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HD 6135

A communication from the Executive Office of Health and Human Services (see Section 80(e) of Chapter 343 of the Acts of 2024) submitting a Massachusetts Health Policy Commission Primary Care, Access, Delivery and Payment Task Force report

194th Legislature (2025-2026)

Requires attestation, audits, and enhanced reporting to ensure primary care payments flow to primary care practices with transparency, aligning with MassHealth sub-capitation.

Placed on file
0
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Bill Summary · HD 6135

Summary of Bill HD 6135 (Session 194th) – Massachusetts

Purpose and intent

  • The bill transmits a Massachusetts Health Policy Commission (HPC) and Executive Office of Health and Human Services (EOHHS) report related to the Massachusetts Health Policy Commission Primary Care, Access, Delivery and Payment Task Force (PCTF). It implements Statutory Deliverable #2, which focuses on data, reporting, and transparency around primary care payments.
  • The overarching goal is to ensure that increased investments in primary care flow to primary care practices and are transparently tracked, thereby supporting accountability for both payers and providers as Massachusetts aims to raise the share of health care spending devoted to primary care (Deliverable #3) without driving up net costs.

Key provisions and changes

  • Attestation and Audit of Primary Care Payments

    • Recommends that primary care practices and provider organizations participating in advanced primary care payment models attest that payments are directed to primary care practices in alignment with the MassHealth Sub-Capitation program.
    • Audits by payers would verify that 90-95% of payments support primary care practices; providers must also attest to meeting enhanced practice capabilities and improved patient outcomes (Deliverable #4 goals).

  • Reporting via MA-RPO (Massachusetts Registration of Provider Organizations)

    • Grants authority for CHIA and HPC to collect data on the flow of primary care payments within provider organizations, including both claims and non-claims revenue or settlements.
    • Requires reporting as part of the existing MA-RPO program, emphasizing information needed to understand financial support for primary care within hospital-based systems.
    • Agencies must work with provider organizations, payers, MassHealth, and other stakeholders to tailor reporting specifications, while limiting administrative burdens.

  • Separate Primary Care Contracts and TINs

    • Encourages developing separate primary care contracts within health systems, distinct from broader system contracts, to increase transparency around primary care payments.
    • Promotes the potential creation of separate Tax Identification Numbers (TINs) for primary care business units to facilitate transparent distribution and accounting of primary care payments.
    • Contracts and TIN separations should align with MassHealth Sub-Capitation processes and support the adoption of advanced primary care payment models without increasing overall health expenditure or insurance premiums.

  • Alignment with MassHealth Sub-Capitation

    • Illustrates MassHealth’s sub-capitation framework where ACOs distribute a portion of capitation to principal primary care TINs; the framework informs attestation, reporting, and payment practices.

Who is affected

  • Primary care practices and provider organizations, especially those participating in advanced primary care payment models and MassHealth sub-capitation structures.
  • Payers (private and public), MassHealth, HPC, and CHIA, which would implement attestations, audits, and enhanced reporting.
  • Hospital-based systems and MSOs/administrative entities that manage funds flow and internal distribution of primary care payments.
  • Providers and clinicians within primary care practices who would benefit from clearer funding streams and reduced administrative burdens.

Procedural and timeline aspects

  • The bill reflects conclusions drawn from PCTF meetings held in 2025, with emphasis on Deliverable #2 (data and reporting) and alignment to Deliverable #4 (payment models) and Deliverable #3 (spending targets).
  • It relies on ongoing MA-RPO reporting enhancements and CHIA/HPC coordination to implement detailed data collection, reporting specifications, and attestation/audit processes.
  • The summary references the statutory framework and the MassHealth sub-capitation payment structure as the basis for implementation.
  • Action status: Placed on file as of 2026-06-01. No immediate fiscal or regulatory changes are enacted without further legislative action, but it sets forth reporting and transparency requirements to be used in future policy enforcement.

Compiled from official sources — confirm details with the bill’s official record.

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