Legislative committee debates timeline, safeguards for reference-based pricing in hospital bills

A legislative markup committee on April 30 debated how and when to put reference-based pricing into law, how to prevent patients from getting surprise bills, and which state agency should lead setting rates for non‑hospital services.

The committee discussed a provision that would require the board to implement reference‑based pricing so providers’ charge amounts take effect “as soon as practicable, but not later than hospital fiscal year 2027.” Anne Harvey of the Office of Legislative Counsel introduced the section and said, “So we were in the section that was creating the reference based pricing provisions.”

Committee members focused on three safeguards: a ban on balance billing, monitoring to ensure lower hospital prices translate to lower health‑insurance premiums, and pre‑defined, measurable criteria under which the use of reference‑based pricing could be modified or ended. Members proposed adding the word “measurable” to factors that could require terminating or modifying RBP so that the board must set objective thresholds rather than rely only on general examples.

Why it matters: reference‑based pricing would cap what hospitals can charge for certain items or services. The committee…