Bill > H1014

This bill amends Chapter 176T of the General Laws to establish a "Statutory Reimbursement rate" for out-of-network healthcare providers who treat patients covered by a Risk-Bearing Provider Organization, which is an organization that takes on financial risk for healthcare services. This rate will be based on Medicare reimbursement rates for services covered by Medicare, and for services not covered by Medicare, it will be 100% of what Medicare would have paid, as determined by the Center for Health Information and Analysis and approved by the Commissioner of Insurance. Licensed healthcare providers in the state must accept this statutory rate for services provided to these patients and cannot bill the patient for any amount beyond what the insurance plan pays, except for standard co-payments, co-insurance, and deductibles. Furthermore, providers are prohibited from recouping these amounts by increasing charges to other insurance plans or payers, and the division will monitor compliance and report any violations to the attorney general, with penalties for non-compliance.