Bill > HB2212

This bill, titled "In regulation of insurers and related persons generally, providing for nondiscrimination by payers in health care benefit plans," amends Pennsylvania law to prohibit health care payers, which are entities responsible for paying for health care services like insurance companies, health maintenance organizations, and self-insured employers, from discriminating against certain facilities that provide health care. Specifically, it prevents payers from refusing to reimburse a facility if it agrees to accept the payer's highest in-network rate or a "baseball-style arbitration" (a dispute resolution method where an arbitrator chooses between the payer's or the facility's proposed payment amount), meets certain quality metrics, can perform a procedure sooner than the nearest in-network facility, or is partially owned by physicians who are in-network with the payer. The bill also outlines specific criteria for arbitrators to consider when determining payment amounts in disputes, focusing on disparities in payment rates, the facility's quality, and the circumstances of the case, and prohibits payers from retaliating against physicians who own out-of-network facilities for exercising their rights under this new chapter. This legislation applies to health care benefit plans that pay facilities on a fee-for-service or similar basis, but not to plans where facilities accept significant financial risk.