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Health Care Cost Containment bill on its way to Governor’s desk

After an exhaustive and careful deliberation, the Health Care Conference Committee -- led by Representative Steven Walsh and Senator Richard Moore -- has reached an agreement on Health Care Cost Containment legislation, more commonly known as the "Payment Reform Bill." 

At almost 350 pages, the bill is considerable in both its scope and ambition. It will create a more efficient, more accountable, and more transparent health care system.

We encourage you to review the summary of the bill (PDF) or the entire bill (PDF) for detailed information. However, among some of the many provisions included are:

  • Setting Health Care Cost Growth on a Sustainable Long-Term Path
    • Establishes a statewide health care cost growth goal for the health care industry pegged to state's overall economy
  • Leading by Example
    • Establishes a certification process for accountable care organizations or "ACOs" - health care provider systems dedicated to cost growth reduction, quality improvement and patient protection. These ACOs would receive contracting preference in state health programs.
    • Establishes a certification process for patient-centered medical homes -- a care delivery model that provides patients with a single point of coordination for all their care needs 
  • Investing in a Healthy Future for the Commonwealth
    • $60 million over the next four years in a historic investment in community-based prevention, public health, and wellness efforts
    • A new wellness tax credit for businesses that implement recognized workplace wellness programs, up to $10,000 per employer
    • Requirement that health insurance companies provide a premium adjustment for small businesses that adopt approved workplace wellness programs
  • Increasing Access to Essential Services
    • Expands the role of physician assistants and nurse practitioners
    • Expands the role of "limited-service-clinics" to act as a cost-effective and convenient point of access for health care services provided by nurse practitioners 
    • Expands an existing workforce loan forgiveness program to include providers of behavioral, substance use disorder, and mental health services
  • Protecting Access to Necessary Care
    • Requires certified ACOs, patient-centered medical homes, and provider organizations that receive a risk-based payment to set up a system of internal appeals
    • Requires certified ACOs to guarantee access to all medically necessary services for patients, either internally or through providers outside of the ACO
  • Integrating Behavioral, Substance Use Disorder, and Mental Health Services
    • Requires health insurance companies to comply with federal mental health parity law and submit documentation to the Attorney General certifying compliance
    • Establishes a special task force to make recommendations on how to integrate behavioral health services in the payment and delivery systems developed under the bill
  • Health Savings Accounts - Requires a review and recommendations relative to increasing the use of health savings accounts, flexible savings accounts, and other "consumer-driven plans"  

We will keep you informed as we continue to learn more about other provisions of this bill and how they impact the human services community. Please let Kevin Gilnack know if you have any questions.