Amendment ID: S3116-41

Amendment 41

Payment Innovation

Mr. Driscoll moves that the proposed new draft be amended in Section 5, line 44, by striking the word “uniform”

, and again in said Section 5, lines 45 and 46, by striking the words “across all carriers, including the group insurance commission established in section 3 of chapter 32A,”

, and again in said Section 5, line 57, by striking the word “shall” and replacing with the following:- may

, and again in said Section 5, line 67 and, by striking the words “audits of participating providers or provider organizations; (ix)”;

, and again in said Section 5, line 68, by striking “(x)” and replacing it with the following:- (ix)

, and again in said Section 5, line 69, by striking “(xi)” and replacing it with the following:- (x)

, and again in said Section 5, line 71 by adding after the words “payment model.” the following:- The office shall, in coordination with the primary care technical advisory council, create a deeming process for provider or provider organizations that participate in a qualifying alternative payment methodology that meets certain criteria for the payment of primary care services, so that such provider or provider organizations shall be deemed to have adopted or implemented the advanced primary care payment model for the purposes of this statute.

, and again in said Section 5, line 72, by striking the word “shall” and replacing it with the following:- that provides primary care services may

, and again in said Section 5, line 75, by adding after the words “regulations and guidelines.” the following:- If a provider or provider organization participates in a qualifying alternative payment methodology that meets certain criteria for the payment of primary care services, they shall be deemed to have adopted or implemented the advanced primary care payment model for the purposes of this statute.

, and again in said Section 5, line 78, by striking the word “shall” and replacing it with the following:-  that provides primary care services may

, and again in said Section 5, lines 86 and 87, by striking the words “and submit to such audits”

, and again in said Section 5, line 94, by striking the number “8” and replacing it with the following:- 10

, and again in said Section 5, line 103, by adding after the words “hospital-based systems” the following:- , 1 of whom shall be from a health system with primary care services, 1 of whom shall be from a community hospital with primary care services,

, and again in said Section 5, line 127, by striking the word “revenue” and replacing it with the following:- reimbursement

, and again in said Section 5, line 138, by adding after the word “utilization” the following:- , including remote patient monitoring services, remote therapeutic monitoring services, e-consults, e-visits, and mobile integrated health

, and again in said Section 5, LINE 145, by adding after the word “management” the following:- , including care management and coordination for patients with disabilities

, and again in said Section 5, line 147, by adding after the words “medication-assisted treatment;” the following:- (vii) innovations in care including, but not limited to: telehealth, remote therapeutic monitoring, and mobile integrated health; (viii) providing advance care planning to patients and healthcare proxy completion;, and again in said Section 5, line 147, by striking the clause “(vii)” and replacing it with the following:- (ix)

, and again in said Section 5, line 187, by striking the words “attestation, reporting and audit process” and replacing it with the following:- “attestation and reporting process”

, and again in said Section 5, lines 191 through 195, by striking the words “; provided, however, that not less than 90 per cent of the per-member per-month payment to participating providers or provider organizations shall be directly allocated to and retained at the practice level, with not more than 10 per cent of the per-member per-month payment distributed at the system level for use in system-level services that benefit or are otherwise used by primary care practices participating in the system”

, and again in said Section 5, lines 198 and 199, by striking the words “, which shall be implemented uniformly across all carriers and the group insurance commission”

, and again in said Section 5, line 204, by striking the word “reach” and replacing it with the following:- benefit

, and again in said Section 5, line 208, by adding after the words “payment model” the following:- or for any primary care service that receives reimbursement under a qualifying alternative payment model

, and further moves to amend the bill in Section 18, line 544, by striking the word “implement” and replacing it with the following:- provide the option to participate in

, and again, in said Section 18, line 545, by adding after the words “chapter 6D” the following:- that provide primary care services

, and again, in said Section 18, line 552, by adding after the words “provider organizations” the following:- that provide primary care services

, and again in said Section 18, line 554, by striking the words “and submit to such audits”

, and further moves to amend the bill in Section 20, line 601, by striking the word “implement” and replacing it with the following:- provide the option to participate in

, and again in said Section 20, line 602, by adding after the words “provider organizations” the following:- that provide primary care services

, and again in Section 20, line 610, by adding after the words “provider organizations” the following:- that provide primary care services

, and again in said Section 20, line612, by striking the words “and submit to such audits”

, and further moves to amend the bill in Section 21, line 652, by striking the word “implement:” and replacing it with the following:- provide the option to participate in

, and again in Section 21, line 654, by adding after the words “chapter 6D” the following:- that provide primary care services

, and again in said Section 21, line 661, by adding after the words “provider organizations” the following: that provide primary care services

, and again in said Section 21, line 663, by striking the words “and submit to such audits”

, and further moves to amend the bill in Section 22, line 707, by striking the word “implement” and replacing it with the following:- provide the option to participate in

, and again in said Section 22, line 708, by inserting after the words “chapter 6D” the following:- that provide primary care services

, and again in said Section 22, line 716, by adding after the words “provider organizations” the following:- that provide primary care services

, and again in said Section 22, line 718 , by striking the words “and submit to such audits”

, and further moves to amend the bill in Section 24, line 776, by striking the word “implement” and replacing it with the following:- provide the option to participate in

, and again in Section 24, line 778, by adding after the words “chapter 6D” the following:- that provide primary care services

, and again in said Section 24, line 785, by adding after the words “provider organizations” the following:- that provide primary care services

, and again in said Section 24, line 787, by striking the words “and submit to such audits”