Amendment #103 to H4617

Incentivizing ACO Contracting with High-Value Providers

Mr. Cahill of Lynn moves to amend the bill by inserting the following sections:-

SECTION XX. Section 15 of chapter 6D is hereby amended by inserting in subsection (f) in the first line after the phrase “which providers of” the following:- health care services as defined within subsection (c)(3) and

SECTION XX. Section 15 of chapter 6D is hereby amended by striking in subsection (f) in the second paragraph after the phrase “approval by an ACO” the following:- as a provider of free standing ancillary services for ACO patients.

SECTION XX. Section 15 of chapter 6D is hereby amended by inserting the following subsection:-

(h) The commission shall annually review each certified ACO’s published standards as required pursuant to subsection (f) and shall report its findings, including any recommendations. Such review shall include, but not be limited to, if such standards ensure consideration and participation by providers of health care services and free-standing ancillary services as defined within this section sufficient to ensure the goals of subsection (c), including ensuring maximized value to patients as expressed in a reduction in price and health status adjusted total medical expenses and an increase in quality. Such findings shall be used by the commission in the examination and cross examination of witnesses at the annual cost trend hearings pursuant to Section 8 of chapter 6D. The commission shall bi-annually amend the commission’s minimum standards pursuant to subsection (b) in order to ensure processes by which participants and out-of-ACO arrangements are selected and structured, including through joint venture arrangements, by certified ACOs such that said goals are sufficiently advanced.

SECTION XX. Notwithstanding any other general or special law to the contrary, the health policy commission shall promulgate by March 1, 2019 regulations to establish an aggrieved provider review process pursuant to subsection (f) of Section 15 of chapter 6D.