Proposed Methodology for Referring Health Care Entities to the HPC


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The Center for Health Information and Analysis (CHIA) issued a proposed methodology for the confidential referral of health care entities to the Health Policy Commission (HPC) “whose increase in health status adjusted total medical expense is considered excessive and who threaten the ability of the state to meet the health care cost growth benchmark.” CHIA is required to confidentially refer such entities pursuant to G.L. c. 12C, § 18. Referred entities may be required by the HPC to implement a performance improvement plan pursuant to G.L. c. 6D, § 10.

In December 2016, CHIA requested public comment on the proposed methodology which can be found in the "Related Materials" box on the right of this page. CHIA is currently reviewing comments on the proposed methodology and expects to release either a final methodology or a revised proposal in early 2017.

Following issuance of a final methodology, CHIA will make referrals to the HPC beginning with the calendar year (CY) 2014 - 2015 Total Medical Expense data reported in May 2016.