April 29, 2020

Governors Sign Temporary Scope and Surprise Billing Measures

Governors in three states have issued executive orders temporarily amending the scope of practice for physician assistants and advanced practice nurses (APRNs). New Mexico’s Office of Superintendent of Insurance issued new rules modifying out-of-network billing for testing and treating COVID-19 symptoms.

Scope of Practice

In Connecticut, Gov. Ned Lamont issued Executive Order No. 7DD, which temporarily suspends physician supervision for physician assistants and APRNs. The order went into effect April 22, 2020, and will remain in effect for the duration of the public health and civil preparedness emergency, unless earlier modified, extended or terminated.

Kansas’s Gov. Laura Kelly issued Executive Order No. 20-26, which temporarily suspends physician supervision for physician assistants and APRNs. The order was effective April 22, 2020, and will remain in force until May 31, 2020, or until the statewide State of Disaster Emergency relating to COVID-19 expires, whichever is earlier.

In Michigan, Gov. Gretchen Whitmer issued Executive Order No. 2020-61, which temporarily suspends physician supervision for physician assistants and APRNs. The order was effective April 26, 2020, and will continue until the end of the declared state of emergency and disaster.

Out-of-Network Billing

In New Mexico, the Office of Superintendent of Insurance issued Bulletin 2020-009. The mandate eliminates enrollee out-of-pocket cost-sharing for testing and treatment of COVID-19 symptoms. For emergency out-of-network services, carriers shall pay the in-network rate for the services provided.

For other services performed by out-of-network providers, carriers shall reimburse providers, including facilities, using the surprise billing rate described in Section 59A-57A-13, NMSA 1978. Where there is no data available in the Fair Health benchmarking database for a particular billing code, a carrier shall reimburse a provider at 150% of the 2017 Medicare reimbursement rate. No provider shall balance or surprise bill a patient. A health care provider that knowingly surprise bills a patient for out-of-network care may be subject to a fine pursuant to Section 59A-16-21.3, NMSA 1978. The bulletin is effective immediately. The duration is not specified.