <level label="a">
    <text>The Department shall administer the Pilot Program.</text>
  </level>
  <level label="b">
    <text>The Department shall identify at least 500 adults whose behavioral health condition or functioning places them at risk of hospital emergency department utilization or inpatient psychiatric hospital admission.</text>
  </level>
  <level label="c">
    <text>The Pilot Program shall be operational for a 3–year period.</text>
  </level>
  <level label="d">
    <text>A provider or network of providers selected to participate in the Pilot Program shall:</text>
    <level label="1">
      <text>Be licensed and in good standing with the Maryland Medical Assistance Program;</text>
    </level>
    <level label="2">
      <text>Have experience in providing community–based care coordination to specialty behavioral health program recipients;</text>
    </level>
    <level label="3">
      <text>Use an electronic medical record for documenting care coordination activities and outcomes collection; and</text>
    </level>
    <level label="4">
      <text>Have an automated data exchange with the State–designated health information exchange.</text>
    </level>
  </level>
  <level label="e">
    <text>The Department shall:</text>
    <level label="1">
      <text>Provide reimbursement on a per member per month basis for the behavioral health care coordination activities that are not otherwise covered by the Maryland Medical Assistance Program;</text>
    </level>
    <level label="2">
      <text>Collect outcomes data on recipients of health care services under the Pilot Program; and</text>
    </level>
    <level label="3">
      <text>Evaluate the effectiveness of the value–based purchasing model by analyzing the following outcome measures:</text>
      <level label="i">
        <text>A comparison of the following data elements before and after enrollment of recipients of health care services under the Pilot Program:</text>
        <level label="1">
          <text>Emergency department utilization for both behavioral and somatic health purposes;</text>
        </level>
        <level label="2">
          <text>Inpatient hospitalization for both behavioral and somatic health purposes; and</text>
        </level>
        <level label="3">
          <text>Total health care expenditures;</text>
        </level>
      </level>
      <level label="ii">
        <text>Outcomes for recipients with and without primary care services coordinated by a behavioral health provider; and</text>
      </level>
      <level label="iii">
        <text>Recognized clinical quality metrics which may include patient experience measures.</text>
      </level>
    </level>
  </level>
</section>
