HB1703

House Bill 1703 establishes a formal administrative appeal process for healthcare providers to challenge reimbursement rates for drugs that fall below their acquisition costs. The bill applies to contracting entities, such as health insurers, that manage health benefit plans. Under the proposed law, providers can initiate an appeal via designated communication channels within 60 business days of a claim's adjudication. If an appeal is upheld, the contracting entity is required to adjust the reimbursement rate to at least 110% of the provider’s acquisition cost and reprocess the claim accordingly. Additionally, the bill allows providers to submit quarterly notifications of drugs with insufficient reimbursement rates to encourage rate adjustments without a formal appeal. The legislation specifically excludes services reimbursed through pharmacy benefits managers.