August 04, 2020

Massachusetts and Virginia Advance Out-Of-Network Billing Requirements

Massachusetts’ House chamber passed a bill that would modify reimbursement requirements on out-of-network billing, while Virginia’s Bureau of Insurance issued a proposed rule establishing requirements and processes on out-of-network billing from a previously enacted law.

Out-of-Network Billing

In Massachusetts, SB 2796 passed the House chamber and is currently in conference committee with the Senate. It would reimburse out-of-network emergency care at in-network rates when there is a contract with that carrier and 135 percent of Medicare when there is no contract with the carrier. The conference committee is charged with deliberations on SB 2796, and the outcome of the conference committee is likely to include provisions related to telemedicine and scope of practice of advanced practice nursing.

Virginia’s Bureau of Insurance has issued Proposed Rule 14VAC5-405. The ruling establishes requirements and processes regarding out-of-network billing from providers for emergency healthcare services or nonemergency ancillary and surgical services received at an in-network facility, including procedures for the use of arbitration between health carriers and out-of-network providers to address reimbursement disputes.

Comments on the proposed rule must be received by Sept. 1, 2020.