Lawmakers begin to address surprise bills in session’s first week
Sen. Chuck Hufstetler (R-Rome) introduced a bill that would address out-of-network billing. Under S.B. 293, the “initial” payment for out-of-network emergency care would be 1) the average contracted amount or – if that doesn’t exist – 2) the average contracted amount of all of the eligible insurers that are in an “all-payers health claims database” that would be created or an amount that the insurer deems appropriate given the complexity and circumstances of the services that were provided, whichever is greater. This payment would be made without the need for prior authorization and without the physician risking having the payment denied on a retrospective basis. And the patient would not be required to pay more than their normal in-network cost-sharing amount, and that payment would be applied to their deductible and out-of-pocket limits.
For any non-emergency care that a patient receives out-of-network, S.B. 293 would require insurers to pay physicians 1) the average contracted amount or 2) the average contracted amount for all eligible insurers [based on the aforementioned all-payers database] or 3) an amount that the insurer deems appropriate given the complexity and circumstances of the services that were provided – whichever is greater – without the need for prior approval and without having the physician risk having the payment denied on a retrospective basis. And under S.B. 293, the patient would not be required to pay more than their normal in-network cost-sharing amount, and that would be applied to their deductible and out-of-pocket limits – although this would not be applicable when a patient chooses to receive out-of-network care and documents in writing that they acknowledge that the provider is out-of-network and that they will be responsible for the out-of-network provider’s billed charges.
S.B. 293 would enable physicians who believe that their payment is insufficient given the complexity and circumstances of the services they provide to submit an arbitration request to the Georgia Insurance Commissioner. The physician and applicable insurer would then each submit a final offer payment amount, and the arbitrator would choose between the two amounts – with the party that fails being responsible for the costs associated with the arbitration process.
MAG supports some of S.B. 293’s provisions, as currently written, including the arbitration and retrospective denial protections. But MAG also opposes certain provisions in the bill, including the average contract amount and some inconsistent and unclear language surrounding elective procedures. MAG will continue to work with lawmakers and a coalition of state medical specialty groups to enhance this legislation, which has been assigned to the Senate Insurance and Labor Committee. It is also worth noting that a comparable bill is expected to be introduced in the House.
Other key bills that were introduced this week include…
S.B. 279 by Sen. Jen Jordan (D-Atlanta), which would require “informed consent” to perform a pelvic exam on an unconscious or sedated female patient – emergencies notwithstanding. These exams would also be required to be within the scope of care that is ordered for the patient and be medically necessary for diagnosis or treatment purposes or when a court has ordered a pelvic exam to collect evidence. MAG is evaluating this legislation, which has been assigned to the Senate Health and Human Services Committee.
H.B. 744 by Rep. Mike Wilensky (D-Dunwoody), which would prohibit prescribers from 1) prescribing any combination of opioid medication that is an aggregate amount in excess of 100 morphine milligram equivalents of opioid medication per day and 2) writing a prescription for more than a 30-day supply of an opioid medication within 30 days for patients who are being treated for chronic pain and 3) writing an opioid prescription for a patient who is being treated for acute pain that is more than a seven-day supply within a seven-day period unless the medication has an FDA label that says it should only be dispensed in a stock bottle that exceeds a seven-day supply as prescribed, in which case the amount dispensed may not exceed a 14 day supply. These limits would not apply to opioid prescriptions that are for: pain associated with active and aftercare cancer treatment; pain associated with a fracture or compound fracture; post-operative pain management resulting from a surgical procedure; palliative care for an advanced and progressive disease; hospice care if terminally ill; or medication assisted treatment for a substance abuse disorder. The limits would also not apply to 1) directly ordering or administering a benzodiazepine or opioid medication to a patient in an emergency room setting, an inpatient hospital setting, or a long-term care facility or 2) a surgical procedure. Under H.B. 744, prescribers would be subject to a fine of $250 per violation – up to $5,000 per calendar year. MAG opposes this legislation, which has not yet been assigned to a committee.
H.B. 731 by Rep. Ron Stephens (R-Savannah), which would raise the state’s tobacco tax from 23 percent to 42 percent for wholesale cigars, from $.37 to $1.87 per pack of 20 cigarettes, and from 10 percent to 42 percent of the wholesale price for loose or smokeless tobacco. MAG supports this legislation, which has been assigned to the House Ways and Means Committee.
H.B. 739 by Rep. Rick Jasperse (R-Jasper), which would prevent a hospital or ambulatory surgery center from hiring or retaining surgical technicians who don’t have a “certified surgical technologist” credential – as defined by the legislation. This bill also includes continuing education requirements for the affected technicians. MAG is evaluating this legislation, which has been assigned to the House Health and Human Services Committee.
