Budget Amendment ID: FY2018-S3-32

OTH 32

Minimum Wage for High Value Hospitals

Ms. L'Italien, Messrs. Eldridge and Humason, Ms. Gobi, Mr. Brady and Ms. O'Connor Ives moved that the proposed new text be amended by inserting at the end thereof 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 on and after January 1, 2018, 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 weighted average rate of commercial insurance reimbursement 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 on and after January 1, 2018, 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 weighted average rate of commercial insurance reimbursement 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 on and after January 1, 2018, 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 weighted average rate of commercial insurance reimbursement 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 on and after January 1, 2018, 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 weighted average rate of commercial insurance reimbursement 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.”