HB1251
Health insurance; definitions, payment to out-of-network providers, emergency services.
Summary
As Passed House of Origin. Health insurance; payment to out-of-network providers.
Provides that when a covered person receives covered emergency services from an out-of-network health care provider or receives out-of-network services at an in-network facility, the covered person is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement. The measure also establishes a standard for ... (More) calculating the health carrier's required payment to the out-of-network provider of the services. If such provider determines that the amount to be paid by the health carrier does not comply with the applicable requirements, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the appropriate amount of the reimbursement and, if a resolution is not reached, authorizes either party to request the State Corporation Commission to review the disputed reimbursement amount and determine if the amount complies with applicable requirements. The measure provides that such provisions do not apply to an entity that provides or administers self-insured or self-funded plans; however, such entities may elect to be subject such provisions. The measure requires health carriers to make reports to the Bureau of Insurance and directs the Bureau to provide reports to certain committees of the General Assembly. The measure requires the nonprofit data services organization contracting with the Department of Health to operate the All Payer Claims Database to convene an advisory work group to make recommendations for a methodology to be used for identifying codes for comparable emergency services and statistical adjustments to account for outlier payment amounts for each health planning region to be used for the market-based value calculation and submit its recommendations to the Commissioner of Insurance no later than December 31, 2020. (Less)-
Bill History
- 01/08/2020 - House: Prefiled and ordered printed; offered 01/08/20 20102088D
- 01/08/2020 - House: Referred to Committee on General Laws
- 01/16/2020 - House: Impact statement from DPB (HB1251)
- 01/16/2020 - House: Referred from General Laws
- 01/16/2020 - House: Referred to Committee on Labor and Commerce
- 01/23/2020 - House: Assigned L & C sub: Subcommittee #2
- 01/30/2020 - House: Subcommittee recommends reporting with substitute (8-Y 0-N)
- 01/30/2020 - House: Subcommittee recommends referring to Committee on Appropriations
- 02/04/2020 - House: Reported from Labor and Commerce with substitute (22-Y 0-N)
- 02/04/2020 - House: Referred to Committee on Appropriations
- 02/04/2020 - House: Committee substitute printed 20107376D-H1
- 02/04/2020 - House: Incorporates HB1546 (Adams)
- 02/04/2020 - House: Incorporates HB1494 (Bagby)
- 02/04/2020 - House: Incorporates HB58 (Ware)
- 02/06/2020 - House: Impact statement from DPB (HB1251H1)
- 02/07/2020 - House: Committee substitute printed 20108018D-H2
- 02/07/2020 - House: Incorporates HB1546 (Adams)
- 02/07/2020 - House: Incorporates HB1494 (Bagby)
- 02/07/2020 - House: Incorporates HB189 (Levine)
- 02/07/2020 - House: Incorporates HB901 (Sickles)
- 02/07/2020 - House: Incorporates HB58 (Ware)
- 02/07/2020 - House: Reported from Appropriations with substitute (22-Y 0-N)
- 02/09/2020 - House: Read first time
- 02/10/2020 - House: House committee, floor amendments and substitutes offered
- 02/10/2020 - House: Read second time
- 02/10/2020 - House: Committee Labor and Commerce substitute rejected 20107376D-H1
- 02/10/2020 - House: Committee on Appropriations substitute agreed to 20108018D-H2
- 02/10/2020 - House: Amendments by Delegate Torian agreed to
- 02/10/2020 - House: Engrossed by House - committee substitute with amendments HB1251EH1
- 02/10/2020 - House: Printed as engrossed 20108018D-EH1
- 02/11/2020 - House: Read third time and passed House (94-Y 5-N)
- 02/11/2020 - House: VOTE: Passage (94-Y 5-N)
- 02/12/2020 - Senate: Constitutional reading dispensed
- 02/12/2020 - Senate: Referred to Committee on Commerce and Labor
- 02/20/2020 - House: Impact statement from DPB (HB1251EH1)
- 02/24/2020 - Senate: Reported from Commerce and Labor with substitute (13-Y 2-N)
- 02/24/2020 - Senate: Committee substitute printed 20109073D-S1
- 02/24/2020 - Senate: Rereferred to Finance and Appropriations
- 02/25/2020 - House: Impact statement from DPB (HB1251S1)
- 03/02/2020 - Senate: Reported from Finance and Appropriations (14-Y 0-N)
- 03/04/2020 - Senate: Constitutional reading dispensed (40-Y 0-N)
- 03/05/2020 - Senate: Floor substitute printed 20109579D-S2 (Favola)
- 03/05/2020 - Senate: Read third time
- 03/05/2020 - Senate: Committee substitute rejected 20109073D-S1
- 03/05/2020 - Senate: Reading of substitute waived
- 03/05/2020 - Senate: Substitute by Senator Favola agreed to 20109579D-S2
- 03/05/2020 - Senate: Engrossed by Senate - committee substitute HB1251S2
- 03/05/2020 - Senate: Passed Senate with substitute (40-Y 0-N)
- 03/05/2020 - House: Senate substitute agreed to by House 20109073D-S1 (98-Y 0-N)
- 03/05/2020 - House: VOTE: Adoption (98-Y 0-N)
- 03/12/2020 - House: Enrolled
- 03/12/2020 - House: Bill text as passed House and Senate (HB1251ER)
- 03/12/2020 - House: Signed by Speaker
- 03/12/2020 - Senate: Signed by President
- 03/16/2020 - House: Impact statement from DPB (HB1251S2)
- 03/16/2020 - House: Impact statement from DPB (HB1251ER)
- 03/17/2020 - House: Enrolled Bill communicated to Governor on March 17, 2020
- 03/17/2020 - Governor: Governor's Action Deadline 11:59 p.m., April 11, 2020
- 04/10/2020 - Governor: Approved by Governor-Chapter 1080 (effective - see bill)
- 04/10/2020 - Governor: Acts of Assembly Chapter text (CHAP1080)
