Amendment ID: S3116-37

Amendment 37

Rate‑Band Limits for Outpatient Primary Care Services

Mr. Tarr moves that the proposed new draft be amended by inserting after section 9 the following section:-

"SECTION 9A. Chapter 6D of General Laws as appearing in the 2024 official edition is hereby amended by inserting after section 10 the following new section:-10B. (a).  For any primary care service designated by the commission as clinically comparable across settings, a carrier shall reimburse the service within a rate band established by the commission, in consultation with the center for health information and analysis and the division of insurance.

(b) Not later than 90 days after the effective date of this act, the commission in consultation with the center for health information analysis shall establish by regulation a rate band methodology that:

– identifies the lowest contracted rate for each designated service;

– sets an allowable upper bound rate for hospital owned physician practices and hospital outpatient departments;

– narrows unwarranted payment variation while accounting for legitimate cost differences.

(c) A carrier shall not impose a facility fee or other differential charge for a service subject to this section.

(d) The commission may establish a transition period and supplemental payments for safety net hospitals.

(e) The commission shall monitor the impact of this section on primary care access, independent practice viability, consolidation trends, commercial premiums, and hospital financial stability."