Massachusetts Medical Society: Proposed DOI Regulations on Certification of Risk-Bearing Provider Organizations

Proposed DOI Regulations on Certification of Risk-Bearing Provider Organizations

The state Division of Insurance is holding a hearing on December 12, 2013, regarding its proposed regulations for the certification of  risk-bearing provider organizations.

The regulations apply to any provider organization that manages the treatment of a group of patients and that bears the downside risk of the cost of treating those patients according to the terms of an alternative payment contract.  Pursuant to Chapter 224 of the General Laws of Massachusetts, insurers will be prohibited from entering into arrangements with provider organizations that accept downside risk unless the provider organization holds the appropriate risk certificate or applicable waiver. This will be an annual requirement.

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