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House passes bill tightening provider protections and raising CON thresholds
Summary
House File 2635, as amended, passed the House after debate and technical amendments. Sponsors said it prohibits certain insurer penalties for provider referrals, limits prior authorization in some cancer‑screening and emergent inpatient settings, requires peer reviewers for denials, and raises CON purchasing thresholds from $1.5 million to $4 million.
The House debated and passed House File 2635, a broad package of changes to utilization review, prior authorization and certificate‑of‑need (CON) rules affecting health providers and payers.
Opening remarks described H8080, an amendment that "prohibits health carriers from penalizing health care providers for affiliating with or referring patients to healthcare professional who is not contracted with a healthcare carrier." The introducer told members the package would "prohibit 'take it or leave it' contracts between providers and payers," require that prior‑authorization denials and appeals be handled by a peer of the recommending provider, and prevent prior authorization being used for cancer screenings that meet national guidelines or for emergent inpatient conditions. The amendment also raised thresholds for CON from $1,500,000 to $4,000,000 and removed certain services (open‑heart surgery, organ transplant, cardiac catheterization and radiation therapy) from CON requirements.
A technical amendment to the amendment (H8104) was adopted. Members who spoke in favor emphasized balancing providers' autonomy and patient access; the body's voice and recorded vote showed strong support. The clerk recorded the final vote for the bill as: "Those voting I 94. Those voting no, 1. Absent are not voting, 5." The chair declared the bill passed and the title agreed to.
Supporters framed HF 2635 as restoring provider protections and streamlining costly CON requirements; opponents raised concerns about implementation details and the potential impacts on oversight of certain clinical services but did not prevent passage. The bill now moves to the next steps in the legislative process.
