SCC/DHRM - Develop Proposal for Reimbursement for Out of Network Emergency Services (language only)

Item 477 #1c

Language

Page 507, after line 29, insert:

"D. The State Corporation Commission, in collaboration with the Department of Human Resource Management, shall convene a workgroup, comprised of the employee health benefits consultant for the Department; the vendor(s) providing third-party administrative services for the state's health plans; and staff of the House Appropriations and Senate Finance Committees, to develop a proposal to determine the equitable and fair reimbursement to out-of-network health care providers for emergency services rendered, which shall be based on a percentage above the Medicare Fee Schedule for equivalent services. The out-of-network services rate developed by the workgroup shall be a recommendation for consideration by the General Assembly for future legislation to prohibit the practice of balance billing by out-of-network emergency services health care providers. The workgroup shall consider the fiscal impact of proposed out-of-network emergency services provider reimbursement rates on the state employee health benefits plans, and The Local Choice plan; the impact to the provider networks of the the state health plans' third-party administrator; and shall protect the proprietary and confidential data of the state health plans' third-party administrator, including provider reimbursement rates, in their final report. The Commission shall provide analytical and actuarial services pursuant to the workgroup's analysis and development of a proposal, as needed. The Commission and the Department shall provide information on the proposal to the Chairmen of the House Appropriations and Senate Finance Committees by November 15, 2019."