MN SF883

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

Enrollees can access any health care provider who agrees to reimbursement rates at or below the plan's reference-based pricing rate and accepts the health carrier's standard terms and conditions.

Reimbursement rates must be based on Medicare reimbursement schedules; for services without Medicare values, rates are negotiated using other fee schedules in the health care market.

Plans with reimbursement rates at least 120 percent above Medicare rates and offered in all Minnesota counties are exempt from geographic and network adequacy requirements.

Provider participation is voluntary, and health carriers cannot require providers to participate in reference-based pricing plans as a condition of participation in other health plans or products.