H 1040 (see companion bill S 803) – Massachusetts

Status: In Process
Year Introduced: 2023
Link: https://malegislature.gov/Bills/193/H1040

An Act relative to health care non-discrimination. When establishing alternative payment arrangements, a carrier may take into account patient population characteristics including age, acuity, social determinants of health, and behavioral health service needs. The measures of total medical expense used to establish an alternative payment arrangement should include expenses incurred by all providers in the carrier’s provider network, uniformly applied by provider type. When establishing alternative payment arrangements, a carrier shall not take into account provider prices or historic medical spending attributable only to a subset of its provider network or the historic medical expenses of members based on their attribution to specific providers in the carrier’s network.

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