News & Media

Surprise Out-of-Network Billing Legislation

Thursday, November 7, 2019

Debate around surprise out-of-network (OON) billing legislation continued last week in both the House and the Senate. The Senate Insurance and Banking Committee held a hearing on Senate Bills 570, 571, 572, and 573, which essentially mirror House Bills 4459 and 4460 that MSMS currently opposes. As substituted, the legislation covers emergency and non-emergency settings when a patient does not have the opportunity to choose or the only provider available is OON. In those cases, the reimbursement rate for physicians would default to 150 percent of Medicare or the average contracted rate, whichever is greater. The package also includes provisions around notification and a written estimate of charges, as well as penalties for not complying with the notification requirements. 


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MSMS President-elect S. Bobby Mukkamala, MD, testified before the Senate Insurance Committee on October 30 to express concerns with the legislation, as introduced and offer solutions to improve the bills while still keeping the patient out of the middle. 

 

On October 31, the House Health Policy Committee heard its second week of testimony from Blue Cross Blue Shield of Michigan (BCBSM) and the Michigan College of Emergency Physicians (MCEP). Christin Nohner gave brief remarks to provide some points of clarification following BCBSM's testimony. 

 

This week, the Senate Insurance and Banking Committee held its second hearing on Senate Bills 570571572, and 573, with anesthesiology groups from Grand Rapids and Kalamazoo, along with the pathologists, testified in opposition. Blue Cross Blue Shield of Michigan testified in support.

On November 7, the House Health Policy Committee took a vote on the package of bills. Prior to the vote, an amendment that would allow providers to dispute -- through the Department of Insurance and Financial Services -- the calculation of the "average contracted rate" was included in the bill. While an improvement, MSMS was clear in the message that there is much more work to be done. An effort was made to add a third benchmark to the "greater of" methodology that would be "the average of the 80th percentile of charges and the 50th percentile of allowed amounts." While the amendment was ultimately not offered it may very likely be part of discussions going forward. The bill ultimately passed; however, there were five passes on HB 4459 (three Republicans and two Democrats) and three passes (three Republicans) on HB 4460, a somewhat unprecedented development that sends a clear signal to the Ways and Means committee -- the next stop for this bill -- that there are lingering concerns and this bill is in no way finalized.

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The Ways and Means committee will not take the issue up until December, at the earliest. In addition, it is our understanding that the Senate Insurance Committee will not hold a vote until December, at the earliest.

MSMS continues to deploy grassroots action alerts, and engage in discussions with legislative staff and lawmakers, including leadership in an effort to -- at the very least -- slow the process down and make our concerns heard. Separately, MSMS will continue to advocate for a repeal or adjustment to the payment benchmark along with a separate bill that amends the Insurance Code to addresses dispute resolution and network adequacy. 

The vote total is below. If one of your representatives voted to pass, please call and thank them for their support. We also ask all Board members to contact their representatives and senators, particularly if one of your Representatives or Senators sits on House Ways and Means or the Senate Insurance Committee

Representative Frederick moved to refer House Bill No. 4459 to the committee on Ways and Means, with recommendation as substitute (H-5). The motion prevailed 14-0-5:

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FAVORABLE ROLL CALL

Yeas: Reps. Vaupel, Frederick, Alexander, Hornberger, Lower, Whiteford, Filler, Wozniak, Liberati, Garrett, Clemente, Ellison, Koleszar, Witwer.

Nays: None.

Pass: Reps. Calley, Afendoulis, Mueller, Pohutsky, Stone.

Representative Liberati moved to refer House Bill No. 4460 to the committee on Ways and Means, with recommendation as substitute (H-5). The motion prevailed 16-0-3:

FAVORABLE ROLL CALL

Yeas: Reps. Vaupel, Frederick, Alexander, Hornberger, Lower, Whiteford, Filler, Wozniak, Liberati, Garrett, Clemente, Ellison, Koleszar, Pohutsky, Stone, Witwer.

Nays: None.

Pass: Reps. Calley, Mueller, Afendoulis.