HB 1502: State employee health plan payment limits.

Official summary

Abstract published by the legislature (via Open States). Text as published by the legislature; reproduced verbatim.

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.

Sponsors

Sponsors by party (alphabetical): Republican 2

“Support” is shown only as formal sponsorship recorded by the legislature. Roll-call votes are available on the official bill page.

Recent official actions

1. February 11, 2025Committee report: do pass, adopted
2. January 21, 2025First reading: referred to Committee on Insurance
3. January 21, 2025Authored by Representative McGuire
4. January 21, 2025Coauthored by Representative Carbaugh