Section 7: Quality Reporting
Requires every health care provider to track and report quality information at least annually according to Department of Public Health regulations.
Requires every health care provider to track and report quality information at least annually according to Department of Public Health regulations.
Specifies effective dates.
Specifies effective dates.
Creates a special commission on provider price reform to study rising cost trends of health insurance and the impact of reimbursement rates that health insurers pay to providers. The commission must examine policies that reduce disparities in provider reimbursement rates while enhancing competition, fairness, and cost efficiency in the health care market. Any recommendation the commission offers to the legislature must be consistent with recommendations of the Special Commission on the Health Care Payment System established in Section 44 of Chapter 305 of the Acts of 2008. The commission must consult with state agencies and other organizations with expertise in health care reform and a reasonable number of affected parties before making recommendations. The commission must submit a report of its findings and recommendations to the legislature by September 30, 2011.
Directs the Division of Insurance (DOI) to annually set a limit on the amount of impact that rate adjustment factors may have on the annual base rate increase for an individual or small group.
Provides that a health care provider may contract to provide supplemental funding to a health insurance carrier to be used to issue a premium reimbursement or other form of refund for eligible individuals and small groups currently enrolled in all health benefit plans under the carrier. The Division of Insurance (DOI) must issue a public report listing participating providers and the estimated refunds for individuals and small groups.
Directs the Division of Insurance (DOI) to complete a study by July 31, 2011 to determine whether the 90 day reporting requirement established in Section 31 of this Act gives health insurance carriers a sufficient amount of lead time to make accurate proposals of plan changes to DOI. DOI may recommend a more appropriate length of time if necessary.
Requires that the Division of Health Care Finance and Policy (DHCFP) encourage providers and payers to adopt a payment system on a bundled payment, rather than fee-for-service, basis to reduce costs and improve quality and coordination of health care services. DHCFP must assist providers and payers to adopt such a payment system by making technical support available to them. DHCFP must also examine existing and proposed bundled payment models and publish results of research, study the effects of federal programs that promote bundled payment systems, and identify financial resources that may become available to providers while they implement bundled payment systems. The statute encourages DHCFP to implement pilot bundled payment programs before April 1, 2011 for at least 2 acute conditions or procedures where health benefit payers will reimburse health care providers for inpatient services, as well as certain pre- and post-inpatient stay, on a bundled payment basis. DHCFP is also encouraged to implement additional pilot bundled payment programs for at least 2 chronic conditions by July 1, 2011. DHCFP must file reports with the legislature detailing the efforts it undertakes to support providers and payers to implement bundled payment programs and the progress it makes toward implement the encouraged pilot programs.
Directs the Division of Medical Assistance to revise the Independent Clinical Laboratory Manual to include licensed substance abuse treatment programs as authorized prescribers of random substance treatment-related urine drug screens.
Directs the Division of Health Care Finance and Policy to continue submitting to the legislature an annual public health access beneficiary employer report that must include names and addresses of employers whose employees and/or their dependents receive public medical assistance or medical benefits, the number of employees and/or dependents receiving public benefits, the cost to the Commonwealth for providing the benefits, and whether the employer offers health benefits to its employees.