Bill > H3931

This bill, the Massachusetts Fair Health Care Pricing Act, aims to regulate how health insurance plans (referred to as "carriers") pay healthcare providers, specifically acute care hospitals and their contracting agents, for medical services. It establishes "relative prices" which are calculated by dividing the price a carrier pays a specific provider for a service by the average price that carrier pays all providers for that same service. The bill mandates that carriers cannot enter into or renew contracts with providers for a price that is more than 20% above this carrier-specific average relative price, nor can they pay less than 10% below it, with exceptions for specialty hospitals, geographically isolated hospitals (defined as the sole acute care hospital within a 20-mile radius), and "disproportionate share hospitals" (hospitals where at least 63% of revenue comes from government programs like Medicare and Medicaid, or free care). Providers must accept these payments and cannot "balance bill" patients for amounts beyond their co-pays, co-insurance, or deductibles. Any savings carriers achieve due to this act must be passed on to consumers through reduced premiums, co-pays, and deductibles, with the Division of Insurance overseeing this. The bill also includes provisions for providers to apply for exemptions if compliance would threaten their financial solvency or patient access, and requires the Division of Insurance to publish provider price and quality information annually.