(1) On a quarterly basis, a risk-based provider organization shall submit to the Department of Human Services protected health information for each member of a covered Medicaid beneficiary population and a voluntary Medicaid beneficiary population enrolled with the risk-based provider organization in accordance with standards and procedures adopted by the department, including without limitation: Claims data, including without limitation: Denial rates; and
(2) Claims-paid rates;
(3) Encounter data;
(4) Unique identifiers;
(5) Geographic and demographic information;
(6) Patient satisfaction scores; and
(7) Other information as required by the state.
(8) Personally identifiable data submitted under this section shall be treated as confidential and is exempt from disclosure under the Freedom of Information Act of 1967, § 25-19-101 et seq.
(9) The department shall use the data submitted under subsection (a) of this section to measure the performance of the risk-based provider organization in: Delivery of services;
(10) Patient outcomes;
(11) Efficiencies achieved; and
(12) Quality measures.
(13) Performance measures established by the department shall at a minimum monitor: Reduction in unnecessary hospital emergency department utilization;
(14) Adherence to prescribed medication regimens;
(15) Reduction in avoidable hospitalizations for ambulatory-sensitive conditions; and
(16) Reduction in hospital readmissions.
(17) The department shall issue funds from the quality incentive pool above the amount of the global payments initially provided to a risk-based provider organization that meets or exceeds specific performance and outcome measures established by the department.
(18) On a quarterly basis, the department shall report to the Legislative Council, or to the Joint Budget Committee if the General Assembly is in session, available information regarding: Risk-based provider organization membership enrollment and distribution;
(19) Patient experience data; and
(20) Financial performance, including demonstrated savings.