Legislative Watch: 2018 Retrospective and a Look Ahead

by Matthew Albright, Chief Legislative Affairs Officer, Zelis Healthcare

As one is wont to do this time of year, let’s look back at the last few months and look forward to what may be…in legislative trends.

State and Federal take on surprise balance billing and air ambulances

While four states passed surprise balance billing laws this year, a U.S. Senate bill, sponsored by Senator Cassidy, prohibits surprise balance billing and sets the reimbursement level at the greatest of the median in-network rate, or 125% of the usual and customary rate (UCR) likely to be set by FAIR Health.  There are elements in the state laws self-insured plans can use to protect their members; however, in general, the state laws do not apply to the self-insured market.  In contrast, the Cassidy bill would apply to all payers, both fully and self-insured, if it became law.

Another significant federal action on surprise balance billing involves a sentence in the 540-page Federal Aviation Agency (FAA) Reauthorization Act, signed into law in October, which may have put egregious billing by air ambulances in the hands of the states.  The Act requires non-transportation costs of air ambulances to be split from transportation costs and states that the non-transportation costs are not under FAA authority.  The implication is that air ambulance healthcare costs should be governed by state laws.  The Act further requires the Departments of Transportation (DOT) to set up an advisory committee on air ambulance patient billing with the goal of suggesting federal regulations.

Zelis continues to enhance our Legislative Toolkit, a state-by-state analysis of surprise balance billing laws, used by Zelis during member advocacy and claims settlement conversations with providers.

States support electronic healthcare payments

In 2018, Georgia passed a law that requires payers to offer more payment methods than solely virtual cards and to give notice to providers about costs associated with the different payment methods.  Zelis worked with other stakeholders to educate legislators on some of the technical aspects of the bill.  The final language that was passed was less burdensome to implement for both providers and plans than the original.  Oregon and Maryland have similar laws on provider notices, and we expect a few states will introduce similar bills every year.

Zelis Payments supports giving providers all the information they need to make decisions on payment choices.

States give provider networks a break, but leased networks under fire

States seem to have eased up on passing comprehensive (and burdensome) network directory, adequacy and access laws this year.  We predict this trend to continue in 2019.

In the meantime, leased networks came under fire by dentists in a pair of New Jersey bills (NJ S2507 and NJ A 605) that, in their original form, would have prohibited the leasing of dental networks.  Zelis coordinated with the National Association of Dental Plans (NADP) and other groups to educate legislators about the negative consequences such a law would have on plans, dentists and, especially, patients.  At this writing, the New Jersey Senate has introduced an amended bill which would have much less of a negative impact.  Already a similar bill has been filed in Virginia, and we can expect dental associations across the country to attempt similar legislation.

Here’s a toast to the NADP for raising the alarm and rounding up the troops in New Jersey and Virginia!