Bill > S574

This bill aims to ensure more equitable health care pricing by establishing new regulations for how health insurance carriers and health care providers negotiate payment rates. It defines "Alternative Payment Methods" as payment structures beyond simple fee-for-service, which can include shared savings or bundled payments, and clarifies that the "Center" refers to the Center for Health Information and Analysis (CHIA). For "Health Care Providers," specifically acute care hospitals, the bill mandates that they accept payments from carriers within certain limits and prohibits them from billing patients for amounts exceeding what the carrier pays, excluding standard co-payments, co-insurance, and deductibles. Carriers will be required to calculate and use "median carrier-specific relative prices" – the average price a carrier pays to providers in a given category – to set reimbursement rates. Specifically, contracts entered into or renewed after the bill's effective date cannot reimburse providers more than 20% above or 10% below this median price, with exceptions for specialty and geographically isolated hospitals. The bill also addresses existing contracts and alternative payment methods, ensuring they also adhere to these pricing guidelines. Any cost savings realized by carriers due to these regulations must be passed on to consumers through lower premiums. Providers not in a carrier's network must accept a rate equal to the median price paid to in-network providers. The CHIA, in consultation with the Attorney General, will oversee compliance and can grant exemptions to providers if applying these rules would jeopardize their financial solvency or patient access to care. Finally, the Division of Insurance will annually study the impact of these changes and report its findings and recommendations.