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Stakeholders back guarded exemption from utilization review for true two‑sided value‑based contracts
Summary
House Bill 659 would exempt providers who participate in defined value‑based contracts from certain utilization‑management requirements; backers said the move reduces duplicated safeguards when providers already bear financial downside for outcomes.
Delegate Bonnie Cullison presented House Bill 659, which would exempt health care providers participating in defined value‑based payment arrangements from ordinary utilization‑management steps such as prior authorization in some circumstances. Proponents said the reform recognizes that value‑based contracts align payer and provider incentives and that utilization controls duplicate incentives where providers already…
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