Bill > S1479

Introduced Session

This bill authorizes health care providers to be involved with joint negotiations on the terms and conditions of contracts with health and dental insurance carriers. Under the bill, two or more health care providers authorized by the State to provide services in a health care profession are allowed to participate in a joint negotiation. The negotiations would be carried out through a joint negotiation representative selected by a health care provider to act on their behalf. In the bill, two or more health care providers practicing in a service area of a carrier can jointly negotiate, and engage in related joint activity, regarding non-fee-related matters which may affect patient care, including (1) the definition of medical necessity and other conditions of coverage; (2) clinical practice guidelines; and (3) any provider rating program and the ability to appeal a carrier's rating of a provider. In addition, the bill establishes that if the Attorney General, in consultation with the Commissioner of Banking and Insurance, finds that a carrier has substantial market power in its service area and that any of the terms or conditions of the contract with the carrier pose an actual or potential threat to the quality and availability of patient care among covered persons, two or more independent health care providers may jointly negotiate with the carrier, and engage in related joint activity, on fees and fee-related matters. This includes such items as (1) the amount of payment or the methodology for determining the payment for a health care or dental service, including, but not limited to, cost of living increases; (2) the amount of any discount on the price of a health care or dental service; and (3) the procedure code or other description of a health care or dental service covered by a payment and the appropriate grouping of the procedure codes. The bill also establishes that, before entering into negotiations, a person or entity which proposes to act as a joint negotiation representative is to submit a petition to enter into negotiations to the Attorney General for approval. The petition is to identify, among other items, the representative, the health care providers who the representative will represent, and the intended subject matter of the proposed negotiations. Under the bill, a process is established regarding the steps necessary for when the joint negotiation representative and the carrier have reached an agreement on the contractual terms or conditions that were the subject matter of negotiations. The bill also stipulates that if a party to the negotiations decides to decline or terminate negotiations, within 14 days of this decision, the joint negotiation representative is to report to the Attorney General that negotiations have ended. The Attorney General may, within 30 days of a termination, make a binding determination as to the merits of the joint negotiation request. The bill also establishes the process by which the Attorney General is to provide written approval or disapproval of a petition or proposed contract furnished by a joint negotiation representative. A decision by the Attorney General to approve or disapprove is to be rendered within 30 days after receipt of the petition or proposed contract. If that timeline passes with no decision rendered, the joint negotiation representative may petition a court for an order to require a decision from the Attorney General. The petition or proposed contract is to be approved by the Attorney General shall approve a petition or a proposed contract if a determination is made that the petition or proposed contract demonstrates that the benefits which are likely to result from the proposed joint negotiations or contract outweigh the disadvantages attributable to a reduction in competition that may result from the proposed joint negotiations. If a decision is made to disapprove of a petition or proposed contract, a petitioner has 45 days to submit a written request to the Attorney General for a hearing. Lastly, the bill requires the Attorney General, in consultation with the Commissioner of Banking and Insurance, to report annually to the Governor and the Legislature on the implementation of the bill. The report is to include, among other items, an assessment of the impact that the bill has had on health insurance premiums in the State. The report is to also include the recommendations of the Attorney General as to whether the provisions of the substitute should be expanded to include other types of health care facilities.

Committee Categories

Vin Gopal (D)*,  Joe Lagana (D)*, 

Introduced in the Senate, Referred to Senate Commerce Committee (on 01/09/2024)

Official Document