Bill > S558

This bill aims to establish regulations and requirements for insurance companies' physician performance evaluation programs and tiered network plans. The key provisions include: 1. Defining "quality", "cost efficiency", and "physician performance evaluation" to provide context. 2. Requiring insurance companies to meet specific criteria for their physician performance evaluation programs, such as public disclosure, physician input, data accuracy, and transparency measures. 3. Mandating that insurance companies establish physician performance evaluation programs with similar criteria as described in Section 2. 4. Directing the Commissioner to determine standard tiering criteria based on health outcomes, quality performance, and cost performance, and requiring that providers in the same Accountable Care Organization or Patient-Centered Medical Home be classified in the same tier. 5. Requiring the Commissioner to promulgate regulations for network adequacy in tiered network plans, ensuring reasonable access to providers in the lowest cost-sharing tier. 6. Regulating how and when insurance companies can reclassify provider tiers and participate in selective and tiered plans, and requiring transparency and consumer information regarding these plans.

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https://malegislature.gov/Bills/191/S558