Bill > H1218

This bill aims to establish standards and regulations for physician performance evaluation programs used by insurance companies. It defines key terms like "quality," "cost efficiency," and "physician performance evaluation," and outlines several minimum attributes that such programs must have, including public disclosure, input from physicians and biostatisticians, mechanisms for data accuracy and feedback, and guidelines for quality measures, cost efficiency, and tiering. The bill also requires the commissioner to determine standard tiering criteria based on health outcomes, quality, and cost performance, and to set uniform criteria for network adequacy. Additionally, it includes provisions for how carriers can reclassify provider tiers and participation in selective and tiered plans, as well as requirements for carrier transparency and consumer information.

Business and Industry

https://malegislature.gov/Bills/192/H1218