Thank you to all residential providers who helped make our 2018 Residential Outcome projects a success! At this time all outcome projects are now CLOSED. Payment Information, General Eligibility, and individual Project Deadlines can still be found below. Please watch for future communications regarding the 2019 opportunities, which will be announced in our Provider Partners Newsletter and sent via email during the first quarter of 2019. As always, if you have any additional questions regarding the 2018 Residential Outcome Payments, please feel free to contact us at any time at innovation@inclusa.org.

Please Note:  Residential outcome payments are not the same as the direct care workforce funding initiative – to learn more about the direct care workforce funding initiative, click here.

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, and Health Promotion.

Payment Information:

Inclusa will process all payments to eligible providers as it relates to the 2018 Residential Outcome Payments; eligible providers will not need to do anything further to receive payment. Eligible providers will receive a check sent to the location identified on the organization’s W9 and payments will not be distributed via member authorization(s) found within the Provider Portal.

Checks for completed outcomes will be mailed to eligible providers in the first quarter of 2019. Included in the mailing will be a listing identifying the facility location(s) receiving payment and the amount associated with each outcome met.

General Eligibility:

  • The 2018 Residential Outcome Payment opportunities are available only to those contracted residential providers utilizing the 2018 RRM; providers who support Day Services, Supportive Homecare Days, Supportive Apartments, or the like, are not eligible as the 2018 RRM is not utilized to determine those rates.
  • All eligible providers must remain in good standing with Inclusa throughout the project year, and any payments may be offset to providers who have an outstanding balance due to Inclusa or any of its Legacy Managed Care Organizations (MCOs).

Provider Feedback Opportunity:

As always, we encourage providers to submit feedback regarding the Outcome Payment project experience and the communications associated with the payment opportunities. If you would like to provide feedback via a brief survey, or be added to an electronic mailing list, please visit: https://www.cognitoforms.com/Inclusa1/OutcomePaymentProjectSurvey

2018 Residential Outcome Payment Opportunities:

  • Behavioral Health Outcome
    • Application Deadline July 1, 2018
    • Project Deadline December 1, 2018
  • Quality Improvement Outcome
    • Application Deadline July 1, 2018
    • Project Deadline December 5, 2018
  • Health Promotion Outcome
    • No Application
    • Project Deadline December 1, 2018

Additional Resources: