Summary:

 Senate Bill 512 (SB 512):  The bill updates how “surprise bill” reimbursement is calculated. Rather than being tied to 2017 data, the method now references current claims from two years earlier and retains a floor of 150% of the recent Medicare rate for that same service. 

Legislation Overview:

 Senate Bill 512 (SB 512):  Under current law, when a patient receives an unexpected (or “surprise”) bill from an out-of-network (nonparticipating) health care provider, the reimbursement that the provider gets is set using a specific formula called the “surprise bill reimbursement rate.”
The following are key updates:
Rolling Claims Data:
•	Current Method: The reimbursement rate is based on data reflecting the 2017 plan year.
•	Proposed Method: The rate will now be based on more recent claims specifically, from the calendar year that is two years prior to when the service was performed.
•	Example: If a service is provided in 2026, the reference data would be from 2024.
Nonprofit Benchmarking Database:
•	The law continues to use the sixtieth percentile of allowed commercial reimbursement for the specific service (i.e., the typical payment to providers in a region).
•	The Superintendent of Insurance designates a benchmarking database after consulting with health care sector stakeholders.
Medicare-Based Floor:
•	The final surprise bill reimbursement rate cannot be less than 150% of the approved and published Medicare rate for that service, referencing the Medicare rate from the previous calendar year.
•	(Previously, the law pegged it to “2017” Medicare rates; it now updates to the Medicare rate from the year prior to the service.)
 

Current Law:

 The analysis explains current law and new proposed legislation.