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, ensuring these facilities receive compensation that is at least 90% of the average hospital-based outpatient rate for equivalent services. The bill addresses current disparities in reimbursement rates that can limit competition and access to affordable care, while also emphasizing the need for transparency in reimbursement methodologies to promote fairness in the healthcare marketplace.

Key provisions include a requirement for insurers to disclose their reimbursement methodologies and rates to contracted providers, as well as a prohibition on establishing reimbursement rates below the specified threshold. The bill also restricts insurers from increasing costs or reducing fees for healthcare services without meeting certain financial conditions and obtaining approval from the Insurance Commissioner. Additionally, it includes enforcement mechanisms for compliance and is retroactive to apply to existing contracts and claims, with an emergency clause for immediate implementation to address ongoing issues in healthcare reimbursement practices.

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