Bill > SB487

This bill alters the reimbursement rate that health maintenance organizations (HMOs) are required to pay certain non-participating healthcare providers for services. Specifically, it requires HMOs to pay: 1) Trauma physicians at the greater of 140% of the Medicare rate or the rate paid as of January 1, 2001 in the same geographic area. 2) For evaluation and management services, no less than the greater of 125% of the average rate the HMO paid as of January 31, 2019 (inflated by the Medicare Economic Index) or 140% of the Medicare rate as of August 1, 2008 (inflated by the Medicare Economic Index). 3) For non-evaluation and management services, no less than 125% of the average rate the HMO paid as of January 31, 2019 (inflated by the Medicare Economic Index). The bill also includes provisions related to HMOs requiring adjunct claims documentation, assigning provider numbers, and the enforcement of the reimbursement requirements. The law would take effect on October 1, 2024.