02-031 C.M.R. ch. 855, § 4 - Payment Reform Principles

Pilot projects must demonstrate consistency with the following payment reform principles:

A. Support for integrated, efficient, and effective systems of care delivery and payment;

B. Promotion of a patient-centered approach to service payment and delivery;

C. Encouragement and reward for the prevention and management of disease;

D. Incentives that do not reward the denial or restriction of medically necessary care;

E. Promotion of the value of care over volume to measurably lower costs; and

F. Support for payments and processes that are transparent, easy to understand, and simple to administer for patients, providers, purchasers, and other stakeholders. If a health insurance carrier implements a pilot project that restricts provider participation on the basis of cost and/or quality benchmarks, those benchmarks should be transparent to the provider community.

Notes

02-031 C.M.R. ch. 855, § 4