Amendment #1325 to H4000

Reimbursement for Low Historic Relative Price Hospitals

Mr. Markey of Dartmouth moves to amend the bill by adding the following section:

“SECTION XXXX. Chapter 6D of the General Laws is hereby amended by inserting after section 9 the following section:-

Section 9A. (a) For the purposes of this section, “low historic relative price hospital” shall mean an acute hospital (i) with an average statewide relative price across all carriers during a 5-year period of less than 0.90, and (ii) that is either corporately independent or is corporately affiliated with 2 or more acute hospitals but negotiates carrier contracts separately and on its own behalf. The commission, in consultation with the center, shall annually publish a list of acute hospitals that qualify as low historic relative price hospitals under this section.

(b) The commission shall establish a rate equity target to advance the equitable reimbursement of low historic relative price hospitals:

(1) For the benchmark cycle of calendar years 2026 to 2029, inclusive, a carrier shall not pay any in-network low historic relative price hospital a payment rate that is less than 15 per cent below the average relative price of all acute hospitals in the carrier’s network;

(2) For the benchmark cycle of calendar years 2029 to 2032, inclusive, the average annual reimbursement rate increase from a carrier to a low historic relative price hospital shall be not less than 2 per cent above the health care cost growth benchmark;

(3) For the benchmark cycle of calendar years 2032 to 2035, inclusive, the average annual reimbursement rate increase from a carrier to a low historic relative price hospital shall be not less than 1 per cent above the health care cost growth benchmark; and

(4) Beginning in the benchmark cycle of calendar years 2035 to 2038, inclusive, and beyond, the average annual reimbursement rate increase from a carrier to a low historic relative price hospital shall be not less than the health care cost growth benchmark.”

Additional co-sponsor(s) added to Amendment #1325 to H4000

Reimbursement for Low Historic Relative Price Hospitals