Bill > H1192

This bill aims to establish guidelines for alternative payment arrangements (APAs) in health care to promote non-discrimination. Specifically, the bill defines an APA as a contract between insurance carriers and healthcare providers where payment is made through methods like capitation, shared savings, or global budgeting. When establishing these arrangements, carriers must consider patient population characteristics such as age, health complexity, social determinants of health, and behavioral health needs, while explicitly prohibiting the use of provider prices or historic medical spending from only a subset of their network. The bill requires carriers to use total medical expense measures that include expenses from all providers in their network, uniformly applied across provider types. Additionally, APAs can include adjustments for administrative costs and incentive payments based on quality measures negotiated between carriers and providers. Carriers must file detailed data with the Center for Health Information and Analysis to verify compliance, and violations of these provisions would be treated as violations under consumer protection laws. The goal is to create a more equitable and standardized approach to healthcare payment arrangements that does not unfairly advantage or disadvantage specific providers or patient groups.

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https://malegislature.gov/Bills/194/H1192