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305 Ill. Comp. Stat. § 5/5-30.1. Managed care protections: Medical Assistance – Illinois
Status: Enacted     Year Enacted: 2014
An MCO shall pay any provider of emergency services that does not have in effect a contract with the contracted Medicaid MCO. The default rate of reimbursement shall be the rate paid under Illinois Medicaid …
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A 4305 (see companion bill S 220) – New Jersey
Introduced: 2018    Status: Inactive / Dead    
SETS LEVEL FOR HEALTH CARE BENEFITS; REQUIRES EMPLOYEE CONTRIBUTIONS; PROHIBITS REIMBURSEMENT OF MEDICARE PART B; ADDS MEMBER TO SHBP/SEHBP PLAN DESIGN COMMITTEES; REQUIRES RETIREES TO PURCHASE HEALTH BENEFITS THROUGH EXCHANGES; PROVIDES SUBSIDES FOR OUT-OF-POCKET COSTS. …

A 851 – New Jersey
Introduced: 2018    Status: Inactive / Dead    
SETS LEVEL FOR HEALTH CARE BENEFITS; REQUIRES EMPLOYEE CONTRIBUTIONS; PROHIBITS REIMBURSEMENT OF MEDICARE PART B; ADDS MEMBER TO SHBP/SEHBP PLAN DESIGN COMMITTEES; REQUIRES RETIREES TO PURCHASE HEALTH CARE THROUGH EXCHANGES. Under the bill, all government …

Ga. Code Ann. § 33-64-11. Prohibited activities of pharmacy benefits manager: Regulation and Licensure of Pharmacy Benefits Managers – Georgia
Status: Enacted     Year Enacted: 2017
A pharmacy benefits manager shall be proscribed from prohibiting a pharmacist or pharmacy from providing an insured individual information on the amount of the insured’s cost share for such insured’s prescription drug and the clinical …
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H 1154 – Massachusetts
Introduced: 2019    Status: Inactive / Dead    
Relative to pharmacy benefit managers and pharmaceutical manufacturing companies. Health Care Financing.

H 1265 – Massachusetts
Introduced: 2021    Status: In Process    
Relative to the transparency and affordability of the Group Insurance Commission. Health Care Financing. There shall be a special commission governed by section 2A of chapter 4 of the General Laws to: (i) assess public …

HB 1501 – Florida
Introduced: 2022    Status: Inactive / Dead    
Defines “reference-based pricing”; authorizes cost savings to be paid in cash to enrollee; requires certain contracted entities to use reference-based pricing program to set reimbursement rates.

HB 5842 (see companion bill SB 167) – Rhode Island
Introduced: 2021    Status: In Process    
AN ACT RELATING TO FOOD AND DRUGS — PRESCRIPTION DRUG COST PROTECTION: Prohibits the state, ERISA or any health plans to purchase referenced drugs for a cost higher than the referenced rate.

HF 2195 (see companion bill SF 2111) – Minnesota
Introduced: 2021    Status: In Process    
Health carriers allowed to offer reference-based pricing health plans.

HF 2824 (see companion bill SF 2814) – Minnesota
Introduced: 2019    Status: Inactive / Dead    
Health carrier authorized to offer reference-based pricing health plan in individual and small group markets.

HJ 65 – Montana
Introduced: 2019    Status: Inactive / Dead    
Interim study of reference-based pricing in insurance plans. That the Legislative Council be requested to designate an appropriate interim committee, pursuant to section 5-5-217, MCA, to study the effects of reference-based pricing on health care …

LD 1504 – Maine
Introduced: 2019    Status: Enacted    
This bill replaces the current registration requirement for pharmacy benefits managers doing business in this State with a licensing requirement beginning January 1, 2020. The bill imposes the following requirements on a carrier that provides …

Md. Code, Ins. § 14-205. Benefits for health care services; payments and rates for providers: Preferred Provider Organizations – Maryland
Status: Enacted     Year Enacted: 1997
Services rendered by preferred providers may be compensated either through direct payments to the health care provider or through reimbursement to the insured. PPOs must also pay a reasonable amount of compensation as determined by …
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Md. Code, Ins. § 14-205.1. Policies which condition payment on the use of preferred providers: Preferred Provider Organizations – Maryland
Status: Enacted     Year Enacted: 2007
The Commissioner may authorize an insurer or nonprofit health service plan to offer a preferred provider insurance policy that conditions the payment of benefits on the use of preferred providers if the insurer or nonprofit …
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Md. Code, Ins. § 14-205.2. Payments to on-call physicians and hospital-based physicians: Preferred Provider Organizations – Maryland
Status: Enacted     Year Enacted: 2010
Except as provided in subsection (3), an insured may not be liable to an on-call physician or a hospital-based physician subject to this section for covered services rendered by the on- call physician or hospital-based …
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Md. Code, Ins. §§ 14-201 through 14-206: Preferred Provider Organizations – Maryland
Status: Enacted     Year Enacted: 1997
Insurers may an insurer may offer preferred provider insurance policies that limit, through the use of provider service contracts, the numbers and types of providers of health care services eligible for payment as preferred providers, …
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