Amendment #1157 to H3600

Minimum Wage for High Value Hospitals

Representatives Moran of Lawrence, DiZoglio of Methuen, Matias of Lawrence, Ultrino of Malden, Provost of Somerville, Rogers of Cambridge, Connolly of Cambridge, Gonzalez of Springfield, Donato of Medford, Barber of Somerville, Livingstone of Boston, Whipps of Athol, Vega of Holyoke, Boldyga of Southwick, Ferguson of Holden, Kafka of Stoughton, Hecht of Watertown, Puppolo of Springfield, Wagner of Chicopee, Williams of Springfield, Petrolati of Ludlow, Galvin of Canton, Campbell of Methuen, Carvalho of Boston, Cronin of Easton, Cassidy of Brockton, Velis of Westfield, Garry of Dracut, Mom of Lowell, Zlotnik of Gardner, Tosado of Springfield, Kelcourse of Amesbury, Garballey of Arlington, Arciero of Westford, DuBois of Brockton, Decker of Cambridge and Scibak of South Hadley move to amend the bill by adding the following sections:-

SECTION XX.   Chapter 175 of the General Laws is hereby amended by adding the following new section:-

“Section 229.  Approval of Contracts

The subscriber contracts, rates and evidence of coverage for health benefit plans shall be subject to the disapproval of the commissioner of insurance.  No such contracts shall be approved if the benefits provided therein are unreasonable in relation to the rate charged, or if the rates are excessive, inadequate, or unfairly discriminatory.

To address unwarranted commercial insurance price variation for underpaid acute hospitals and to maintain access to high value acute hospital care in the Commonwealth, for all commercial insured health benefit plan rates effective for rate years on and after October 1, 2017, the carrier's health benefit plan rates filed with the division of insurance are considered presumptively disapproved if the carrier's network provider reimbursement rates, inclusive of rates and targets within alternative payment contacts, do not reimburse acute hospitals at or greater than a minimum of 90 percent of the average rate of commercial insurance reimbursement calculated separately for acute hospital inpatient and outpatient services in accordance with requirements established by the division of insurance, based on the most recent relative price analysis by the center for health information and analysis.”

AND

SECTION XX.   Chapter 176A of the General Laws is hereby amended in section 6, as so appearing, by adding the following after the word “discriminatory”:-

“The subscriber contracts, rates and evidence of coverage for health benefit plans shall be subject to the disapproval of the commissioner of insurance.  To address unwarranted commercial insurance price variation for underpaid acute hospitals and to maintain access to high value acute hospital care in the Commonwealth, for all commercial insured health benefit plan rates effective for rate years on and after October 1, 2017, the carrier's health benefit plan rates filed with the division of insurance are considered presumptively disapproved if the carrier's network provider reimbursement rates, inclusive of rates and targets within alternative payment contacts, do not reimburse acute hospitals at or greater than a minimum of 90 percent of the average rate of commercial insurance reimbursement calculated separately for acute hospital inpatient and outpatient services in accordance with requirements established by the division of insurance, based on the most recent relative price analysis by the center for health information and analysis.”

AND

SECTION XX.   Chapter 176B of the General Laws is hereby amended in section 4, as so appearing, by inserting the following after the word “discriminatory”:-

“The subscriber contracts, rates and evidence of coverage for health benefit plans shall be subject to the disapproval of the commissioner of insurance.  To address unwarranted commercial insurance price variation for underpaid acute hospitals and to maintain access to high value acute hospital care in the Commonwealth, for all commercial insured health benefit plan rates effective for rate years on and after October 1, 2017, the carrier's health benefit plan rates filed with the division of insurance are considered presumptively disapproved if the carrier's network provider reimbursement rates, inclusive of rates and targets within alternative payment contacts, do not reimburse acute hospitals at or greater than a minimum of 90 percent of the average rate of commercial insurance reimbursement calculated separately for acute hospital inpatient and outpatient services in accordance with requirements established by the division of insurance, based on the most recent relative price analysis by the center for health information and analysis.”

AND

SECTION XX.   Chapter 176G of the General Laws is hereby amended in section 16, as so appearing, by inserting the following after the word “reasonable”:-

“To address unwarranted commercial insurance price variation for underpaid acute hospitals and to maintain access to high value acute hospital care in the Commonwealth, for all commercial insured health benefit plan rates effective for rate years on and after October 1, 2017, the carrier's health benefit plan rates filed with the division of insurance are considered presumptively disapproved if the carrier's network provider reimbursement rates, inclusive of rates and targets within alternative payment contacts, do not reimburse acute hospitals at or greater than a minimum of 90 percent of the average rate of commercial insurance reimbursement calculated separately for acute hospital inpatient and outpatient services in accordance with requirements established by the division of insurance, based on the most recent relative price analysis by the center for health information and analysis.”

Additional co-sponsor(s) added to Amendment #1157 to H3600

Minimum Wage for High Value Hospitals