Bill > SF4222

This bill allows health carriers in Minnesota to offer reference-based pricing health plans in the individual, small, and large group markets, subject to certain requirements. Reference-based pricing health plans set reimbursement rates for providers based on a percentage of the most recent medical assistance fee-for-service rates. Providers who agree to participate in these plans must accept the reference-based pricing rates as payment in full. The bill also includes provisions related to provider participation, reimbursement rates, and cost-sharing requirements for these plans. If a reference-based pricing health plan offers rates at least 190% above medical assistance rates and is available statewide, it is exempt from certain geographic and network adequacy requirements.