Bill > H5256

This bill requires health insurance policies to provide equal reimbursement for healthcare services performed by licensed physicians and other qualified healthcare professionals like nurse practitioners and physician assistants, when those services are within the professional's lawful scope of practice. Specifically, when an insurance policy covers a medical service provided by a licensed physician, it must also cover the same service when provided by a nurse practitioner or physician assistant in an "independent practice" - which means billing under their own name and national provider identifier. The bill applies to different types of health insurance entities, including accident and sickness insurance, nonprofit hospital service corporations, and nonprofit medical service corporations. The bill includes a key protection that insurers cannot reduce physician reimbursement rates to comply with this requirement. Some exceptions exist, such as for federally qualified group practice health maintenance organizations or insurers that employ healthcare practitioners and do not use fee-for-service compensation. The provisions will take effect on January 1, 2026, providing a clear timeline for implementation and allowing insurance companies time to adapt their reimbursement practices.

Health and Social Services

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