Amendment #486 to H3600
Amendment Relative to Qualified Plan Networks
Mr. Ryan of Boston moves to amend the bill by adding the following section: "SECTION XXXX. “Section 11 of Chapter 176J is hereby amended by inserting at the end of subsection (a) the following – “The commissioner may waive the requirements of this section for carriers based on: (i) whether the carrier’s service area is already reduced such that the carrier is not certified to issue coverage in all rating regions; or (ii) whether the carrier maintains a network of providers that is already constrained such that the carrier only contracts with a selective network of providers; or (iii) whether the variation in provider reimbursement rates for a majority of providers within the carrier’s network that account for the greatest volume of services is constrained to less than 14 per cent variation; or (iv) whether at least 50 percent of the carrier’s chapter 176J membership is enrolled in a program administered by the Health Connector Authority pursuant to chapter 176Q of the General Laws to provide premium assistance payments and point-of-service cost-sharing subsidies to eligible individuals enrolled in health plans, or any subsequent program of a similar nature. Any waiver granted in this manner shall be effective until such time as the carrier has less than 50 percent of such enrollees; or (v) whether the carrier receives 80 per cent or more of its income from government programs, including subsidized coverage offered under chapter 176Q through which such members receive state or federal subsidies; or (vi) any other factor that impacts whether the carrier is reasonably able to comply with this section."