Stakeholders back guarded exemption from utilization review for true two‑sided value‑based contracts

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 share financial downside.

Nut graf: The bill seeks to reduce administrative friction for providers that have accepted a contract that ties payment to health‑outcome benchmarks and puts providers at some financial risk. Supporters — physician groups, provider associations and some hospital representatives — said an exemption would let clinicians focus on patient care rather than iterative prior‑authorization workflows; insurers and others requested clear guardrails so the exemption applies only when contracts include meaningful downside risk and quality safeguards.

Dana Kaufman and Dan Shattuck spoke for practitioner groups in favor, saying the bill would encourage broader adoption of value‑based care. CareFirst’s Brian Wheeler and insurer witnesses urged caution, noting CareFirst already operates multiple accountable care organization and specialty episode arrangements and said outcomes reporting and a maximum downside risk limit (10% in current statute) are central to protecting members.

Ending: Several witnesses recommended technical amendments to ensure the exemption applies only to arrangements with demonstrable two‑sided risk and independent auditing. The committee asked parties to negotiate technical language; no committee vote was taken at the hearing.