Bill > H906

This bill establishes requirements for insurance companies, referred to as "carriers," when implementing physician performance evaluation programs, which are systems designed to measure the quality and cost efficiency of a physician's care. Key provisions include mandating public disclosure of evaluation methodologies 180 days in advance, requiring meaningful input from practicing physicians and biostatisticians, and establishing a data accuracy mechanism with a feedback cycle of at least 120 days before public reporting. Physicians must receive detailed patient-level information for cost efficiency measures and patient lists for quality measures, and quality measures must have defined targets and be case-mix adjusted when combining multiple conditions. The bill also specifies that adherence to quality measures should be assessed at a physician group practice level, not individually, and that preventive care and under-use measures should not be part of cost efficiency calculations. Furthermore, it outlines requirements for tiering networks, ensuring uniform tier assignment protocols, statistically significant differences for tier changes, and separate categories for physicians who cannot be reliably evaluated, without increasing patient co-payments. The bill also addresses network adequacy by requiring carriers to ensure members have reasonable access to providers in the lowest cost-sharing tier for all covered services and limits how often provider tiers can be reclassified, with specific protections for members undergoing treatment and requirements for clear, understandable information dissemination to consumers.