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SENATE DOCKET, NO. 544 FILED ON: 1/17/2023
SENATE . . . . . . . . . . . . . . No. 803
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Michael F. Rush
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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act relative to health care non-discrimination.
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PETITION OF:
NAME:DISTRICT/ADDRESS :Michael F. RushNorfolk and SuffolkPaul McMurtry11th Norfolk2/8/2023 1 of 2
SENATE DOCKET, NO. 544 FILED ON: 1/17/2023
SENATE . . . . . . . . . . . . . . No. 803
By Mr. Rush, a petition (accompanied by bill, Senate, No. 803) of Michael F. Rush and Paul
McMurtry for legislation relative to health care non-discrimination. Health Care Financing.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 813 OF 2021-2022.]
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act relative to health care non-discrimination.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 176O of the General Laws is amended by adding the following
2Section.
3 Section 28. (a) When establishing alternative payment arrangements, a carrier may take
4into account patient population characteristics including age, acuity, social determinants of
5health, and behavioral health service needs. The measures of total medical expense used to
6establish an alternative payment arrangement should include expenses incurred by all providers
7in the carrier’s provider network, uniformly applied by provider type. When establishing
8alternative payment arrangements, a carrier shall not take into account provider prices or historic
9medical spending attributable only to a subset of its provider network or the historic medical
10expenses of members based on their attribution to specific providers in the carrier’s network. 2 of 2
11 (b) In addition to the factors set forth in subsection (a) of this section, an alternative
12payment arrangement may include adjustments for claims processing and administrative costs
13and incentive payments based on attainment of quality measures or outcomes, as negotiated
14between a carrier and providers participating in the alternative payment arrangement.
15 (c) Each carrier shall file with the center for health information and analysis data on its
16alternative payment arrangements sufficient for the verification of compliance with subsection
17(a) of this section, in a form determined by the center for health information and analysis.
18 (d) A violation of subsection (a) or (c) of this section shall be a violation of chapter 93A
19of the general laws.
20 SECTION 2. Chapter 176O is amended by adding the following definition after the
21definition of adverse determination:
22 “Alternative payment arrangement” means a contract between a carrier and a health care
23provider or group of providers under which payment is made by capitation, shared savings,
24reconciliation of fee-for-service payments against a global budget or per-member-per month
25target, or any other method that bases payments to the provider on a projection of the medical
26expenses to be incurred by a population of individuals.