Health Maintenance Organizations - Payments to Nonparticipating Providers - Reimbursement Rate

HB 418 sets minimum payment rates that health maintenance organizations (HMOs) must pay non-contracted healthcare providers (like doctors or hospitals not under formal agreement with the HMO) for services provided to HMO enrollees. It requires HMOs to pay trauma physicians treating trauma patients at least 140% of the Medicare rate for similar services, or the 2001 rate adjusted for inflation. For other providers, HMOs must pay at least 125% of the rate they paid contracted providers in 2019 (adjusted by the Medicare Economic Index), or 140% of the 2008 Medicare rate (also adjusted). All payments must be made within 30 days of receiving a claim.