June 30, 2020

States Advance Out-Of-Network Billing and Scope of Practice Bills

Massachusetts’ Senate and Michigan’s House chambers pass measures modifying rules on out-of-network billing while Georgia sends a bill to the governor expanding scope of practice for advanced practice registered nurses.

Out-Of-Network Billing

In Massachusetts, SB 2769 passed the Senate chamber. 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 Michigan, the House chamber passed HB 4459 and referred the bill to the Senate Committee on Health Policy and Human Services. The bill would require out-of-network emergency medical personnel who provide a covered emergency or elective service to be reimbursed at 150 percent of the amount covered by Medicare for the service, excluding any in-network coinsurance, copayments or deductibles. An out-of-network provider of an emergency service or of an elective service would not collect from the enrollee, directly or indirectly, any excess amount other than applicable coinsurance, copayments or deductibles. In the event of a dispute, providers and carriers may proceed to arbitration wherein each party would pay half of the total costs of the arbitration proceeding conducted by the state’s Department of Insurance and Financial Services.

Scope of Practice

In Georgia, SB 321 passed the House and Senate and is headed to the governor for his signature. The bill would permit a physician to delegate an advanced practice registered nurse to order radiographic imaging tests in non–life-threatening situations.