Amendment #1 to H4253
Incentivize High-Value Care
Representatives Cahill of Lynn and Dykema of Holliston move to amend the bill by inserting the following sections:-
SECTION XX. Subsection (f) of said section 15 of said chapter 6D, as appearing in the 2018 Official Edition, is hereby amended by inserting after the words “which providers of” the following:- health care services and
SECTION XX. Said subsection (f) of said section 15 of said chapter 6D, as so appearing, is hereby further amended by striking out words “of these services”.
SECTION XX. Said Subsection (f) of said section 15 of said chapter 6D, as so appearing, is hereby further amended by striking out the words “as an approved provider of these free-standing ancillary services for ACO patients”.
SECTION XX. Said Subsection (f) of said section 15 of said chapter 6D, as so appearing, is hereby further amended by striking out the words “of free-standing ancillary services”.
SECTION XX. Said section 15 of said chapter 6D, as so appearing, is hereby amended by adding the following subsection:-
(h) The commission shall annually review the standards published by each certified ACO pursuant to subsection (f) and shall issue a report of its findings, including any recommendations. At a minimum, the commission’s review shall include whether the standards of each ACO ensure consideration and participation by providers sufficient to ensure the goals of subsection (c) and to maximize value to patients by minimizing price and health status adjusted total medical expenses and maximizing quality and access. 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. The commission shall biennially amend the minimum standards established under subsection (b) in order to ensure processes by which participants and out-of-ACO arrangements are approved and structured by certified ACOs, including through joint venture arrangements.
SECTION XX. Notwithstanding any other general or special law to the contrary, not later than January 1, 2021, the health policy commission shall promulgate regulations to implement the aggrieved provider review process established in subsection (f) of section 15 of chapter 6D of the General Laws.