Legislatures hold hearings on measures ranging from breast cancer screening to modifying physician assistant (PA) supervision requirements.
Breast Cancer Screening
In Rhode Island, HB 5156 would mandate coverage for digital breast tomosynthesis screening for women. The bill will be discussed before a hearing at the Health and Human Services Committee.
In Arizona, SB 1320 had a second reading in the Senate. The bill would require carriers to charge enrollees the in-network rate for emergency services provided by out-of-network providers. For the emergency services, carriers would reimburse the out-of-network providers the greatest of the following amounts:
- The in-network rate.
- The usual, customary and reasonable rate, which is defined as the 80th percentile of all charges for a particular healthcare services provided by a provider in a similar specialty in the same geographic area. This rate would be reported in a benchmarking database maintained by a nonprofit organization.
- The Medicare reimbursement rate.
In Oklahoma, HB 2125 had its first reading in the House. In the event a healthcare provider, healthcare facility or administrator has billed an enrollee an amount greater than the applicable copayment, coinsurance and deductible amount required under the Oklahoma Surprise Billing Protection Act, the state Attorney General may bring a civil action in the name of the state to ensure the enrollee is not responsible for an amount greater than the applicable copayment, coinsurance and deductible amounts.
Additionally, carriers would be required to reimburse out-of-network providers for emergency care necessary to evaluate and stabilize a covered person, regardless of the eventual diagnosis.
In the event an in-network facility schedules a procedure or seeks prior authorization from a carrier for elective services, the facility shall provide the enrollee with an out-of-network services written disclosure that states the following:
- That certain facility-based providers may be called upon to render care to the enrollee during treatment;
- That those facility-based providers may not have contracts with the covered person's healthcare and are therefore considered to be out-of-network;
- That the services therefore will be provided on an out-of-network basis;
- A description of the range of the charges for the out-of-network services for which the covered person may be responsible;
- A notification that the enrollee may either agree to accept and pay the charges for the out-of-network services, contact their carrier for additional assistance or;
- A statement indicating that the covered person may obtain a list of facility-based providers from their carrier that are in-network and that the enrollee may request those in-network providers.
The bill would also stipulate the reimbursement for out-of-network billing:
- At 150% of the Employees Group Insurance Division's current contracted rates as of Nov. 1, 2020, or the future adjusted rates, whichever is greater; or
- At a rate established by a representative data set from a statewide health information exchange all-payer claims database.
Out-of-network providers rendering elective services that are aware they are not contracted with the enrollees’ carrier would be required to inform the enrollee of their out-of-network status and advise the enrollee to contact their carrier to discuss their options.
In the event of a dispute, the out-of-network provider, out-of-network facility and carrier or administrator may request mediation of a settlement of an out-of-network health benefit claim utilizing a fair and impartial mediation entity.
Rep. Chris Sneed introduced HB 2807. It would modify Oklahoma’s out-of-network reimbursement rate for emergency services by mandating carriers pay the greater of:
- The Medicare reimbursement rate;
- The in-network rate;
- The usual, customary and reasonable rate — defined as the 80th percentile of all charges for the healthcare service performed by provider in a similar specialty and in the same geographical area as reported in an independent benchmarking database maintained by a nonprofit organization specified by the Insurance Commissioner; or
- The agreed upon rate.
In the event an enrollee services at an in-network facility from an out-of-network provider, the carrier shall pay the out-of-network provider directly and initial payment shall be at the usual, customary and reasonable rate or at an agreed upon rate.
An out-of-network provider, out-of-network facility, and carrier or administrator may request arbitration of a settlement of an out-of-network health benefit claim through the state insurance department's website. Based on the arbitrator's binding award amount, the losing party shall be required to pay the arbitrator's fees and expenses.
Scope of Practice
In Delaware, HB 33 passed the Sunset Committee on Policy Analysis and Government Accountability. The bill seeks to change the practice agreement between a physician assistant and physician from supervising to a collaborating agreement. PAs would also be permitted to order therapeutic orders or procedures.
In Florida, HB 111 and its companion bill SB 424 would revise practice requirements for an advanced practice registered nurse to practice autonomously in their respective specialty. The House bill was referred to the Health and Human Services Committee and its Professions and Public Health Subcommittee. The Senate version was referred to the Health Policy, Banking and Insurance, and Rules Committees.
In Oregon, the Health Care Committee will hold a hearing on HB 3036. The bill seeks to change the practice agreement between a physician assistant and physician from supervising to a collaborating agreement.
In Rhode Island, HB 5198 was referred to the Health, Education and Welfare Committee. It would seek to permit physical therapists to order diagnostic imaging, defined as “basic radiological imaging.” Unless extended by the state general assembly, authorization for physical therapists to order diagnostic imaging would sunset on Dec. 31, 2023.
In Utah, SB 27 will be heard before the Health and Human Services Committee. The bill seeks to change the practice agreement between a PA and physician from a supervising to a collaborating agreement. PAs would also be permitted to order, perform and interpret diagnostic studies and therapeutic procedures.
In Virginia, HB 2039 passed the House chamber. The measure seeks to change the practice agreement between a physician assistant and physician to a collaborative agreement. Additionally, the physician in the collaborative agreement would not be liable for the actions or inactions of the PA.