March 21, 2018

State Balance Billing Legislation Update

Legislation with various provisions related to out-of-network billing, transparency and disclosure continues to be debated in state capitols. Several bills have moved from one chamber to another, including the bills in Georgia and New Hampshire.

New Hampshire’s HB 1809 passed the House on March 6. For managed care plans, “a health care provider performing anesthesiology, radiology, emergency medicine or pathology services shall not balance bill the patient for fees or amounts other than copayments, deductibles or coinsurance, if the service is performed in a hospital or ambulatory surgical center that is in-network under the patient’s health insurance plan.” The bill is now in Committee on the Senate side.

In New Jersey, Democratic Gov. Phil Murphy is backing the legislative efforts to limit balance billing. Legislators are considering NJ AB 2039, a bill to limit provider’s ability to send out-of-network bills. The stakeholders are actively meeting to discuss the details of the proposal.

Oregon’s HB 2339 passed last year and took effect on March 1, 2018. Under the new law, health care providers are prohibited from charging patients out-of-network rates for care provided at in-network facilities; however, specifics for out-of-network provider reimbursement are still under consideration.

In Virginia, HB 1584 prohibits an out-of-network health care provider from charging a covered person who is insured through a health benefit plan an amount for ancillary services that is greater than the allowed amount the carrier is obligated to pay to the covered person. The measure defines "ancillary services" as screening, diagnostic or laboratory services provided in connection with or arising out of other health care services that the covered person receives from or at an in-network provider. The measure also requires an in-network provider to provide certain notices regarding the provision of ancillary services by an out-of-network provider. The measure has a delayed effective date of January 1, 2019.

To see a full list of bills tracked by the ACR, see the Statescape – State Legislative Summary.