July 28, 2020

Nebraska Enacts Out-Of-Network Billing Legislation

State legislatures in Massachusetts and Michigan advance and Nebraska signs into law bills that would modify reimbursement and arbitration requirements on out-of-network billing. California’s legislature considers a bill that would expand the scope of practice of nurse practitioners.

Out-of-Network Billing

Nebraska’s Gov. Pete Ricketts signed LB 997 into law. The law will prohibit providers from billing enrollees in excess of any deductible or coinsurance amount for emergency services at an in-network or out-of-network facility. Out-of-network providers may bill insurers for emergency services rendered at an in-network or out-of-network facility. The insurer will pay the billed amount or notify the provider within 20 days after the claim date if the insurer deems the claim as excessive. A reasonable claim will be defined as:

  • The contracted rate under existing in-networks between the carrier and the out-of-network provider for same or similar services; or
  • 175% of the Medicare reimbursement rate for similar services in the same geographic area.

When the insurer considers the claim to be excessive, the insurer and provider will have 30 days to negotiate a settlement or engage in a mediation process.

The law will become effective Jan. 1, 2021.

In Massachusetts, HB 4871 would reimburse out-of-network emergency care at in-network rates when there is a contract with that carrier and 135% of Medicare when there is no contract with the carrier, effective from the time of passage until July 31, 2021. The bill was referred to the House Committee on Ways and Means.

In Michigan, HB 4459 and companion bill HB 4460 were referred the Senate Committee on Insurance and Banking. The bills would require out-of-network emergency medical personnel who provide a covered emergency or elective service to be reimbursed at 150% of the amount covered by Medicare for the service, excluding any in-network coinsurance, copayments or deductibles. An out-of-network provider of an emergency service or of an elective service would not collect from the enrollee, directly or indirectly, any excess amount other than applicable coinsurance, copayments or deductibles. In the event of a dispute, providers and carriers may proceed to arbitration wherein each party would pay half of the total costs of the arbitration proceeding conducted by the state’s Department of Insurance and Financial Services.

Scope of Practice

In California, AB 890 was re-referred to the Senate Committee on Business, Professions and Economic Development. It would remove the mandatory physician supervision of nurse practitioners and expand their scope of practice by allowing them to order, perform and interpret diagnostic procedures involving imaging such as X-rays, mammography and ultrasounds.