HB 1200 IN

0likes☆Favorite🔕SubscribeShare

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. Provides that a provider, after receiving payment from a state employee health plan for a medical facility service provided to a covered individual, is prohibited from charging the covered individual an additional amount, other than cost sharing amounts authorized by the terms of the state employee health plan. Provides that a determination of the state personnel department, a state employee health plan, or a firm providing administrative services to a state employee health plan that a medical facility service provided to a covered individual is of a type similar to a particular type of medical facility service covered by the Medicare program is conclusive. 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.

• Julie McGuire Republican · author

1. Jan 9, 2024 Coauthored by Representatives Carbaugh, Lehman, Schaibley · lower
2. Jan 9, 2024 Authored by Representative McGuire · lower
3. Jan 9, 2024 First reading: referred to Committee on Insurance · lower
4. Jan 25, 2024 Committee report: amend do pass, adopted · lower
5. Jan 31, 2024 Amendment #9 (McGuire) prevailed; voice vote · lower
6. Jan 31, 2024 Second reading: amended, ordered engrossed · lower

The published texts of this bill as it moves through the legislature. Each links to the official document on the state legislature site. Data from OpenStates.

• Engrossed House Bill (H) · PDF
• House Bill (H) · PDF
• Introduced House Bill (H) · PDF