June 27, 2019

States Push Practice Scope and Out-of-Network Billing Legislation

This week’s update features bills that address out-of-network “surprise” billing and scope of practice expansion for physical therapists.

Out-Of-Network Billing

In Ohio, HB 166 is in conference committee. The budget bill includes an out-of-network billing amendment. It would prohibit out-of-network providers from billing an enrollee for the difference between the insurer’s reimbursement and provider’s charge for services. In the event of a dispute between the provider and insurer, arbitration would occur if the billed amount exceeds $700 and 120 percent of the usual and customary charge, which would be the 80th percentile of charges.

Scope of Practice

In Rhode Island, SB 774 is scheduled for consideration in late June after being held in the Senate Health and Human Services Committee since May. The bill would expand the scope of practice for physical therapists to include ordering diagnostic imaging and studies.