State employee health plan payment limits.
Summary
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.
Bill status
in committee
1 of 4 stages cleared
Introduction
Jan 2025
Committee Review
Floor Vote
Governor
Introduced Jan 21, 2025
Last action Feb 11, 2025
Maddy AI version diff · 1 comparison
What changed between versions
Introduced House Bill (H)
→
House Bill (H)
·
3 edits
MINOR
The bill text was updated from an 'Introduced' version to a 'House Bill' version, indicating it has been reported out of committee with a 'Do Pass' recommendation. The changes are primarily technical, including updated bill numbers, dates, and formatting, rather than substantive policy modifications.
TECHNICAL
Bill title and digest header updated from 'Introduced House Bill' to 'House Bill' with revised date and tracking numbers.
New line added indicating the bill was reported with a 'Do Pass' recommendation on February 11, 2025.
Page headers and bill reference numbers were updated to reflect the new version status.
Floor votes
How they voted
No floor votes recorded yet.
Full legislative history
Actions timeline
Total actions
4
Key actions
1
Committee
1
Feb 11, 2025
Lower · Passed
Committee report: do pass, adopted
lower
1 primary · 1 co-sponsor
Sponsors
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