HB1200

State employee health plan payment limits.

Latest bill text (Comm Sub) [PDF]

Summary

State employee health plan payment limits. Limits the amount that a state employee health plan may pay for a medical facility service provided to a covered individual to: (1) the lesser of the amount of compensation established by the network plan or 200% of the amount paid by the Medicare program for that type of medical facility service or for a medical facility service of a similar type, if the medical facility service is provided by an in network provider; and (2) 185% of the amount paid by the Medicare program for that type of medical facility service or for a medical facility service of a similar type, if the medical facility service is provided by an out of network provider. Provides that a provider, after receiving payment from a state employee health plan for a medical facility service provided to a covered individual, is prohibited from charging the covered individual an additional amount, other than cost sharing amounts authorized by the terms of the state employee health plan. Provides that a determination of the state personnel department, a state employee health plan, or a firm providing administrative services to a state employee health plan that a medical facility service provided to a covered individual is of a type similar to a particular type of medical facility service covered by the Medicare program is conclusive. Requires a medical facility that provides drugs to a covered individual, in billing a state employee health plan for the cost of the drugs, to include in the billing the same "TB" or "JG" modifier that the medical facility would include in the billing if the medical facility were billing the Medicare program for the drugs.

Authors

Authored by Representative McGuireCoauthored by Representatives Carbaugh, Lehman, Schaibley

Fiscal Outlook

Title Description Date View
Fiscal NoteFiscal Note #1: House Engrossed2024-01-31 Click To View
Fiscal NoteFiscal Note #1: House Comm Sub2024-01-26 Click To View
Committee ReportHouse Committee Report2024-01-25 Click To View
Vote SheetVote Sheet January 24, 20242024-01-24 Click To View
Fiscal NoteFiscal Note #1: Introduced2024-01-08 Click To View

History

Date Chamber Action
2024-01-31HouseSecond reading: amended, ordered engrossed
2024-01-31HouseAmendment #9 (McGuire) prevailed; voice vote
2024-01-25HouseCommittee report: amend do pass, adopted
2024-01-09HouseFirst reading: referred to Committee on Insurance
2024-01-09HouseAuthored by Representative McGuire
2024-01-09HouseCoauthored by Representatives Carbaugh, Lehman, Schaibley