Bill > H848

This bill aims to ensure fairness in health insurance rates and reduce costs by establishing new regulations for how health insurance carriers (companies that provide health insurance) pay healthcare providers. Specifically, it introduces "Alternative Payment Methods," which are new ways for carriers and providers to agree on payment for services that encourage better care coordination, higher quality, and lower costs, potentially including shared savings or prospective payments. The bill mandates that on or after January 1, 2017, contracts between carriers and providers must adhere to specific rate standards, preventing providers from being paid at rates significantly above the 80th percentile or below the 20th percentile of what carriers are already paying within defined geographic regions, based on data analyzed by the Center for Health Information and Analysis (CHIA). However, these rate limits do not apply to contracts using alternative payment methods if the provider's total medical expenses are at or below the statewide median. The bill also prevents providers from recouping excess payments by increasing charges to other payers and allows for exemptions from these rate regulations for providers offering unique services, facing financial hardship, or located in specific areas, with a public hearing process overseen by the CHIA executive director and potential intervention from the Attorney General. Any cost savings achieved by carriers due to these new regulations must be passed on to consumers through lower premiums, and the Division of Insurance will study the impact of these changes.