HB 530

Abstract

Health care coverage; qualified health plans.Requires the Department of Medical Assistance Services, in collaborationwith the State Corporation Commission, to contract with health carriersto offer qualified health plans on the health benefit exchange beginningJanuary 1, 2022. The bill provides that such qualified health plansare designed to reduce deductibles, make more services availablebefore the deductible is met, provide predictable cost sharing, maximizesubsidies, limit adverse premium impacts, reduce barriers to maintainingand improving health, encourage choice based on value, and limitadverse premium impacts and increases in premium rates. The billrequires that any health carrier contracted with the Department tooffer such qualified health plans (i) is licensed and in good standingto offer health insurance coverage in the Commonwealth and (ii) offersat least one qualified health plan at a silver level of coverageand one qualified health plan at a gold level of coverage. The billprovides that any fee-for-service rates for providers and facilitiesunder any such qualified health plan cannot exceed the Medicare ratesfor the same or similar covered services, and for reimbursement otherthan fee-for-service, the aggregate amount the qualified health planpays to providers and facilities cannot exceed the equivalent ofthe aggregate amount the qualified health plan would have reimbursedproviders using fee-for-service Medicare rates.