Bill > S660

This bill amends Chapter 176O of the General Laws to regulate how health insurance carriers can establish alternative payment arrangements with healthcare providers. The key provisions are: 1) Carriers must consider patient population characteristics like age, acuity, social determinants of health, and behavioral health needs when setting alternative payment arrangements, and cannot base arrangements solely on provider prices or historic medical spending for a subset of the provider network. 2) Alternative payment arrangements may include adjustments for claims processing, administrative costs, and incentive payments based on quality measures or outcomes. 3) Carriers must file data on their alternative payment arrangements with the Center for Health Information and Analysis for compliance verification, and violations are subject to Chapter 93A penalties. The bill also adds a definition of "alternative payment arrangement" to Chapter 176O, describing contracts between carriers and providers that use methods like capitation, shared savings, or global budgets to base payments on projected medical expenses for a population.

Health and Social Services

https://malegislature.gov/Bills/190/S660