§ 7–771.10c. Department of Health Care Finance reporting requirements.

(a) By January 1, 2024, the Director shall submit the following reports to the Council:

(1) A report on medical respite care for homeless individuals, including:

(A) Recommendations for the establishment of medical respite care services for homeless individuals, through either an amendment to the District of Columbia Medicaid State Plan or a waiver pursuant to section 1115 of the Social Security Act, approved July 25, 1962 (76 Stat. 192; 42 U.S.C. § 1315);

(B) The types of services that may be offered to homeless individuals through a medical respite care program; and

(C) An identification of any potential restrictions on the provision of services identified pursuant to subparagraph (B) of this paragraph, including the use of prior authorization; and

(2) A report on the status of value-based payment methods within the District's public and locally funded health benefit programs operated by managed care organizations ("MCOs"), which shall include:

(A) Specific efforts undertaken by each of the District's public and locally funded health benefit programs operated by MCOs to incorporate value-based payment initiatives with their network providers, along with qualitative and quantitative outcomes associated with those efforts;

(B) A description of how each public and locally funded health benefit program operated by MCOs aligns financial incentives and accountability with the total costs of care and overall health outcomes;

(C) A description of how each public and locally funded health benefit program operated by MCOs aligns payments directly with quality and efficiency of care; and

(D) An analysis of the percentage of total medical expenditures by public and locally funded health benefit programs operated by MCOs that are linked to alternative payment methods.

(b)(1) Beginning January 1, 2024, and every 3 months thereafter, each of the District's public and locally funded health benefit programs operated by MCOs shall report to the Department the following data on a de-identified basis:

(A) The total number of beneficiaries in its plan, including those enrolled in a value-based payment model;

(B) The number of its beneficiaries who do not have an assigned primary care physician;

(C) The number of its beneficiaries who have not had a primary care visit in the previous 12 months; and

(D) The number of its beneficiaries who have had more than 5 emergency room visits in the previous 90 days.

(2) Within 30 days of receiving the information required under paragraph (1) of this subsection, the Director shall report such information to the Council and post it publicly on the Department's website.