Adds to existing Division of Health Care Finance and Policy (DHCFP) payer data submission requirements by including health status adjusted total medical expenses (TME) by provider group, relative prices paid to every health care provider in the payer’s network by type of provider, and hospital inpatient and outpatient costs. Payers must report each of the three new data categories according to a uniform methodology determined by DHCFP. Hospitals must report to DHCFP inpatient and outpatient costs, including direct and indirect costs, according to a uniform methodology.
Each year, DHCFP must annually report and post on its website information on TME, relative prices, and hospital inpatient and outpatient costs. Providers will have 10 days advance notice of the public release or posting to review the data. DHCFP is required to request TME data for Medicare patients from the Centers for Medicare & Medicaid Services (CMS). The uniform reporting is intended to allow DHCFP to track statewide and regional trends in the cost, utilization, and availability of medical services.
DHCFP is required to notify payers of any reporting deadlines and may penalize payers that fail to report by the deadlines.
