HF 4094 Summary

• Requires health plan companies and third-party administrators to submit data on contractual value-based payments as part of encounter data submissions to the all-payer claims database, effective on an ongoing basis.

• Mandates submission of non-claims-based payments data beginning in 2024, including alternative payment models, infrastructure investments, and workforce expenditures, attributed to providers in the same manner as claims-based data.

• Requires the commissioner of health to report to the legislature by February 15, 2023, on health care spending across payment models, with specific estimates on claims-based and non-claims-based payments by health plan company and payer type.

• Directs the commissioner to conduct analyses of primary care payment magnitude and interview health plan companies and third-party administrators about non-claims-based payment types, purposes, provider qualification criteria, and payment structures.

• Designates all collected data as nonpublic with protections for confidentiality and integrity; health plan companies must comply with commissioner data requests within 60 days.