Bill > SF883

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 a reference-based pricing plan, the health carrier sets reimbursement rates for providers based on a percentage of the Medicare reimbursement schedule, and providers who agree to participate must accept the set rates as payment in full. The bill also exempts certain reference-based pricing plans from geographic and network adequacy requirements if the reimbursement rates are at least 120% of the Medicare rate and the plan is offered statewide. The bill specifies that providers are not required to participate in a reference-based pricing plan, and health carriers cannot require participation as a condition of participating in other plans.