October 29, 2020

Out of Network Regulatory Updates on Georgia and Texas

Georgia’s House Bill 789 healthcare transparency legislation aimed at filling a gap in Georgia’s new surprise billing law will take effect Sunday, Nov. 1. The insurance companies will be required to maintain and publish accurate provider directories and to publish its ‘surprise bill’ ranking based on the number of physician specialty groups contracted in-network with a hospital. The supporters of the bill argued that the disclosure of ratings may serve as an incentive for insurance companies to work with hospitals and specialty providers to offer enrollees better coverage options.

Georgia issued its proposed regulations for HB 888, the Surprise Billing Protection Act, and noted that the deadline for submission of comments and testimony is Nov.19, 2020. Failure of an insurer to comply with the regulations will be deemed an unfair trade practice. House Bill 888 was signed into law earlier this year and provides a mechanism to resolve billing and payment disputes between insurers and out-of-network providers. The measure also established an arbitration process to handle such disputes. Once finalized, the regulations will apply only to “healthcare plans” and “state healthcare plans,” as defined in statute. The ERISA Exempt Plans are subject to the exclusive jurisdiction of federal law and are not subject to the rule-making.

Texas Department of Insurance (TDI) has issued the Senate Bill 1264: Six-month preliminary report (July 2020). Since the law went into effect on Jan. 1, early data sets show positive trends. Most notably, the report indicates that the provider complaints have decreased more than 70% this year. Before SB 1264, consumers could request mediation for certain surprise bills, but the only recourse available through TDI for providers seeking to resolve billing disputes was to file a complaint. TDI received 1,770 complaints from healthcare providers and billing services in the first six months of 2020, down from 6,461 for the same period in 2019. New law requires TDI to issue a report on the impacts of the legislation each biennium and the first such report is due Dec. 1, 2020.