June 25, 2020

Georgia and Massachusetts Aim to Revise Out-Of-Network Billing Rules

Georgia’s Senate chamber passes a measure modifying rules on out-of-network billing, while a Senate committee in Massachusetts introduces a bill that would require its Health Policy Commission to recommend a rate for emergency and elective health services.

In Georgia, HB 888 passed the Senate floor and headed to the governor for his signature. The bill would require providers to collect no more than their enrollee’s deductible or other cost-sharing amount, as determined by the enrollee’s health insurance policy for emergency medical services performed by an out-of-network provider. The carrier would pay the provider the greater of:

  • The verifiable contracted amount paid by all carriers for similar services;
  • The most recent verifiable amount agreed to by the carrier and out-of-network provider for the services; or
  • A higher amount as the carrier deems appropriate.

The provider or facility may request arbitration with the insurance commissioner when the out-of-network provider concludes that payment from the carrier is not sufficient.
Unless vetoed by the governor, the measure will become law 40 days following adjournment (June 26, 2020). It is expected to become effective Jan. 1, 2021.

In Massachusetts, SB 2769 was introduced in the Senate Ways and Means Committee. 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 five years.

The commission would conduct a review of established rates in the fourth year of the rates’ operation via a public hearing and recommend rates to be effective for the next five-year term. The bill would also address telehealth and other related issues in response to the COVID-19 pandemic.