Insurers would pay providers in full and collect patient cost sharing

Insurers would pay providers the full amount due under their agreement, including cost sharing, and would be solely responsible for collecting that cost sharing. This applies to insurers, including administrators and pharmacy benefit managers, providing individual or group coverage, self-funded plans, or Medicaid managed care coverage. The provisions would take effect January 1, 2027.

Insurers could not withhold cost sharing from provider payments, require extra discounts, delay or deny provider payment because cost sharing was not collected, or require someone else to collect it. They could not cancel coverage solely for failure to collect cost sharing or use compliance costs to justify higher premiums or lower provider payments. These restrictions apply to insurers and protect covered people and health care providers. Coverage could not be canceled solely because cost sharing was not collected. Expenses to implement or comply with these requirements could not justify higher premiums or lower payments to providers. The provisions would take effect January 1, 2027.

Insurers would certify to the insurance commissioner that they fully complied with the requirements during the previous calendar year. The certification would need a signature from the insurer’s chief executive or chief financial officer. Each insurer covered by the chapter would submit the certification. The certification would be due before December 31 each year and cover the previous calendar year; the requirement would take effect January 1, 2027.