Bill > S4076

Introduced Session

This bill requires the State Health Benefits Commission and School Employees' Health Benefits Commission to conduct comprehensive reviews of reference-based pricing health benefits models and the fiscal impact of implementing reference-based pricing for the State Health Benefits Program and the School Employees' Health Benefits Program. The review must be conducted in consultation with the actuary of each program and the carriers under contract with each program. The review must identify areas of health care benefits and services where reference-based pricing can be implemented. The bill specifies the areas and issues to be evaluated by each commission and requires each commission to issue a final report on its findings and recommendations within 180 days after the effective date of the bill. Within one year following the effective date of this bill, each commission must implement reference-based pricing for each contract entered into with a carrier after the effective date in a manner that places limitations on reimbursement rates using Medicare rates as the reference point. Each commission, prior to implementation, must adopt a written report detailing how the reference percentages have been set by each commission, the expected cost savings, and the existing negotiated cost ranges by procedure that each carrier under contract with each commission has in place prior to implementation of the reference-based price limitation.

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Joe Vitale (D)*, 

Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 06/30/2023)

Official Document