Bill > HB2243

This bill, known as the "Stopping Health Insurers from Excluding Legal Decisions (SHIELD) Act," aims to prevent health insurance entities from penalizing healthcare providers based on patient vaccination exemptions. Specifically, it prohibits health insurance entities from using patients who have legally declined vaccinations, referred to as "exempt patients," in a way that negatively impacts a provider's reimbursement or quality ratings. This means that if a provider properly documents a patient's exemption and submits a claim with a relevant diagnosis code, the insurance company cannot include that exempt patient in calculations for vaccination-related quality measures, which can affect a provider's payment, bonuses, or network status. The bill also prevents insurers from terminating a provider from their network, reducing their reimbursement rates, or withholding incentive payments solely because they have exempt patients. Furthermore, it clarifies that claims denied or reduced in violation of these provisions are considered "clean claims" and are subject to interest penalties for delayed payment, and it prohibits insurers from downcoding claims or reducing reimbursement levels simply because a patient is exempt or a preventative care standard wasn't met due to an exemption.