Amendment ID: S2202-125

Amendment 125

Quality Measures

Ms. Donoghue moves to amend the bill in section 2 by inserting in line 60 before the term “shall” the following new language:- “shall include all Healthcare Effectiveness Data and Information Set (HEDIS) measures and”  

And that the bill be further amended in section 2 by striking subsection (b) and replacing it with the following new subsection:-

(b) Periodically, but not more frequent than every three years, the secretary of health and human services shall establish an aligned measure set to be used by the commonwealth and carriers in contracts with health care providers that incorporate quality measures into the payment terms pursuant to section 28 of chapter 32A, section 81 of chapter 118E, section 108N of chapter 175, section 40 of chapter 176A, section 26 of chapter 176B, section 35 of chapter 176G, section 14 of chapter 176I and for assigning tiers to health care providers in tiered network plans pursuant to section 11 of chapter 176J, provided however that a carrier may apply for a waiver from this requirement from the secretary of health and human services. The aligned measure set shall designate: (i) core measures that shall be used in contracts between payers, including the commonwealth and carriers, and health care providers, including provider organizations and accountable care organizations, that incorporate quality measures into payment terms; and (ii) non-core measures that may be used in such contracts.

And in section 43 by inserting at the end of line 745 after the term “health plan”, the following new language:- “, provided however that a carrier or third party administrator with whom a carrier contracts may apply for a waiver from this requirement from the secretary of health and human services. “

And in Section 94 by inserting at the end of line 1517 after the term “section 9A”, the following new language:- “, provided however that contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract with a Medicaid managed care organization or primary care clinician plan may apply for a waiver from this requirement from the secretary of health and human services.”

And in Section 97 by inserting at the end of line 1574 after the term “health plan”, the following new language:- “, provided however that an insurer may apply for a waiver from this requirement from the secretary of health and human services.”

And in Section 98 by inserting at the end of line 1624 after the term “hospital service plan”, the following new language: “, provided however that a nonprofit hospital service corporation may apply for a waiver from this requirement from the secretary of health and human services.”

And in Section 99 by inserting at the end of line 1672 after the term “medical service plan”, the following new language:-  “, provided however that a nonprofit medical service corporation may apply for a waiver from this requirement from the secretary of health and human services.”             

And in Section 100 by inserting at the end of line 1720 after the term “health maintenance contract”, the following new language:- “, provided however that a health maintenance organization may apply for a waiver from this requirement from the secretary of health and human services.”

And in Section 101 by inserting at the end of line 1762 after the term “health benefit plan”, the following new language:- “, provided however that an organization may apply for a waiver from this requirement from the secretary of health and human services.”