HB 1597 IN

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Limits the amount that a state employee health plan may pay for a medical facility service provided to a covered individual to: (1) 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 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 "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 19, 2023 Coauthored by Representative Schaibley · lower
2. Jan 19, 2023 Authored by Representative McGuire · lower
3. Jan 19, 2023 First reading: referred to Committee on Insurance · 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.

• Introduced House Bill (H) · Jan 19, 2023 · PDF