The bill S.43 proposes the implementation of a reference-based pricing program for inpatient and outpatient hospital services within the State employees health plan, set to begin in 2026. It aims to limit the growth rate of premiums in the health plan to align with medical inflation rates. Additionally, the bill allows school employers the option to include their employees in the State employees health plan, thereby expanding coverage options for school staff.

To facilitate these changes, the bill amends current law by defining "employees" to include school employees at the discretion of school employers and mandates the Secretary of Administration to ensure the utilization of a reference-based pricing program for hospital services, excluding critical access hospitals. Furthermore, it stipulates that the annual premium growth must not exceed the percentage change in the Consumer Price Index for medical care in the Northeast region. The Secretary is also required to report annually to the General Assembly on the impact of the pricing program on insurance costs, with the first report due by March 15, 2027.

Statutes affected:
As Introduced: 3-631