Bill > H1003

This bill aims to establish alternative payment arrangements in the healthcare system to promote non-discrimination. The key provisions are: 1) When establishing alternative payment arrangements, carriers (insurance companies) can consider patient population characteristics like age, acuity, social determinants of health, and behavioral health needs, but cannot base payments solely on provider prices or historic spending by a subset of providers. 2) Alternative payment arrangements may include adjustments for claims processing, administrative costs, and incentive payments based on quality measures or outcomes, as negotiated between the carrier and providers. 3) Carriers must file data on their alternative payment arrangements with the Center for Health Information and Analysis to verify compliance. Violations can be considered a violation of state consumer protection laws. 4) The bill also defines "alternative payment arrangement" as a contract between a carrier and provider that bases payments on a projection of medical expenses for a population, such as through capitation, shared savings, or per-member-per-month targets.

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https://malegislature.gov/Bills/191/H1003