July 15, 2020

States Advance Out-Of-Network Billing, Enact Certificate of Need Legislation

State legislatures in Michigan and New Jersey advance bills that would modify reimbursement and disclosure requirements on out-of-network billing. North Carolina’s governor signs into law legislation eliminating certificate of need provisions.


In Massachusetts, SB 2796 passed the Senate chamber and was referred to the Joint Committee on Health Care Financing. The bill would prohibit balance billing and require the Health Policy Commission to recommend the non-contracted commercial rate for emergency and elective health services. The rate would be in effect for a term of five years, followed by an evaluation for the following five-year term. The bill would also address telehealth and other related issues in response to the COVID-19 pandemic.

In New Jersey, AB 3817 passed 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.

Certificate of Need

North Carolina’s Gov. Roy Cooper signed SB 361 into law. The law eliminates all certificate of need provisions including for home dialysis and freestanding dialysis stations for hospitals. The American College of Radiology® North Carolina chapter actively supported removing the provisions of this bill that were dropped. The law effectively raises the limits on capital expenditures to develop health services and diagnostic centers to $2 million and $1.5 million respectively.

CORRECTION 7/21: The original draft proposal sought to repeal existing Certificate-of-Need (CON) program in the state, but due to successful lobbying efforts of the ACR North Carolina all of the proposed CON program changes were dropped from the legislation prior to its passage.