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Atlanta, GA 30339-4503
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PURPOSE OF SB 119
To clarify payment for healthcare services performed by certain outpatient surgery centers.
ACTUARIAL STATEMENT
The Fiscal Impact Statement was prepared according to generally accepted actuarial principles and
practices, in compliance with ACT 112. The Statement provides an estimate of the financial and
actuarial effect of the proposed change(s) on the Plans, if possible. The Statement makes no
comment or opinion with regard to the merits of the measure for which the Statement is prepared;
however, any identified technical or mechanical defects have been noted.
We have reviewed the input and results of our analysis for reasonableness and relied upon the data
and information provided by the Plans and their Claims Processing Contractors.
3/13/2023
_________________________________________ _________________
Patrick Klein, FSA, MAAA Date
Vice President
3/13/2023
_________________________________________ __________________
Matthew Kersting, FSA, MAAA Date
Vice President
 PROJECTED COSTS
Estimated Cost as a Percent of
Annual Estimated Cost
Plan Total Annual Medical Spend
EBD $2,795,000 0.6%
UOA $758,000 0.7%
ASU $98,000 0.5%
UCA $64,000 0.7%
AHEC $28,000 0.7%
NWACC $16,000 0.6%
SAU $18,000 0.8%
PRICING APPROACH AND COMMENTS
Senate Bill 119 requires self-insured health plans to reimburse providers for services provided at
outpatient surgery centers at least 90% of what would be paid for that same healthcare service
performed at an outpatient hospital setting, within the same county as where the outpatient
surgery center is located.
In the absence of plan specific utilization to develop the cost impact for the plans, we relied on
statewide claims and utilization data from Segal’s internal data warehouse. We analyzed the cost
and frequency of procedures performed in an outpatient hospital setting compared to those same
procedures performed in an outpatient surgery center setting.
The cost for procedures performed in an outpatient hospital setting is generally greater than those
same procedures performed in an outpatient surgery center setting. Reimbursing outpatient
surgery center procedures at a level of at least 90% of what would be paid in an outpatient hospital
setting resulted in an expected increase of $22 per member to the plans after applying member
cost sharing.
Actual legislative cost impacts to health plans may vary as actual future experience differs from
the assumptions made in developing these cost estimates. Potential for actual experience to vary
from the assumptions made in these estimates includes underlying changes to the cost of
procedures in outpatient hospital and outpatient surgery center settings, changes in the utilization
of procedures at these settings, and regional changes in the cost of medical procedures for each
plan.


Statutes affected:
SB 119: 23-79-115(a)