PA HB2212

Health care payers must reimburse physician-owned hospitals and ambulatory surgical facilities that agree to accept either the payer's highest in-network rate or baseball-style arbitration, maintain CMS accreditation, can perform procedures earlier than in-network facilities, and achieve at least 4-star patient satisfaction ratings

Baseball-style arbitration requires an independent arbitrator to select either the payer's or facility's final payment proposal without modification, based on criteria including payment disparities, facility quality metrics, case complexity, and prior arbitration awards

Arbitration fees are paid by the losing party, or split equally if the dispute is resolved through negotiation after arbitration begins; parties may bundle multiple cases involving the same service type or billing code

Protections apply only to fee-for-service and per diem payment arrangements, not to capitated plans or arrangements where facilities accept significant financial risk

Payers are prohibited from retaliating against in-network physicians who have ownership stakes in out-of-network facilities for exercising rights under this chapter; takes effect 60 days after enactment