HF2195 Summary

• Health carriers may offer reference-based pricing health plans in individual, small, and large group markets subject to federal approval.

• Participating providers must agree to reimbursement rates based on a percentage of Medicare rates, with rates for non-Medicare services negotiated using other fee schedules.

• Enrollees may access any provider who agrees to the specified reimbursement rate and other carrier terms, and providers must serve all enrollees if their rates meet the plan requirements.

• Plans with reimbursement rates at least 120 percent above Medicare rates and offered statewide are exempt from geographic and network adequacy requirements.

• Providers cannot be required to participate in reference-based pricing plans as a condition of participation in other health plans, and plans may impose standard cost-sharing and prior authorization requirements.