Bill > HF2195

This bill allows health carriers to offer reference-based pricing health plans in the individual, small, and large group markets, subject to certain requirements. Under these plans, enrollees can access any health care provider who agrees to accept the reimbursement rate specified in the plan, which must be based on a percentage of the most recent Medicare reimbursement rates. Providers who agree to participate must accept the reimbursement rate as payment in full, and the health carrier cannot require provider participation as a condition of participating in any other plan. The bill also includes provisions related to geographic and network adequacy requirements, cost-sharing, and referral and prior authorization requirements.