Bill > LD2196

Introduced Session

Part A of this bill limits, beginning January 1, 2028 and annually thereafter, the annual aggregate growth in hospital prices to a percentage equal to the inpatient prospective payment system hospital market basket established by the federal Medicare program. Part A also limits the maximum amount that a hospital may charge or collect for any inpatient or outpatient facility service to no more than 200% of the Medicare rate for the same service in the same geographic area beginning January 1, 2028 subject to certain exceptions. An insurer or health plan sponsor must comply with statutory requirements related to utilization review and prior authorization in order to access the caps on maximum prices charged by hospitals. Part A authorizes the Office of Affordable Health Care to fine hospitals if they do not comply with these requirements. Part B of the bill requires that a prior authorization for health care services for the treatment of a chronic condition and for diagnostic procedures or tests related to the treatment of a chronic condition remains valid for one year. It prohibits a health insurance carrier from requiring the renewal of a prior authorization more frequently than once every 2 years for treatment of a chronic condition that is necessary for more than one year. It also prohibits a health plan from restricting coverage for a health care service or a prescription that was approved under a previous health plan within 90 days of an enrollee's enrollment in the new health plan if the prescribed drug is included on the health plan's formulary at the time of that enrollee's enrollment and requires a health plan to provide at least 90 days' notice to an enrollee prior to restricting coverage of a previously approved health care service or prescription. Part C of the bill requires each rate filing submitted by a carrier for the 2028 plan year and for each plan year thereafter to provide detailed information to the Superintendent of Insurance within the Department of Professional and Financial Regulation related to the experience period and projected trends in utilization and per-unit payment by benefit category and by hospital. Part C also requires that the minimum negotiated charge of a health insurance carrier for in-network primary care or behavioral health care services may not be less than 110% of the Medicare rate for the same service in the same geographic area.

AI Summary

Committee Categories

Drew Gattine (D)*,  Donna Bailey (D),  Mattie Daughtry (D),  Ryan Fecteau (D),  Henry Ingwersen (D),  Michele Meyer (D),  Matthew Moonen (D), 

Unfinished Business (on 04/09/2026)

Official Document