Massachusetts Governor Deval Patrick filed legislation on February 17 designed to achieve health care payment and delivery system reform in the Commonwealth. The proposed legislation, “An Act Improving the Quality of Health Care and Controlling Costs by Reforming Health Systems and Payments”, offers standards and guidelines for the development of “integrated care organizations” (ICOs) and global payment methods, aligned with provisions in the Affordable Care Act (ACA) promoting accountable care organizations (ACOs). The proposed legislation would create a process for certification of ICOs by the Massachusetts Division of Health Care Finance and Policy, financial oversight by the Division of Insurance, and legal oversight by the Attorney General (to reduce the risk of anti-trust violations, an impediment to more widespread ACO development nationally). The proposed legislation aims to expand the development of ICOs and to reduce reliance on fee-for-service payment methods for Massachusetts insurers by June 30, 2015. Other provisions of the legislation would facilitate pilot projects to test payment reform strategies (rewarding providers for quality of care rather than volume of care), create an advisory council of stakeholders and consumers to monitor payment reform, expand the criteria that the Division of Insurance may use in reviewing requests for increases in Massachusetts health insurance premiums, and reduce medical malpractice litigation through a 180 day “cooling off” period before such lawsuits may be filed and a process to help providers and patients exchange information and resolve disputes without litigation.
About Tom Entrikin
A former policy specialist with the U.S. Health Care Financing Administration (now Centers for Medicare & Medicaid Services (CMS)), Tom Entrikin has vast experience providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; and Medicaid waiver programs.
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