Amendment ID: S3116-60

Amendment 60

Preserving the Opportunity for Cost Savings and Innovation

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

"SECTION ___. Notwithstanding the foregoing provisions, one or more healthcare payers and providers may develop and submit for approval to the Health Policy Commission a system of billing, approval, and payment which does not conform to the requirements of the advanced primary care payment model system prescribed by this act, provided that an application for approval of such alternative system shall contain all of the following components and attributes:

1) A clear and transparent description of the methodology utilized by the system;

2) All forms, codes, and other relevant documents necessary to the operation of the system;

3) A clear and concise written justification for using the system, including but not limited to its impacts on access, quality of care, cost containment and reduction, efficiency of utilization, sustainability, minimizing resources dedicated to utilizing the system, compatibility and interoperability with other systems, and any advantages gained by utilizing the proposed system;

4) A  description of any technology, human resources, or other costs associated with implementing or utilizing the system;

5) One or more methodologies to measure and report the efficacy of the system in reasonable, routine periods of time; and

6) An identification of all proposed participants in the system, together with a description of all such participants, and their signed assent to the application.

The Health Policy Commission shall receive any such properly submitted application and subject it to a comprehensive review, which may include consultation with other relevant state and federal agencies, experts, and the receipt of public testimony.  Said commission shall make a determination on the disposition of the application not later than 180 days following its submission, provided that such disposition may include approval, rejection, or additional review and analysis for a period of 60 days, provided, however, that the total of such periods shall not exceed an additional 180 days from the date of first disposition.

The commission may approve the use of an applicant system if it finds that such a system will:

1) Be cost-effective;

2) Minimize resources dedicated to billing and payment by providers;

3) Ensure access and promote quality healthcare outcomes;

4) Provide consumers with timely, accurate information; and

5) Deliver particular benefits that would improve healthcare delivery in the commonwealth

Provided, that the commission may approve a pilot program utilizing said system for a period not to exceed five years, provided that such program include appropriate monitoring and reporting.

Any application so approved by the commission shall contain any reporting, disclosures, or other documentation which the commission deems necessary.  The commission shall report any application so approved to the clerks of the House and Senate, the secretary of administration and finance, and the joint committee on health care financing not later than 30 days following such approval."