HB 184

Health carrier contracts; site-neutral payment policy for applicable services; annual report; civil penalty. Requires any provider that enters into a provider contract with a health carrier to accept as payment in full for all applicable services, as defined in the bill, rates that shall not exceed 150 percent of the amount paid as the Medicare non-hospital rate, as defined in the bill, for the same services. The bill also prohibits such providers from charging, billing, or accepting payment for applicable services that exceeds the lesser of (i) 150 percent of the Medicare non-hospital rate or (ii) the negotiated rate agreed upon with the carrier. The bill requires the State Corporation Commission, in consultation with the Department of Health, to annually submit a report to the Governor and General assembly on information regarding payment for applicable services and to publish such report online. Under the bill, each carrier is also required to submit an annual report to the Commission. The bill includes civil penalty provisions of (a) $1,000 per claim improperly billed or (b) $100,000 per contract occurrence. Under the bill, 'applicable services' means outpatient or ambulatory services that can be provided safely and appropriately across ambulatory care settings.