Section 52: Directs DHCFP To Create Relative Pricing Regulations

Notwithstanding any special or general law to the contrary, the division of health care finance and policy, in consultation with the division of insurance, shall promulgate regulations on or before January 1, 2011 to establish uniform methodology for calculating and reporting relative prices paid to hospitals, physician groups, other health care providers licensed under chapter 112 of the General Laws, freestanding surgical centers by each private and public health care payer under section 6 of chapter 118G of the General Laws. The uniform methodology for calculating and reporting relative prices under this section shall, at a minimum:

(i) specify a method for basing the calculation on a uniform mix of products and services by payer that is case mix neutral;

(ii) specify a uniform method for including in the calculation all non-claims related payments to providers, including supplemental payments of any type, such pay-for-performance, care management payments, infrastructure payments, grants, surplus payments, lump sum settlements, signing bonuses, and government payer shortfall payments;

(iii) permit reporting of relative price in the aggregate for all physician groups whose price equals the payer's standard fee schedule rates; and

(vi) designate and annually update the comprehensive list of physician groups for which payers shall report relative prices.

Summary: 
Instructs the Division of Health Care Finance and Policy (DHCFP), in consultation with the Division of Insurance, to establish regulations directing health insurance carriers to calculate and report relative prices paid to health care facilities and providers. In the regulations, DHCFP must specify a method to account for a uniform mix of products and services and all non-claims related payments to providers.