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2019 SESSION

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HB 2639 Health care shared savings; incentive programs.

Introduced by: Kathy J. Byron | all patrons    ...    notes | add to my profiles | history

SUMMARY AS PASSED:

Health care shared savings; incentive programs. Requires health carriers to establish a comparable health care service incentive program under which savings are shared with a covered person who elects to receive a covered comparable health care service from a lower-cost provider. Incentive payments are not required for savings of $25 or less. The measure requires health carriers to comply with transparency requirements beginning with health benefit plans offered or renewed on or after July 1, 2020. Programs are required to be approved by the Commissioner of Insurance. This bill is identical to SB 1611.

SUMMARY AS PASSED HOUSE:

Health care shared savings; incentive programs. Requires health carriers to establish a comparable health care service incentive program under which savings are shared with a covered person who elects to receive a covered health care service from a lower-cost provider. Incentive payments are not required for savings of $25 or less. Programs are required to be approved by the Commissioner of Insurance.

SUMMARY AS INTRODUCED:

Health care shared savings; incentive programs. Requires health carriers to establish a comparable health care service incentive program under which savings are shared with a covered person who elects to receive a covered health care service from a lower-cost provider. Incentive payments are not required for savings of $25 or less. Programs are required to be approved by the Commissioner of Insurance. The measure also requires health carriers to make available an interactive mechanism on their website that enables a covered person to compare costs between providers in-network, calculate estimated out-of-pocket costs, and obtain quality data for those providers, to the extent available. The measure exempts certain health maintenance organizations from these requirements. The measure requires health care facilities and practitioners to provide a covered person an estimate of charges prior to an admission, procedure, or service. All health care providers are required to provide a description of the elective procedure or test, or the applicable standard procedural terminology or medical codes used by the American Medical Association, sufficient to allow a patient to compare care options if the patient is being referred for an elective procedure or test.