Amendment #18 to H4888

Out-of-Network

Mr. Santiago of Boston moves to amend the bill, as amended, by inserting after the word “provider”, in line 729 and in line 735, the following words:-

“the greater of: (i) 115 per cent of the average allowed amount, which is the contractually agreed upon amount paid by a carrier to a health care provider for health care services provided to an insured, the carrier pays for that service performed by a health care provider in the same geographical area and 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, using data for the year 2019, adjusted annually by the growth rate of potential gross state product, obtained from an independent benchmarking database maintained by a nonprofit organization specified by the commissioner of the division of insurance, and excluding public payer claims and other claims which do not accurately reflect the valuation of provider services for commercial carrier plans; and (ii)”

Additional co-sponsor(s) added to Amendment #18, as changed to H4888

Out-of-Network