New Hampshire State Senator Proposes Bill Targeting Surprise Emergency Room Bills

November 2018 ~

A New Hampshire senator has announced plans to file legislation that is designed to address surprise medical bills that some patients say keep coming after a visit to the emergency room for an illness or injury.

The No More Surprise Medical Bills Act of 2018 was introduced last month by Senator Maggie Hassan and cosponsored by Senator Jeanne Shaheen.

The legislation has been designed to protect group health plan enrollees from surprise out-of-network bills by restricting the provider from charging the patient any more than what they would owe an in-network provider and would require the insurer to count cost-sharing amounts for surprise out-of-network bills (which as just mentioned could not exceed in-network amounts) toward in-network deductibles and limits on out-of-pocket costs.

The bill would also provide patient protection in both emergency and nonemergency situations by establishing a “binding arbitration” process to determine the appropriate provider payment rate in surprise out-of-network scenarios. The arbiter would be instructed to consider Medicare and negotiated network rates, rather than artificially high provider charges, in making their rate determination.

Additionally, a companion bill, introduced by co-sponsor Senator Shaheen, would affect the individual market more broadly, capping the amount that out-of-network providers can charge in any situation to enrollees in individual market plans (and uninsured patients). The bill would allow states to choose between three options to set an out-of-network charge limit:

  1. 125% of Medicare fee-for-service (FFS) rates (with an allowance in rural areas to set payments up to 200% of Medicare rates),
  2. 80% of the “usual and customary rate” (UCR) based on provider’s billed charges, or
  3. The insurer’s in-network contracted rate for the service in question.

Though the proposed provisions would not directly prohibit surprise bills in the individual market, they have been designed to “considerably reduce” the liability that patients potentially face in such situations by capping the amount that the out-of-network provider could charge. By reducing the potential financial benefit to providers of remaining out-of-network, these provisions would likely also reduce the frequency of surprise bills by encouraging more providers to join insurers’ networks.

 

 

Source(s): Congress.gov; WMUR; Vox; Health Affairs;

 

 

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