02-031 C.M.R. ch. 855, § 3 - Authorization of Health Insurance Payment Reform Pilot Projects

A. A carrier that offers health plans in this State may seek authorization from the Superintendent to conduct a pilot project that implements payment reform strategies with providers through an accountable care organization to reduce costs and improve the quality of patient care.

B. In order to be approved, a pilot project application must:

1. include a detailed project narrative including, where appropriate a work planand project timeline, including project commencement and conclusion dates;

2. demonstrate consistency with the payment reform principles set forth in Section 4 of this Rule;

3. include copies of all contracts, written agreements, memoranda of understanding, or other similar documents pertinent to the program.Forms to be used in multiple agreements should be submitted in blank;

4. demonstrate compliance with all applicable Maine laws;

5. include a methodology for periodic measurement and evaluation of the results of the pilot project.The methodology shall include identification of the baseline data or information to be analyzed and the analysis of project costs, project benefits, the effect of the project in reducing health care costs, any effect on insurance premiums, and any effect on the quality of care;

6. provide for reporting to the Superintendent by May 31 of each year the pilot project results as of December 31 of the preceding year, or on such other schedule as may be agreed to by the carrier and the Superintendent; and

7. have received accreditation status from the National Council on Quality Accreditation (NCQA) or provided such other assurances of quality as the Superintendent may determine acceptable.

Notes

02-031 C.M.R. ch. 855, § 3