Bill > S509

This bill aims to establish standards and requirements for insurance companies when implementing physician performance evaluation programs. Key provisions include: - Defining "quality," "cost efficiency," and "physician performance evaluation" terms - Requiring public disclosure of methodologies, meaningful input from physicians and statisticians, data accuracy checks, and transparency in performance reporting for any physician evaluation programs - Setting guidelines for quality and cost efficiency measures, including reasonable targets, case-mix adjustment, and appropriate weighting of measures - Establishing requirements for tiering providers, such as uniform tier assignment protocols, statistically significant differences in ratings to shift tiers, and avoiding higher copays for providers in separate categories - Mandating that carriers provide comprehensive and understandable information to consumers on their tiered and selective network plans, including criteria for provider selection and tiering. The bill seeks to ensure that physician evaluation programs are fair, transparent, and driven by quality improvement, while also promoting consumer awareness and access to care in tiered insurance networks.

Business and Industry

https://malegislature.gov/Bills/190/S509