Bill > S906

This bill amends Massachusetts health care laws to regulate how insurance carriers (called "carriers") establish alternative payment arrangements (APAs) with healthcare providers. An APA is a payment method that moves away from traditional fee-for-service billing, instead paying providers based on projected medical expenses for a patient population. The bill specifies that when creating these arrangements, carriers can consider patient population characteristics like age, health complexity, social factors, and behavioral health needs, but cannot base payments on historic medical spending of only some providers or members. Carriers must include expenses from all providers in their network and apply measurements uniformly. Additionally, APAs can include adjustments for administrative costs and incentive payments tied to quality measures. Carriers are required to file detailed data about their APAs with the Center for Health Information and Analysis to verify compliance, and violations can be pursued under consumer protection laws. The bill aims to create more standardized and equitable payment methods in healthcare that don't discriminate against specific providers or patient groups.

Health and Social Services

https://malegislature.gov/Bills/194/S906