July 07, 2020

States Consider Out-Of-Network Billing and Scope of Practice Legislation

State legislatures in Michigan and New Jersey hold hearings on bills that would modify reimbursement and disclosure requirements on out-of-network billing. Vermont’s governor signs into law legislation that relaxes supervision requirements for physician assistants.

Out-of-Network Billing

In Michigan, SB 570 would amend the state’s Public Health Code. In the event a patient is receiving emergency care by an out-of-network provider, SB 570 would reimburse out-of-network providers the greater of:

  • The average amount negotiated by the enrollee’s healthcare plan with in-network providers excluding in-network coinsurance, copayments, or deductibles; or
  • 150% of the Medicare reimbursement amount, excluding in-network coinsurance, copayments, or deductibles.
    The bill is scheduled for a second reading on the Senate floor.

In New Jersey, AB 3817 is scheduled for a hearing before the Assembly Committee on Financial Institutions and Insurance. The bill would require a healthcare provider to give written notice to an enrollee whenever that provider refers the enrollee to any out-of-network provider. The notice would include:

  • A disclosure explaining the financial responsibility of the enrollee concerning any applicable deductibles, copayments, and coinsurance for the receipt of out-of-network healthcare services, and include a comparison with the enrollee’s financial responsibility for receipt of services in-network; and
  • A list of in-network healthcare providers, if any, that are available to the enrollee within a reasonable geographic area that provide the same healthcare service or range of services as the out-of-network provider to which the provider is referring the enrollee.

Scope of Practice

Vermont’s Gov. Phil Scott signed SB 128 into law. The law will remove the mandatory physician supervision of physician assistants (PAs). It will also change the current delegation agreement where the supervising physician delegates the PA’s duties and scope of practice to a collaboration agreement where a PA would consult with a physician or other healthcare professional based on the patient’s condition and the PA’s education, competencies and experience.