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Committee introduces bill to raise outlier threshold for Medicaid value care organizations
Summary
Representative Jordan Redmond introduced RS32085 to raise the outlier-claim threshold for value care organizations (VCOs) from $100,000 to a phased schedule reaching $1 million; sponsor said the change is intended to stabilize Medicaid budgeting and follows recommendations in a 2023 task force minority report.
Representative Jordan Redmond (District 3, Kootenai County) told the House Health and Welfare Committee that RS32085 would raise the monetary threshold that defines an "outlier" claim for value care organizations participating in Medicaid.
Redmond said the current outlier threshold is $100,000. He reported that, in the previous year, there were 473 outlier claims, 466 of which exceeded $100,000 and seven of which were over $500,000. RS32085 would increase the threshold to $250,000 in year one, $500,000 the next year, and $1 million in the following year.
"This is one of the ways that we can create stability within our Medicaid budget," Redmond said, and he cited the measure as a recommendation from the minority report of the Medicaid Managed Care Task Force dated February 2023.
Representative Kaler moved to introduce RS32085 and the committee approved the motion by voice vote; the chairman announced the RS was introduced.
The transcript records limited discussion on implementation details. Redmond tied the proposal to the task force minority report, which he said he and several committee members signed. The committee did not record a fiscal note or day-to-day operational details in the transcript; Redmond did not provide specifics about which VCO contracts or programs would be affected beyond the numerical thresholds.
RS32085 was introduced and will be scheduled for a full hearing where the committee and department staff can examine anticipated costs, how the threshold change would affect payments to VCOs, and any downstream effects on Medicaid beneficiaries.
