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Committee introduces bill raising outlier-claim thresholds for Medicaid VCOs
Summary
Representative Jordan Redmond introduced RS32085 to raise the minimum outlier claim threshold for value-based care organizations, proposing phased increases from $250,000 to $1 million; the committee approved introduction by voice vote.
Representative Jordan Redmond, representing District 3 (Kootenai County), described RS32085 as a change to the state Medicaid program’s outlier-claim threshold for value care organizations (VCOs).
"An outlier claim is any claim by a VCO that's over an amount which is currently set in a $100,000," Redmond said, noting that last year there were "473 outlier claims, 466 were over a 100,000, only 7 were over 500,000." He said RS32085 "would increase that minimum threshold to 250,000 the first year, 500,000 the next year, and up to a million dollars the year after that." Redmond described the change as one way to "create stability within our Medicaid budget" and cited the recommendation in a minority report from the Medicaid Managed Care Task Force (02/23).
Representative Kaler moved to introduce RS32085. The committee approved the motion on a voice vote and the RS was introduced for further consideration.
At introduction, members did not debate technical implementation or request a fiscal-note explanation on the record; the sponsor tied the measure to budget stability and the task-force recommendation. No roll-call vote was recorded.
