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April 16, 2015

Proposed Legislation Will Increase Legal Authority of Health Policy Commission and Attorney General

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Legislation recently filed will give the Health Policy Commission (“Commission”) and the Attorney General enhanced legal authority by placing greater weight on the Commission’s cost and market impact review findings with respect to proposed material changes by providers and provider organizations.
 
When a provider files a material change notice, the Commission may decide to conduct a cost and market impact review. Through this review, the Commission seeks to determine if a provider meets the following criteria:
 
1) Has a dominant market share for the services it provides;
 
2) Has prices for services that are materially higher than the median prices charged by other providers for similar services in the same market; and
 
3) Has a health status adjusted total medical expense that is materially higher than the median total medical expense for other providers offering similar services in the same market.
 
The Commission’s findings of this review are detailed in a final report. Under current law, the Commission may refer this report to the Attorney General for further action. Under the proposed bill, if the Commission finds that the criteria is met, it will submit the report to the Attorney General and the report will be considered sufficient evidence that a violation of the Commonwealth’s consumer protection laws will occur if the material change is consummated.  The proposed bill gives the Attorney General the power to seek injunctive relief from the court to stop the provider from going forward with the material change. In addition, the proposed bill provides that if the Attorney General brings an action in court against a provider, the provider is prohibited from moving forward with the propose material change while the action is pending.

You can find a copy of the legislation here.

About the Authors

Crystal Bloom

Crystal Bloom is a partner and a senior healthcare regulatory attorney in Donoghue Barrett & Singal's Health Law group. She provides state and federal regulatory guidance and corporate legal services to healthcare providers. You can find her on LinkedIn.

Andrew Levine

Andrew Levine is a partner and head of the firm's regulatory practice. He provides regulatory guidance, business and corporate legal services, as well as strategic advice to healthcare clients. You can find him on Google+ and LinkedIn.

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