SB 2070

This bill prohibits health insurance entities from calculating quality measures, quality ratings, incentive payments, or reimbursement tiers for a healthcare provider by including any exempt patient in the denominator of any vaccine-related metric. Furth er, upon receiving documentation from a healthcare provider that a patient is an exempt patient, the health insurance entity must exclude the patient from the calculation of the provider's vaccination rate performance or any other quality metric related t o vaccine status. This bill also prohibits health insurance entities from terminating a healthcare provider from a network, reducing reimbursement rates, or withholding an incentive payment solely because the provider retains exempt patients in its practice. Any claim fo r reimbursement that is reduced, denied, or recouped by a health insurance entity in violation of this bill is a clean claim and is subject to the interest penalties and remediation as provided in present law. As used in this prohibition, a "clean claim"" i s a claim received by a health insurance entity for adjudication that requires no further information, adjustment, or alteration to be paid by the health insurer. ""EXEMPT PATIENT"" DEFINED As used in this bill, an ""exempt patient"" means a patient, or the parent or legal guardian of a minor patient, who has declined a specific vaccination or series of vaccinations and has provided the healthcare provider with a written statement of refusal based on religious tenets or medical contraindication as recognized under state law. APPLICABILITY This bill applies to contracts entered into on or after July 1, 2026. ON MARCH 26, 2026, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 2070, AS AMENDED. AMENDMENT #1 removes this bill's requirement that a patient must have provided the healthcare provider with a written statement of refusal of a vaccination based on religious tenets or medical contraindication in order to be an exempt patient for purposes of this bill. This amendment expands this bill's definition of ""quality measure"" to include capitation rate, shared-savings distribution, and downside risk-sharing arrangement . This amendment specifies that a health insurance entity shall not calculate a ""final"" quality measure, quality rating, incentive payment, or reimbursement tier for a healthcare provider at the end of each measurement period that is used to calculate provider payments by including an exempt patient documented by a healthcare provider in the denominator of a vaccination-related metric. Under this amendment, if a provider submits documentation that supports that a patient is an exempt patient and submits an electronic claim containing a standard diagnosis code indicating the immunization was not carried out, then a health insurance entity must exclude the patient from the final calculation of the provider's vacci nation rate performance, or any other quality metric derived from vaccination status, for the applicable measurement period. This amendment makes this bill's prohibition against a health insurance entity terminat ing a healthcare provider from a network, reduc ing a provider's reimbursement rate, or withhold ing an incentive payment because the provider retains exempt patients in the provider's practice applicable to situations where the termination, reduction, or withholding is based in whole or in part on such retention of exempt patients (instead of when the action is based solely on such retention) ."