Health Maintenance Organizations - Payments to Nonparticipating Providers - Reimbursement Rate

HB 737 requires health insurance plans (HMOs) to pay non-contracted healthcare providers at minimum rates: 140% of Medicare rates for trauma care, and 125% of the 2019 rate adjusted for inflation for other services. This affects independent doctors, hospitals, and clinics that treat HMO members but aren’t directly contracted with them. The law updates payment standards to better reflect current costs using Medicare’s inflation index, replacing older fixed-rate calculations. It ensures non-contracted providers receive fairer compensation for services rendered to HMO enrollees.