January 27, 2016

15 States Consider Balance Billing Legislation

Fifteen of 44 state legislatures in session as of Jan. 27 are considering bills that would regulate balance billing and out-of-network medical services.

Such legislation has been introduced in Arizona, Connecticut, Georgia, Indiana, Missouri, Montana, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Rhode Island, Texas, Virginia and Washington. Relevant legislative activity in selected states includes:


Connecticut HB 6191-Introduced. To Joint Committee on Insurance and Real Estate. Prohibits health insurers and other entities from setting the amount of payments to health care providers for non-covered benefits; prohibits insurance companies and other entities from setting the amount of any payment for services or procedures that are not covered benefits under certain health insurance policies or health benefit plans.

Connecticut HB 6437-Introduced. To Joint Committee on Insurance and Real Estate. Concerns public disclosure of changes to health insurer network directories and prescription drug formularies; requires health insurers to immediately and publicly disclose changes made to their listings of participating health care providers and facilities and prescription drug formularies.

Connecticut SB 546-Introduced. To Joint Committee on Insurance and Real Estate. Concerns participating provider directories provided by health carriers and participating providers accepting new patients on an outpatient services basis; requires that health carriers include in each participating provider directory a current and accurate list of participating providers accepting new patients on an outpatient services basis.


Georgia SB 8 pre-filed. To Health and Human Services. A bill to provide for consumer protections regarding health insurance; to provide for definitions; to provide for disclosure requirements of providers, hospitals, and insurers; to provide for billing and reimbursement of out-of-network services; to provide for procedures for dispute resolution for surprise bills for nonemergency services; to provide for payment of emergency services; and to provide for an out-of-network reimbursement rate workgroup.


Massachusetts HD 2662-Filed. Relates to out-of-network billing. Massachusetts SD 1211-Filed. Relates to out-of-network services provided by emergency medicine clinicians.


New York SB 3118-Introduced. To Senate Committee on Insurance. Amends state insurance law; requires notification to insureds that an out-of-network physician may be used in their procedure, test or surgery and such physician's services shall not be covered by their insurance policy. Such services must be covered if the insured person does not receive notification prior to such services or procedure.


Oklahoma SB 518-Pre-filed. Relates to health maintenance organizations; relates to reasonable standards of quality of care and liability of subscriber for health maintenance organization debts; declares provider compensation reasonable under certain standards; defines out-of- network provider; prohibits out-of-network providers from charging health maintenance organization patients.

Oklahoma SB 713 Pre-filed. Relates to health care billing; creates Task Force on Balance Billing in Health Care; provides membership; specifies procedure for vacancies; provides for quorum; permits certain persons to conduct official business; stipulates appointive authorities; requires convening by certain date; provides staff assistance.


Rhode Island HB 5012-Scheduled for hearing and/or consideration on January 24, 2017. Relates to insurance; relates to surprise bills for medical services; provides for a dispute resolution process for emergency services and surprise bills for medical services performed by nonparticipating out-of-network health care providers.

ACR members are encouraged to refer to the Statescape Legislative Report for current information about health care legislation in all states about balance billing and other health care issues. Please contact Eugenia Brandt at ebrandt@acr.org or 703-715-4398 if your chapter requires assistance or has questions about state legislative matters.