The Center of Health Information and Analysis (Center) is required under M.G.L. c. 12C to collect and report on Health Status Adjusted Total Medical Expenses (TME); Relative Prices (RP), including the annual rate of growth of average RP; Alternative Payment Methods (APM); and Provider Payment Methods (PPM). The Center assumed TME and RP responsibilities from the Division of Health Care Finance and Policy on November 5, 2012, when Chapter 224 of the Acts of 2012 (Chapter 224) and M.G.L. c. 12C went into effect. The collection and reporting of APM, PPM, and the annual rate of growth of average RP were new requirements introduced under M.G.L. c. 12C.
Section 11 of Chapter 288 of the Acts of 2010 (Chapter 288) defines TME as the total cost of care for the patient population associated with a provider group based on allowed claims for all categories of medical expenses and all non-claims related payments to providers, adjusted by health status, and expressed on a per member per month basis. The methodology for calculating TME is defined in Section 51 of Chapter 288.
Section 12 of Chapter 288 defines relative prices as the contractually negotiated amounts paid to providers by each private and public carrier for health care services, including non-claims related payments and expressed in the aggregate relative to the payer's network-wide average amount paid to providers.
M.G.L. c. 12C, Section 10 requires the Center to collect information on changes in the type of payment methods implemented by payers, the number of members covered by alternative payment methodologies, and provider payment methods and levels. Section 10 also requires the Center to collect information on the annual rate of growth of average RP by provider type and product type.
Regulation 957 CMR 2.00 defines APMs as payment methods that are not based solely on Fee-For-Service payments. APMs may include, but are not be limited to, shared savings arrangements, bundled payments, and global budget/payments.
Regulation 957 CMR 2.00 (Payer Data Reporting) can be found on the CHIA regulations page .
For questions related to TME, Relative Price, APM, or PPM filings please email the Center for Health Information and Analysis at TMERP@state.ma.us.