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§ 532-A. Managed care organization performance reporting

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 62 P.S. Poor Persons and Public WelfareEffective: March 31, 2019

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 62 P.S. Poor Persons and Public Welfare (Refs & Annos)
Chapter 1. Human Services Code (Refs & Annos)
Article V-a. Health Care Outcomes
(d) Managed Care Organization Outcomes Program
Effective: March 31, 2019
62 P.S. § 532-A
§ 532-A. Managed care organization performance reporting
Currentness
The department shall develop and maintain a reporting system to provide each managed care organization with regular confidential reports regarding the managed care organization's performance with respect to potentially avoidable admissions, readmissions and emergency visits. The department shall:
(1) Conduct ongoing analyses of existing and relevant State claims databases to identify instances of potentially avoidable admissions, readmissions and emergency visits with potential excess expenditures associated with the cases.
(2) Create or locate Statewide norms for admissions, readmissions and emergency visits.
(3) Measure actual-to-expected managed care organization performance compared to Statewide norms.
(4) Compare managed care organizations with the managed care organizations' peers using risk adjustment procedures that account for the chronic illness burden of each plan's enrollees.
(5) Distribute reports to managed care organizations to provide the managed care organizations with actionable information to create policies, contracts and programs designed to improve target outcomes.

Credits

1967, June 13, P.L. 31, No. 21, art. 5-A, § 532-A, added 2018, June 22, P.L. 258, No. 40, § 3.1, effective March 31, 2019.
62 P.S. § 532-A, PA ST 62 P.S. § 532-A
Current through Act 13 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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