H1387 — An Act to increase reimbursement for low historic relative price hospitals

Summary

An Act to increase reimbursement for low historic relative price hospitals

Bill Text

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The bill establishes a new section for low historic relative price hospitals, outlining specific reimbursement rates and requirements for insurance carriers.

• Chapter 6D

  Section 9A. (a) For the purposes of this section, 'low historic relative price hospital' shall mean an acute hospital (i) with an average statewide relative price across all carriers during a 5-year period of less than 0.90, and (ii) that is either corporately independent or is corporately affiliated with 2 or more acute hospitals but negotiates carrier contracts separately and on its own behalf. The commission, in consultation with the center, shall annually publish a list of acute hospitals that qualify as low historic relative price hospitals under this section. (b) The commission shall establish a rate equity target to advance the equitable reimbursement of low historic relative price hospitals: (1) For the benchmark cycle of calendar years 2026 to 2029, inclusive, a carrier shall not pay any in-network low historic relative price hospital a payment rate that is less than 15 per cent below the average relative price of all acute hospitals in the carrier’s network; (2) For the benchmark cycle of calendar years 2029 to 2032, inclusive, the average annual reimbursement rate increase from a carrier to a low historic relative price hospital shall be not less than 2 per cent above the health care cost growth benchmark; (3) For the benchmark cycle of calendar years 2032 to 2035, inclusive, the average annual reimbursement rate increase from a carrier to a low historic relative price hospital shall be not less than 1 per cent above the health care cost growth benchmark; and (4) Beginning in the benchmark cycle of calendar years 2035 to 2038, inclusive, and beyond, the average annual reimbursement rate increase from a carrier to a low historic relative price hospital shall be not less than the health care cost growth benchmark.

  A new framework for pricing and reimbursement for certain hospitals is created.

Sponsors

• Christopher M. Markey · Primary

Subjects