Bill > S719

This bill seeks to amend Chapter 176O of the Massachusetts General Laws to provide guidelines for health insurance carriers when establishing alternative payment arrangements with healthcare providers. The key provisions include: (1) Allowing carriers to consider patient population characteristics such as age, acuity, social determinants of health, and behavioral health needs when setting alternative payment arrangements, but prohibiting them from basing payments solely on provider prices or historic medical spending of a subset of their provider network; (2) Permitting carriers to include adjustments for claims processing, administrative costs, and quality/outcome-based incentive payments in alternative payment arrangements; and (3) Requiring carriers to file data on their alternative payment arrangements with the Center for Health Information and Analysis for compliance verification, with violations subject to Chapter 93A penalties.

Health and Social Services

https://malegislature.gov/Bills/191/S719