Bill > H1040

This bill aims to establish alternative payment arrangements in health care to promote non-discrimination. It amends Chapter 176O of the General Laws to require that when carriers (insurance providers) set up alternative payment models, they must consider patient population characteristics like age, acuity, social determinants of health, and behavioral health needs, and use measures of total medical expense across their entire provider network, rather than basing payments on historic costs of a subset of providers. The bill also allows for adjustments to account for claims processing, administrative costs, and quality incentives. Carriers must file data on their alternative payment arrangements with the Center for Health Information and Analysis to verify compliance, and violations can lead to penalties under Chapter 93A.

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https://malegislature.gov/Bills/193/H1040