Bill > S813

This bill amends Chapter 176O of the General Laws to regulate the use of alternative payment arrangements by health insurance carriers. The key provisions are: (1) Carriers must consider patient population characteristics, such as age, acuity, social determinants of health, and behavioral health needs, when establishing alternative payment arrangements, and cannot base them solely on provider prices or historic medical spending of a subset of the provider network. (2) Alternative payment arrangements may include adjustments for claims processing, administrative costs, and quality or outcome-based incentive payments. (3) Carriers must file data on their alternative payment arrangements with the Center for Health Information and Analysis to verify compliance, and violations are subject to penalties under Chapter 93A. The bill also adds a definition of "alternative payment arrangement" to the law.

Health and Social Services

https://malegislature.gov/Bills/192/S813