Bill > H971

This bill aims to reduce payment disparities among healthcare providers by establishing new regulations for how healthcare services are paid for, particularly concerning MassHealth and private insurance carriers. Specifically, MassHealth will be prohibited from contracting with managed care organizations that reimburse providers at rates exceeding 15% above the published median network relative price, as determined by the Center for Health Information and Analysis (CHIA), a state agency that collects and analyzes health care data. Additionally, contracts between acute care hospitals and private insurance carriers (referred to as "carriers") for medical services must ensure that the carrier's provider network relative prices, as calculated by CHIA, do not exceed 1.25 times the median relative price, unless certain exceptions apply, such as a hospital having a significant portion of its revenue from state-funded public payers like Medicaid. The Health Policy Commission, another state agency involved in healthcare policy, will define what constitutes a "relative price" and oversee compliance, with the power to direct carriers to adjust rates if they are found to be in violation. Hospitals will not be allowed to refuse participation in a carrier's network solely because the carrier is complying with these new payment regulations. Existing contracts will have until October 1, 2015, to comply with these provisions.