State employee health plan payment limits.
Sponsored By: Julie McGuire (Republican)
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Summary
Limits the amount that a state employee health plan may pay for a medical facility service provided to a covered individual to: (1) the lesser of the amount of compensation established by the network plan or 200% of the amount paid by the Medicare program for that type of medical facility service or for a medical facility service of a similar type, if the medical facility service is provided by an in network provider; and (2) 185% of the amount paid by the Medicare program for that type of medical facility service or for a medical facility service of a similar type, if the medical facility service is provided by an out of network provider. Prohibits a provider from charging a covered individual an additional amount for a medical facility service, other than cost sharing amounts authorized by the terms of the state employee health plan. Requires a medical facility that provides drugs to a covered individual, in billing a state employee health plan for the cost of the drugs, to include in the billing the same "TB" or "JG" modifier that the medical facility would include in the billing if the medical facility were billing the Medicare program for the drugs.
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Bill Overview
No Economic Impacts Identified for this Bill
Sponsors & Cosponsors
Sponsor
Julie McGuire
Republican • House
Cosponsors
Martin Carbaugh
Republican • House
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
Committee report: do pass, adopted
2/11/2025HouseFirst reading: referred to Committee on Insurance
1/21/2025HouseAuthored by Representative McGuire
1/21/2025HouseCoauthored by Representative Carbaugh
1/21/2025House
Bill Text
House Bill (H)
Introduced House Bill (H)
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