Committee advances amendment to health bill addressing site-neutral payments, transparency and prior-authorization disputes

Representative Barrett presented an 18-page amendment to the bill described in the hearing as "10 o 3," saying it addresses a range of health-insurance topics and still requires further work. "This amendment does, gosh, 12 to 15 things," Barrett said, summarizing changes that include a clearer definition for a Medicare fraud unit, a reportable standard for prior-authorization disputes, carve-outs for some small grant recipients in a 340B-like provision, a delayed effective date for that provision to 2027 and language allowing a reasonable markup on certain sales.

Barrett identified site-of-service payment rules as the largest area of change. He said the amendment tries to avoid a confusing rulemaking step, aligns with CMS standards and draws on recommendations from MedPAC about services that do not require facility fees. "If you look through the bridal... an organization called MedPAC that studied this situation for CMS ... came up with a list of codes that were deemed to be codes that, could be done without facility fees," Barrett said. He also said the amendment includes transparency provisions for contracting and targets so-called materiality clauses in contracts that shift losses to public payers.

Representative Borders asked whether the amendment's language on sharing information with a state agency would apply to other health-information exchanges. Barrett said the amendment incorporated recommendations and emphasized HIPAA protections and patient control over data, and that the bill's drafters had met with the current vendor to refine the language. "We incorporated some language... emphasized the importance of HIPAA... the need for patient to be able to control access to their data, and be able to opt out or rescind authorization," Barrett said.

The amendment also raises peer-to-peer prior-authorization review to the level of board certification for reviewers, and includes language intended to promote consumer use of the state all-payer claims database —"let's develop an app" Barrett said, so consumers can compare prices and quality for tests and procedures.

Committee discussion included recognition that the site-neutral payment area remained complex and might require additional federal guidance to resolve conflicts with surprise-billing standards. After discussion the committee voted to report the bill "due pass as amended." The roll call produced seven affirmative votes and three negative votes; the committee chair announced, "Bill passes 7 to 3." Barrett said the group would continue work ahead of second reading.

The amendment passage is procedural: it advances a revised bill to the next committee stage but does not finalize rulemaking or administrative implementation details. Lawmakers and stakeholders signaled further technical drafting and vendor meetings before the bill reaches the floor.