January 18, 2018

States Again Consider Out-of-Network Legislation

In 2017, many medical specialty societies supported proposed state legislative reforms to regulate the behavior of private health care insurers and managed care. In early 2018, the same themes are emerging again with efforts to pass reforms and to educate lawmakers about utilization management, provider networks, timely credentialing and fair contracting.

Legislative proposals to ensure strong regulation of the health insurance industry are being filed across the country. They address provider networks, transparent insurer practices, administrative simplification, physician data, fair contracting, and state-based payment and delivery reforms.

Out-of-network/surprise billing legislation is likely to be considered in the following 27 states: Alabama, Arizona, California, Connecticut, Georgia, Idaho, Kentucky, Louisiana, Massachusetts, Maine, Missouri, Maryland, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, Vermont and Washington State.