May 17, 2019
The big news this week was the unveiling of two separate bills addressing surprise out of network bills.
- Senate – The Senate version, spearheaded by Sens. Cassidy and Bennett, would prohibit balance billing for emergency care, elective care at in-network facility but service done by an out-of-network provider, and when a patient needs additional care after an emergency at an out-of-network facility but can’t get there. Providers would be paid median in-network rates for such instances but providers can trigger an arbitration process to make a final determination.
- House – The House version, spearheaded by Reps. Pallone and Walden, would treat out-of-network emergency care as in network for purposes of cost-sharing, prohibit balance billing, and require insurers to make minimum payment to out-of-network providers based on nearby in-network providers.
There are expected other bills to emerge to tackle surprise billing. There’s still a long way to go for any legislation to pass but if health legislation will pass this term it’s likely to be on surprise billing.
AHP Guidance – The Department of Labor released new guidance on Association Health Plans clarifying that given the recent court ruling, enrollees in AHPs created under the new rules can stay in their plan for the remainder of the plan/contract period but cannot renew.
More Hospital Price Transparency Regulations Coming? – The Wall Street Journal reported that “The administration is strongly interested in forcing insurers to publicize the negotiated rates they pay for services.” The WSJ reported that the Department of Labor is considering releasing a regulation that would require private insurers to publish the negotiated rates of services they have with providers.
Maryland – The Governor of Maryland (Hogan) signed into the law a first in the nation “easy enrollment” bill. The bill would allow Maryland residents to check a box on their tax returns that would allow them, if they qualify, to be either automatically enrolled in Medicaid or get outreach by the Exchange for enrollment. The bill is expected to increase coverage take-up by the uninsured.
Washington – The Governor of Washington signed into law a bill that will create the first “public option” to be offered on-Exchange. Starting in 2021, Washington will offer something called “Cascade Care”. Cascade Care will be offered by a private insurance company but overseen by the Exchange. The bill requires certain provider reimbursement rates to be required of a carrier offering “Cascade Care”.
Several states have now released their 2020 proposed rate filings:
- Maryland announced proposed rate increases of -2.9% and 4.3% in the individual and small group markets, respectively.
- Oregon announced proposed rate increases of 3.3% and 8.7% in the individual and small group markets, respectively.
- Vermont announced proposed rate increases of 13%.
Reminder- Maryland and Oregon have reinsurance programs that affect their individual markets and Vermont has a merged market.