The proposed bill seeks to amend existing laws related to healthcare provider reimbursement, specifically for licensed ambulatory surgical centers, outpatient psychiatric centers, and outpatient imaging facilities. It aims to establish fair reimbursement rates, mandating that insurers reimburse these facilities at a minimum of 90% of the average hospital-based outpatient rate for equivalent services. The bill addresses disparities in current reimbursement rates that can limit competition and access to affordable care, particularly in light of a recent court ruling that permitted lower reimbursements for these centers. Additionally, it emphasizes the need for transparency in reimbursement practices, requiring insurers to disclose their methodologies and ensuring that these rates apply retroactively to relevant claims and contracts.

Key provisions of the bill include a comprehensive schedule of reimbursement rates that insurers must provide, detailing how payments are determined based on factors like geographic location and service type. Insurers are prohibited from setting reimbursement rates below the mandated threshold and cannot increase costs or reduce rates without meeting specific conditions, including maintaining a certain medical loss ratio and obtaining approval from the Insurance Commissioner. The bill also empowers the Insurance Commissioner to enforce these regulations and impose penalties for violations. With an emergency clause included, the act is designed to take effect immediately to safeguard patient access to necessary healthcare services.

Statutes affected:
Old version SB626 Original - 4-3-2025 05:45 PM: 23-79-101, 23-79-115, 20-9-201, 20-10-213, 20-9-214, 20-9-215, 23-99-201, 23-99-801, 23-66-201, 4-88-101
SB 626: 23-79-101, 23-79-115, 20-9-201, 20-10-213, 20-9-214, 20-9-215, 23-99-201, 23-99-801, 23-66-201, 4-88-101