Amendment #476 to H3600

Addressing Provider Reimbursement Disparities Through the Cost Growth Benchmark

Mr. Cullinane of Boston moves to amend the bill by adding the following three sections:

“SECTION XXXX:

Section 18 of chapter 12C of the general laws is hereby amended by adding the following after the first sentence:

For providers and provider organizations, excessive spending shall be determined based on the increase in the provider or provider organization’s total health care expenditures in excess of:  (a) the cost growth benchmark divided by (b) the provider or the provider organization’s all-payer weighted average payer rate as compared to the all-payer weighted average payer rate median.”

“SECTION XXXX:

Chapter 176O of the general laws is hereby amended by adding the following section:

Section 28. Notwithstanding any other general or special law to the contrary, no carrier shall grant a provider or provider organization an annual increase in rates that exceeds the cost growth benchmark established in section 9 of chapter 6D divided by the provider or provider organization’s weighted average payer rate as reported by the center for health information and analysis. The commissioner shall adopt regulations to carry out this section.”

“SECTION XXXX:

To the extent permissible under federal law, the division of insurance shall issue bulletins and advisories to ensure that carriers and third-party administrators hold high cost providers to rates at or below the cost growth benchmark divided by the provider’s or the provider organization’s all-payer weighted average payer rate for all health care networks as compared to the all-payer weighted average payer rate median for all health care networks.”