Final Methodology for Confidential Referral of Entities with Excessive TME Growth



CHIA has adopted a final 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 M.G.L. c. 12C, § 18. Referred entities may be required by the HPC to implement a performance improvement plan pursuant to M.G.L. c. 6D, § 10.

CHIA will make referrals to the HPC on an annual basis based upon final TME data.