Bill > H1186

This bill aims to strengthen oversight of the healthcare provider and insurance market by the Health Policy Commission (HPC) and the Center for Health Information and Analysis (CHIA). The key provisions are: 1. Providers or provider organizations must notify the HPC, CHIA, and Attorney General at least 60 days before making any material changes to their operations or governance structure, such as mergers, acquisitions, or affiliations. The HPC can then conduct a cost and market impact review to determine if the change is likely to significantly impact the state's ability to meet healthcare cost growth targets or the competitive market. The HPC can deny requests for material changes that would result in unfair competition, deceptive practices, increased costs, or reduced competition. 2. If a provider organization is identified by CHIA as exceeding the state's healthcare cost growth benchmark, the HPC can prohibit that organization from making any material changes until its costs are brought back in line with the benchmark. 3. The HPC must annually review the impact of previously approved material changes to determine if the promised benefits, such as lower costs or improved quality, have been realized. The HPC can then take enforcement actions, such as enhanced review or corrective action plans, if the benefits have not materialized. 4. If the HPC finds that an approved material change has failed to produce the stated benefits and the provider organization has exceeded the cost growth benchmark, the HPC must notify CHIA, which will then calculate the excess cost to the state and adjust the organization's payments to or from the Health Safety Net accordingly.

Health and Social Services

https://malegislature.gov/Bills/191/H1186