Amendment #54, as changed to H4617

Clarifying the Average In Network Insurance Formula

Mr. Cassidy of Brockton moves to amend the bill in section 102 by inserting, in lines 2315 and 2322, after the word “service”, the first time it appears in each instance, the following words:-

performed by a health care provider in the same or similar specialty and provided in Massachusetts, as determined by the commissioner of the division of insurance, and in consultation with the center for health information and analysis.

And moves to further amend the bill in said section 102 by inserting, in line 2316, after the words “provider.”, the following words:-

The commissioner of the division of insurance shall indicate the types of claims to be excluded from the “average rate” calculation in this section, including the exclusion of public payer claims, and by excluding other claims which do not accurately reflect the valuation of provider services for commercial carrier plans.

And moves to further amend the bill in said section 102 by striking, in line 2323, the words “services.” and inserting in place thereof the following:-

provider. The commissioner of the division of insurance shall indicate the types of claims to be excluded from the “average rate” calculation in this section, including the exclusion of public payer claims, and by excluding other claims which do not accurately reflect the valuation of provider services for commercial carrier plans.