MMS Overview of Payment Reform Legislation - S.2400

The following is our current reading of the key points of Senate 2400. However, we caution that some sections could be subject to different interpretations in the future by state agencies, the courts, or other parties. Section-by-section analysis is available here

  • No provider is required to become an accountable care organization (ACO).
  • The state sets standards for ACOs and certifies them. Providers of freestanding services may appeal if an ACO declines to contract with them.
  • Sets statewide targets for annual increases in health care costs:
    • 2013 to 2017: Equal to the potential annual growth rate of the gross state product (GSP). 
    • 2018 to 2022: One half percentage point below the annual growth in the GSP. 
    • Starting in 2018, there is limited ability to modify the target.
  • Provider groups whose spending exceeds the target may be required to file a performance improvement plan.
  • The state may conduct a "market impact review" of any provider whose costs exceed the state target. The attorney general may investigate to determine if the provider is engaging in anti-competitive behavior.
  • Provider groups who carry downside financial risk must register with the state. Appears to exempt groups without financial risk who have fewer than 15,000 patients or less than $25 million in net patient service revenue.
  • The state will collect and publicly report cost and quality data provided by provider groups.
  • Providers must report their cost and quality information to the state annually. Requirements for who reports will be determined by regulation.
  • The state will certify groups that carry downside financial risk, to determine if they are likely to meet their financial obligations.
  • Reasserts that physicians must demonstrate competency in the use of EHRs, as a condition of licensure. Expands requirements for the implementation of EHRs for a wide range of contracting entities. Every patient must have access to his or her EHR data.
  • Malpractice reform: Patients must give 182-day notice before filing a claim following an unanticipated medical outcome. Apologies are not admissible as evidence in a judicial proceeding.
  • Reinforces state mental health parity laws, and promotes patient access to such care.
  • Expands the Determination of Need process.
  • Standardizes prior authorization forms.
  • Requires uniform quality measures.
  • Establishes various loan repayment, loan forgiveness and primary care training programs to address health care workforce shortages.
  • Creates tax incentives for small businesses that establish employee wellness programs.
  • Health plans and large hospitals assessed $225 million to establish new funds for distressed hospitals, prevention and wellness programs, and health information technology adoption.
  • Allows patients to designate physician assistants as primary care providers. Removes limits on the number of PAs that a physician can supervise.
  • Allows nurse practitioners to sign forms that physicians must currently sign, as long as they are still practicing within the scope of their license.
  • Directs the state to rewrite the regulations of limited service clinics, to eliminate many of the current public health requirements for their operation.
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