About The Program

Residential Outcome Payments are part of Inclusa’s Residential Rate Methodology (RRM). These outcomes allow Residential Providers to receive an additional payment when meeting certain criteria designed to promote member success. Payments are based on offering an additional level of care not captured within other areas of the RRM.

The Residential Outcome Payments were created in partnership with residential providers as a way to build a reimbursement model to compensate for residential cares and create opportunities for providers who offer an additional level of care. Based on provider feedback, outcome categories were developed in areas where many providers were already participating, and areas seen to address high cost drivers in residential care. These categories are comprised of Behavioral Health, Quality Improvement, Health Promotion, and a new category for 2019 which relates to Commonunity®, Inclusa’s trademarked model of managed care.

Payment Information:

The outcome payment amounts will be determined in the Fall of 2019 when Inclusa receives its capitation rate from the State; payments will then be distributed to eligible providers in the first quarter of 2020.

General Eligibility:

  • The 2019 Residential Outcome Payment opportunities are available to only those contracted residential providers utilizing the Inclusa’s RRM; some exceptions will be made regarding the Commonunity® Outcome opportunity, please see additional details by following the Commonunity® Outcome link below.
  • All eligible providers must remain in good standing with Inclusa throughout the project year as determined by Inclusa, and any payments may be offset to providers who have an outstanding balance.

Opportunities

  • Behavioral Health Outcome
    • Dementia Care Toolkits are to be submitted within three months after application submission.
      • Applications will not be accepted after September 1, 2019
      • Completed Dementia Care Toolkits will not be accepted after December 1, 2019
  • Quality Improvement Outcome
    • Application Deadline:  May 15, 2019
    • Progress Report Deadlines:  September 1, 2019 and December 1, 2019
  • Health Promotion Outcome
    • Application Deadline:  May 15, 2019
    • All training items are to be completed/submitted by December 1, 2019
  • Commonunity™ Outcome
    • All project items are to be completed/submitted by December 1, 2019