Section 54: Standard Quality Measure Set

Instructs the Department of Public Health to organize a statewide advisory committee to develop and recommend a standard set of quality measurements for health care providers by January 1, 2011. The governor must appoint 6 representatives of health facility and provider organizations to join 10 state officials on the advisory committee.

In developing the Standard Quality Measure Set for 2010, the committee may only consider adopting state and federal quality and safety measures already in existence. In 2011, the committee may consider amending the Set to include nationally recognized quality measures that are not yet developed. At a minimum, the Set must include measures specified in this section.

The advisory committee must annually recommend to DPH updates to the Standard Quality Measure Set by each November 1st.

Section 53: Health Care Facility Total Cost Reporting Requirement

Instructs the Division of Health Care Finance and Policy (DHCFP), in consultation with the Division of Insurance, to establish regulations directing hospitals to calculate and report all costs, including inpatient and outpatient costs and direct and indirect costs. Calculations must include costs and cost trends for labor, debt-related expenses, advertising and marketing, insurance, health information technology, management, research, academic costs, contributions, and all business operation costs. Before adopting final regulations, DHCFP must consult with designated stakeholders.

Section 52: Directs DHCFP To Create Relative Pricing Regulations

Instructs the Division of Health Care Finance and Policy (DHCFP), in consultation with the Division of Insurance, to establish regulations directing health insurance carriers to calculate and report relative prices paid to health care facilities and providers. In the regulations, DHCFP must specify a method to account for a uniform mix of products and services and all non-claims related payments to providers.

Section 51: Directs DHCFP To Create TME Regulations

Instructs the Division of Health Care Finance and Policy (DHCFP), in consultation with the Division of Insurance, to establish regulations directing health insurance carriers to calculate and report health status adjusted total medical expenses for provider groups determined by zip code. In the regulations, DHCFP must specify a uniform method for calculating total medical expenses among each provider group, determine which non-claim related payments must be included in the calculations, account for health status and number of patients within each group, and specify reporting requirements.

Section 50: Directs DOI To Create MLR Regulations

Instructs the Division of Insurance (DOI), in consultation with the Division of Health Care Finance and Policy, to establish regulations directing health insurance carriers to calculate and report medical loss ratios of health benefit plans. The regulations must provide definitions for carriers to distinguish between medical claims expenditures and administrative cost expenditures. Before adopting final regulations, DOI must consult with designated stakeholders.

Section 5: GIC Wellness Program

Requires the Group Insurance Commission to develop a wellness program for enrollees and to offer reductions in premiums or co-payments, or other incentives to encourage enrollees to comply with the wellness program goals. After 1 year of implementation, the GIC must issue a report to the legislature noting collective data, including level of participation and health services participants received and the savings incurred as a result of the program.

Section 48: Creates Community Hospital and Community Health Center Capital Reserve Funds

Creates Community Hospital and Community Health Center Capital Reserve Funds for the benefit of nonprofit community hospitals and nonprofit community health centers licensed by the Department of Public Health. These funds are to be used solely for the payment of the principal of Health and Education Facilities Authority (HEFA) bonds. Fund beneficiaries include only facilities where the ratio of the number of physician residents-in-training to the number of inpatient beds does not exceed 0.25. The Office of Health and Human Services and the Office of Administration and Finance may require that fund beneficiaries submit financial records to verify eligibility and agree to certain terms of lending, including reimbursement to the fund in the event a facility defaults on repayment of a loan. Section 188 of chapter 240 of the acts of 2010 subsequently dissolved HEFA and merged its functions into MassDevelopment.

Section 47: Authorizes HEFA To Direct Funds To Community Hospital and Community Health Center Capital Reserve Funds

Authorizes the Health and Educational Facilities Authority (HEFA) to allocate capital reserve funds to Community Hospital and Community Health Center Capital Reserve Funds created in Section 48 of this Act. These funds will support community hospitals and community health centers through loans and grant programs according to terms in Section 48 of this Act. Section 188 of chapter 240 of the acts of 2010 subsequently dissolved HEFA and merged its functions into MassDevelopment.

Section 46: Permits HEFA To Collect Fees

Authorizes the Health and Educational Facilities Authority (HEFA) to collect fees and administrative costs associated with the delegation of funds to various programs.

Section 188 of chapter 240 of the acts of 2010 subsequently dissolved HEFA and merged its functions into MassDevelopment.