HB 5345 Summary

• Authorizes health care collaboratives comprised of physicians, chiropractors, podiatrists, naturopaths, and optometrists to collectively negotiate with health plans for compensation agreements that incentivize quality over volume and place practitioners at risk for inefficient care delivery.

• Requires prospective health care collaboratives to obtain a preliminary certificate of public advantage from the Office of the Healthcare Advocate before negotiating with health plans, demonstrating they will implement quality-focused payment mechanisms or active practice pattern modification programs.

• Establishes a 20-day approval process for preliminary certificates and requires health care collaboratives to notify the Healthcare Advocate within 14 days of negotiation events, with provisions for mediation and fact-finding if negotiations reach an impasse or a health plan refuses to negotiate in good faith.

• Mandates Healthcare Advocate review and approval of final agreements within 60 days, with 30-day public comment period, based on whether the agreement fosters reasonably priced, quality services and meets criteria including fee reasonableness, access, efficiency, and financial stability.

• Imposes civil penalties of up to $25,000 per day per violation on health plans that refuse to negotiate in good faith, with annual monitoring and reporting requirements for approved agreements.