October 27, 2020

Michigan OON Billing Legislation Becomes Law; Pennsylvania CRNP Bill Passes House

Michigan’s governor signs two out-of-network billing bills into law that would modify reimbursement for out-of-network providers. Pennsylvania advances a bill expanding the scope of practice for nurse practitioners.

Out-of-Network Billing

Michigan’s Gov. Whitmer signed HB 4459 and companion bill HB 4460 into law. The bills require out-of-network emergency medical personnel who provide a covered emergency or elective service to be reimbursed at 150% 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 are prohibited from collecting, directly or indirectly, any excess amount other than applicable coinsurance, copayments or deductibles from enrollees. In the event of a dispute, providers and carriers may proceed to arbitration wherein each party will pay half of the total costs of the arbitration proceedings. The bills went into immediate effect following the governor’s signature.

Scope of Practice

In Pennsylvania, HB 100 passed the House chamber and was referred to the Senate’s Consumer Protection and Professional Licensure Committee. The bill would establish the Certified Registered Nurse Practitioner Pilot Program, which would permit certified registered nurse practitioners (NPs) to receive additional certification to practice as an independent practitioner in a health professional shortage area. The bill would define a shortage area as a geographic or population area in the state designated by the U.S. Department of Health and Human Services that indicates a healthcare professional shortage in primary care. While practicing in a health professional shortage area, the NP would be permitted to practice and prescribe medical therapeutic measures without a supervising physician and recognized as a primary care provider.