Governor's Bill No. 6871 seeks to regulate out-of-network health care costs for individuals with health benefit plans, effective January 1, 2026. The bill establishes that total out-of-network charges for inpatient or outpatient hospital services cannot exceed 240% of the Medicare reimbursement rate for the same service in the same geographic area. It also prohibits health care providers from charging patients more than the specified cost-sharing amounts in their health benefit plans. Additionally, any savings from reduced payments to providers must be passed on to consumers and reflected in health carriers' annual rate filings. The legislation designates the Office of Health Strategy as the regulatory body responsible for monitoring compliance and mandates that health care providers submit necessary data for transparency, while ensuring the confidentiality of this data.

Moreover, the bill enhances the enforcement capabilities of the Office of Health Strategy by requiring it to issue cease and desist orders and impose civil penalties for violations found by a preponderance of the evidence. The commissioner or their designee is granted the authority to audit health care providers and carriers for compliance, necessitating the retention of relevant records for up to four years. The bill introduces new legal language regarding the auditing process and consequences for violations, while deleting outdated procedural language. This legislative update aims to strengthen oversight and ensure adherence to health care regulations, with certain rural hospitals and federally qualified health centers exempt from the cost limitations.