Bill > SF622

This bill allows health insurance carriers in Minnesota to offer reference-based pricing (RBP) health plans in individual, small, and large group markets. In an RBP health plan, the insurance carrier sets a predetermined payment rate for medical services based on a percentage of Medicare reimbursement rates, rather than negotiating prices individually with healthcare providers. Providers can choose to participate if they agree to accept the specified reimbursement rate, which must be at least based on Medicare rates. If a provider agrees to the rate, they must provide services to all plan enrollees. Health carriers can require providers to meet reasonable data, quality, and utilization review requirements. The bill includes provisions that providers cannot be required to participate in an RBP plan, and that participation in an RBP plan cannot be a condition for participating in other health plans. If an RBP health plan's reimbursement rate is at least 120% of the Medicare rate and is offered statewide, it may be exempt from certain network adequacy requirements. The plan can still impose typical cost-sharing mechanisms like copayments, deductibles, and prior authorization requirements, and is not required to cover services outside of the standard plan's coverage.

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https://www.revisor.mn.gov/bills/bill.php?b=Senate&f=SF0622&ssn=0&y=2025