Bill > SF2814

This bill allows health carriers to offer a reference-based pricing health plan in the individual and small group markets. The plan must reimburse providers at a percentage of the Medicare reimbursement rate, with exceptions for services without a corresponding Medicare rate. Providers who agree to participate in the plan must accept the negotiated rate as payment in full. The plan is exempt from certain geographic and network adequacy requirements if the reimbursement rate is at least 120 percent of the Medicare rate and the plan is offered statewide. The bill specifies that providers cannot be required to participate in the reference-based pricing plan as a condition of participating in other plans offered by the carrier.