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Committee introduces bill to raise Medicaid outlier thresholds for value care organizations
Summary
Representative Jordan Redmond introduced RS32085 to raise the Medicaid outlier-claim threshold in phases from $100,000 to $1 million over three years to stabilize Medicaid budgeting for value care organizations (VCOs).
Representative Jordan Redmond (District 3, Kootenai County) told the House Health & Welfare Committee that RS32085 would raise the threshold for Medicaid "outlier" claims filed by value care organizations (VCOs).
Redmond said, “This bill would increase that minimum threshold to 250,000 the first year, 500000 the next year, and up to a million dollars the year after that.” He described the change as a tool to create stability in the Medicaid budget and said the proposal was one recommendation in the minority report of the Medicaid Managed Care Task Force dated February 2023.
Redmond provided figures from the prior year, saying there were 473 outlier claims, of which 466 were over $100,000 and only seven were over $500,000. He presented the change as a phased approach intended to limit the number of high-dollar outlier payments affecting state Medicaid finances.
Representative Kaler moved to introduce RS32085; the committee adopted the motion by voice vote and RS32085 was introduced. Members asked no further questions during the introduction; substantive debate and fiscal analysis were reserved for a full hearing.
The sponsor tied the measure to previous task-force recommendations and indicated the change was intended to improve budget predictability for the state's Medicaid system.
