The Massachusetts Division of Insurance (the "Division") is soliciting final comments concerning the Division's proposed regulation 211 CMR 155.00 pdf format of 211-155-final.pdf , "Risk Bearing Provider Organizations" (the "Regulation").  The Division has prepared this Regulation in furtherance of its responsibility to implement the requirements of Massachusetts General Law Chapter 176T ("Chapter 176T") concerning Risk-Bearing Provider Organizations in a manner that will promote the development of alternate payment contracts containing downside risk while establishing appropriate safeguards for Massachusetts' health care delivery system and the patients it serves.  Chapter 176T mandates that the Division must "certify" provider organizations on an annual basis that take on certain financial risk through alternative payment contracts with insurance carriers.  The purpose of this certification is ensure that provider organizations entering into alternate payment contracts with downside risk do not assume excessive financial risk that could threaten their financial solvency. Redlined version of the Division's proposed regulation showing the changes that have been made to it since the December 12, 2013 public hearing is posted here pdf format of 211-155-redlined.pdf

The Division has set forth below, the final version of the proposed Regulation.  The Division has also set forth below, its proposed bulletin pdf format of bulletin-2014-xx.pdf concerning the certification of Risk-Bearing Provider Organizations (the "Bulletin").  The proposed Bulletin is intended to provide additional guidance with respect to the requirements of provider organizations when applying for Risk Certificates or Risk Certificate Waivers as required by Chapter 176T and 211 CMR 155.00.  The Division will be accepting written comments concerning the proposed Regulation and Bulletin until June 23, 2014, at 12 noon.  Interested parties and members of the public are encouraged to submit their respective written comments in a timely fashion.  No comments will be accepted if not received by the referenced date and time.

Written comments may be submitted by email only to:  Olivia Vache, Legal Intern, Division of Insurance, at Olivia.vache@MassMail.state.ma.us