The bill requires the division of insurance (division) to collaborate with the department of health care policy and financing, the department of personnel, and the primary care payment reform collaborative to develop and promulgate rules for alternative payment model parameters for primary care in the commercial health insurance market.
For health-care plans that are issued or renewed on or after January 1, 2025, the bill requires each carrier to ensure that the carrier's alternative payment models for primary care incorporate the aligned alternative payment model parameters created by the division.
The division is also required to develop and periodically update a set of core competencies around whole-person care delivery that primary care providers must meet in order to be eligible to receive practice support provided by the division and other value-based payments provided by a carrier. In updating the core competencies, the division shall consider recommendations provided by the primary care payment reform collaborative.
Once the division has 5 years of data, the division is required to analyze the data, produce a report on the data, and present the findings to the general assembly during the department of regulatory agencies' presentation to legislative committees at hearings held pursuant to the "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act".
With regard to the primary care payment reform collaborative (collaborative), the bill:
- Requires the collaborative to annually review the alternative payment models developed by the division and provide the division with recommendations on the models;
- Requires the collaborative to provide the division with recommendations on the core competencies developed by the division; and
- Adjusts the date on which the collaborative must deliver its annual reports.
With regard to the all-payer health claims database, the bill:
- Requires the administrator to include in the primary care spending report data related to the aligned quality measure set determined by the division; and
- Adjusts the date on which the annual reports are due.
(Note: This summary applies to this bill as introduced.)