Budget Amendment ID: FY2018-S3-431

EHS 431

GIC Provider Rates

Messrs. Tarr and O'Connor moved that the proposed new text be amended by inserting, after section ___, the following new section:-

"SECTION __. Chapter 32A as appearing in the 2014 Official Edition is hereby amended by inserting after section 20 the following section:-

Section 20A. (a) For purposes of this section the words insurer and administrator shall include any insurance carrier, nonprofit hospital or medical service corporation or third-party health care administrator operating within the scope of its license and providing coverage for an individual under a plan offered by the commission under section 4, 4A, 10B, 12 or 15.

(b) No insurer or administrator shall pay more than 160 per cent of the average Medicare hospital base rate, as determined by the center for health information and analysis, for inpatient and outpatient services.

(c) No insurer or administrator shall pay more than 160 per cent of the Medicare fee schedule, for physician or other services.

(d) For all services for which Medicare does not provide a rate, no insurer or administrator shall pay more than 160 per cent of the average Medicare base rate or Medicare fee schedule for a comparable service, as determined by the commission in consultation with the center for health information and analysis.

(e) No individual insured under the group insurance commission shall be denied care by any provider licensed to provide medical care in the commonwealth.

(f) The commission, in consultation with the center for health information and analysis, may review and make recommendations to revise the reimbursement rate every 3 years.