Bill > H1916

This bill amends Chapter 111 of the General Laws by adding a new section, 51K, which aims to promote competition among healthcare providers within integrated systems. The bill defines a "Facility" as a hospital or a hospital-affiliated clinic that undergoes separate on-site reviews by the Joint Commission on the Accreditation of Healthcare Organizations. Key provisions require that any such facility, even if part of a larger system, must negotiate its contracts with public and private payers separately, establishing distinct negotiating teams and implementing "firewall mechanisms" to prevent the sharing of information that could hinder competition. Furthermore, contracts cannot be contingent on entering into agreements with other providers within the same system, nor can the availability of prices or terms be dependent on contracting with another facility. These separate negotiations will apply to both inpatient and outpatient services. The Department of Public Health and the Office of the Attorney General are empowered to enforce these requirements. However, the bill allows for exemptions if a system can demonstrate integration through regulations that the Department, in consultation with the Division of Insurance, will develop, considering factors like revenue from alternative payment arrangements, a unified electronic medical record system, quality improvement initiatives, directing care to appropriate settings, and eliminating service duplication. These new negotiation requirements will take effect at the time of contract renewal or expiration.