HB 1153 Summary

• Establishes reimbursement rates for hospital-based physicians (radiologists, anesthesiologists, pathologists, emergency room physicians) who are not contracted with insurers or health maintenance organizations, requiring payment at the same percentage rate as contracted providers applied to the lesser of the physician's charges, usual and customary amounts, or mutually agreed amounts.

• Prohibits physicians from collecting payments from patients, suing patients, or reporting them to credit agencies for services when the insurer or health maintenance organization is liable, except for applicable copayments and cost-sharing.

• Requires insurers and health maintenance organizations to report suspected violations to the Department of Health.

• Defines "hospital-based physician" as any physician with a hospital contract that allows provision of services without patient selection, precludes similar-specialty competitors, or fosters such opportunities.

• Effective date: July 1, 2013.