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Mass. Gen. Laws. Ann. ch. 12C, § 10 - Reporting requirements for private and public health care payers and third-party administrators

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The Center for Health Information and Analysis must require the uniform reporting of information from public and private health care payers, including third-party administrators to analyze:

  • Changes over time in health care insurance premiums;
  • Changes in benefit and cost-sharing design of plans offered by the payers;
  • Changes in measures of plan cost and utilization;
  • Changes in the types of payment methods used by payers and the number of covered individuals using alternative payment methodologies.

The Center must require private and public payers to submit claims data, member data, and provider data to develop and maintain a health care claims database.

The Center requires data to be submitted from private health care payers including:

  • Average annual individual and family plan premiums for each payer’s most popular plans;
  • Information regarding the underlying actuarial assumptions of each plan’s premiums;
  • Summaries of each plan’s network and plan design, including whether mental health, dental, behavioral or other specific plans are carved out;
  • Information on medical and administrative expenses, including the medical loss ratio for each plan;
  • Payer’s current level of reserves and surpluses;
  • Information on provider payment methods and levels;
  • Health status adjusted total medical expenses by registered provider organization, provider group and local practice group and zip code;
  • Relative prices paid to each hospital, registered provider organization, physician group, ambulatory surgery center, and other health care facilities, by provider type, with separately listed inpatient and outpatient prices, by product;
  • Hospital inpatient and outpatient costs;
  • Annual growth rate;
  • A comparison of relative prices for the payer’s participating health care providers by provider type, showing average relative price, extent of price variation, and shows providers who are paid a certain percentage over the average price.

The Center also requires data submission from public and private health care payers who use alternative payment contracts, including the negotiated budget for each contract, applicable measures of provider performance in the contract, and the average negotiated budget, weighted by geographic area.

Current as of June 2015