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Bill would require insurers to set uniform outpatient therapy rates across settings; committee debates effects and facility fees
Summary
H.585 would require insurers to establish uniform outpatient reimbursement rates (expressed as a percentage of Medicare) for physical therapy, occupational therapy and athletic training across all plans; the committee debated likely negotiation outcomes, effects on independent providers and whether facility fees remain unresolved.
Senate Finance reviewed a site‑neutral reimbursement proposal in H.585 that would require private health plans to adopt uniform outpatient reimbursement amounts for specified therapy services and report back on implementation.
Joe Valente, director of policy at DFR, explained the provision would require insurers to express each outpatient therapy reimbursement amount as a percentage of the Medicare rate for that item or service so the same outpatient code is paid the same by a given insurer across the state. Inpatients and facility fees are treated separately and may be reimbursed on different terms.
Committee members and witnesses discussed competing concerns: some argued site‑neutrality could reduce consumer cost and support independent providers by narrowing the hospital price premium; others warned that absent controls the negotiated uniform rate could gravitate upward and increase overall spending. Members raised a real‑world example of a patient who received physical therapy and later received a large hospital bill after a facility takeover—underscoring unresolved questions around facility fees and billing practices.
DFR representatives said the change is intended to apply to outpatient services and that implementation should include an insurer reporting requirement (March 1, 2027) summarizing trends, financial impacts and any recommendations. The initial statutory scope is narrower than earlier drafts and limited to PT/OT/athletic training to test the approach in a known code set before considering expansion.
What’s next: The committee asked DFR for implementation detail and data about likely negotiated rates and impacts on independent practices and critical access hospitals. The statutory text does not change facility‑fee practices; committee members discussed whether a separate policy would be needed to address that issue.
