Budget Amendment ID: FY2018-S3-332

EHS 332

Qualified Plan Networks

Mr. Boncore moved that the proposed new text be amended amend the bill by adding the following new section:

"SECTION  XXXX. “Section 11 of Chapter 176J is hereby amended by striking the last paragraph of subsection (a) and replacing it with the following:

The commissioner may apply waivers to the base premium rate discount determined by the commissioner under this section to carriers which (i) receive 80 per cent or more of their incomes from government programs or which do not have a state wide service area; or (ii) which have service areas which do not include either Suffolk or Middlesex counties and who were first admitted to do business by the division of insurance on January 1, 1986, as health maintenance organizations under chapter 176G; or (iii) which have at least 50 percent of their chapter 176J membership enrolled in a program administered by the Health Connector Authority pursuant to chapter 176Q of the General Laws that provides subsidies to eligible individuals enrolled in health plans offered through the Health Connector Authority, or any subsequent program of a similar nature; or (iv) whose main provider network includes either fewer than 85% of the hospitals licensed by the Massachusetts Department of Public Health which are located within its Massachusetts service area or fewer than 85% of physicians licensed by the Board of Registration in Medicine which practice within its Massachusetts service area; or (v) whose full network excludes the state’s highest paid providers and whose network is already reduced to such an extent that further excluding providers would be impracticable.