Editorial: Laura Colbert of Georgians for a Healthy Future cites Georgia’s high uninsured rate, the opioid epidemic, and the financial struggles of rural hospitals in calling for the state to…
Blog (February 2018)
Pair of consumer protection bills introduced in House
Two bills that propose stronger protections for consumers in health insurance were introduced last week by a group of House lawmakers led by Representative David Knight. We are encouraged by the introduction of both bills which aim to provide consumers with increased transparency and enhanced financial protections, along with heightened accountability on the part of health insurers and pharmacy benefit managers. We will monitor and weigh in on the bills as they progress through the legislative process.
HB 872: Provider network transparency
HB 872 requires insurance companies to be more transparent about the structure of and changes within their provider networks, beginning with a provision that requires insurers to make publicly available a plain language description of their provider network standards on their website among other provisions. Importantly, the bill also stipulates that if an insurer advertises a physician as being in a plan’s provider network as a consumer enrolls in an insurance plan, the insurer is required to cover the health care services received from that provider at an in-network rate during the entire contract year. That means that a consumer may select a plan during open enrollment that includes their preferred provider and would be able to receive services at an in-network rate for the entire plan year regardless of changes to the provider’s participation status.
HB 873: Prescription drug formulary & prior authorization transparency
HB 873, titled the Prescription Drug Benefits Freedom of Information and Consumer Protection Act, proposes to improve the consistency and clarity of prescription drug formularies and prior authorization processes. The bill requires that insurers provide an easy-to-find, accurate, and updated formulary list on their website and requires the Insurance Commissioner to create rules about the format and information within the formulary so that consumers can more easily understand what prescriptions are covered under their insurance plan, the cost-sharing associated with the drug, and any prior authorization required to gain access to the prescription. The legislation also requires that a single, standard prior authorization form be developed that would apply to all insurers and pharmacy benefit managers regulated in Georgia to allow consumers and providers to more easily request access to higher cost and more restricted health services and prescriptions. The standard form would be developed by an advisory committee made up of an equal number of consumers, physicians, pharmacists, insurers, insurance agents, and pharmacy benefit managers.
Both chambers busy with health care legislation
House Insurance Committee approves HB 678
The House Insurance Committee, chaired by Representative Richard Smith, considered and approved HB 678 last week. The bill improves transparency for consumers by outlining the information that must be provided to consumers by health care providers and insurers about the consumer’s provider network. HB 678 is expected to receive a vote by the full House today. (For a more detailed summary of HB 678, check out last week’s legislative update.)
Senate approves SB 352 and SB 357
Two pieces of legislation resulting from the Health Care Reform Task Force were approved by the Senate this week. Both SB 352, which establishes the Commission on Substance Abuse and Recovery and creates a director position to lead the commission, and SB 357, which establishes the Health Coordination and Innovation Council among other actions, received strong support from legislators. The bills will now move to the House for its consideration. (For more information on both bills, read the January 29th legislative update.)
Surprise medical billing emerges as prominent issue at the Capitol
Surprise out-of-network medical billing is emerging as a prominent issue within the Georgia General Assembly. A surprise medical bill can occur when a consumer encounters an out-of-network (OON) provider at an in-network facility or in other circumstances. Three pieces of legislation have been introduced to address surprise billing and each attempts to resolve the issue in its own way. In this week’s legislative update, we will provide a broad look at each bill and its provisions. (If you would like more information about any of the bills, click on the provided links to read the full legislation.) All three bills seek to protect patients, and we will monitor and weigh in on the bills as they undergo the inevitable amendment process in committee. We appreciate all of the bill sponsors for remaining vigilant towards protecting patients from unexpected medical bills.
HB 678: Increased network and billing transparency by health care providers and insurers
HB 678 is sponsored by Rep. Richard Smith, chairman of the House Insurance Committee, and has the backing of several powerful House lawmakers. The bill improves transparency for consumers by outlining the information that must be provided to consumers by health care providers and practices and by insurers. Providers must inform consumers about their participation in the patient’s insurance network and about how to check the network status of other providers with which the primary provider has coordinated services (e.g. laboratory or radiology services). It also requires insurers to provide consumers with information about when and how to receive approval for services from an out of network provider. Insurers must also communicate to a consumer ahead of a planned procedure if the provider is out of network (OON), and if so, the estimated amount the insurer will cover for the OON services. Lastly, HB 678 provides consumers with 90 days from the time of receiving a medical bill to pay the bill, negotiate payment or initiate arbitration through the Georgia Department of Insurance. After that time period, providers would be allowed to initiate collection proceedings to secure their payment.
HB 799: Out of network care in emergency situations
While HB 678 applies only to non-emergency situations, HB 799 applies solely to emergency care and medically necessary follow-up care. The legislation, sponsored by Rep. Sharon Cooper, Chairperson of the House Health & Human Services Committee, disallows managed care plans from denying payment for emergency services and disallows hospitals from billing patients for medically necessary care following an emergency situation except for their standard co-pays, co-insurance, and deductibles. For a patient receiving emergency care at an OON hospital and who is covered by a plan that requires prior authorization for post-stabilization care, the legislation outlines how the OON hospital and insurer must coordinate the patient’s transfer to an in-network facility and defines which entities are responsible for specific costs. Under this bill, if a patient (or their representative) does not consent to be transferred to an in-network hospital, the OON hospital must provide verbal notice to the patient that they may be financially responsible for any further post-stabilization care provided.
SB 359: Consumer Coverage & Out of Network Medical Care Act
SB 359 is the only Senate-side legislation introduced thus far to address surprise out-of-network billing and is sponsored by Senator Chuck Hufstetler, Chairman of the Senate Finance and member of HHS committees. The legislation contains many of the same transparency provisions for non-emergency care as HB 678 with regard to information that health care providers and hospitals must supply to consumers, but provides for more robust disclosure by insurers to consumers about possible OON costs. It also contains provisions similar to that of HB 799 with respect to emergency situations, but goes farther to stipulate that insurers must treat OON emergency care as if it were in-network by applying a consumer’s cost-sharing towards their in-network deductible and out-of-pocket maximum. The legislation also makes mediation available to consumers who receive elective medical care during which an unexpected event arises resulting in surprise bill greater than $1000. SB 359 is expected to be more controversial than the other two bills because it sets a payment resolution process that sank previous legislative attempts.
RSVP today for Cover Georgia Day at the Capitol!
Join us next Thursday, February 15th for Cover Georgia Day at the Capitol when we will ask our state legislators to close Georgia’s coverage gap by putting insurance cards in the pockets of low-income Georgians. This is the most important step that our elected officials can take to slow the growing opioid crisis, strengthen our state’s struggling rural health care system, and improve the health & finances of hard-working, low-income Georgia families. Take advantage of this opportunity to talk with your elected officials about closing Georgia’s coverage gap! RSVP today!
Can’t make it? Send an email to your state legislators asking them to put an insurance card in the pockets of all low-income Georgians.
Legislation prioritized by Senate leaders approved by HHS Committee
At Thursday’s Senate Health & Human Services Committee, the two pieces of legislation resulting from the Health Care Reform Task Force were considered. Both SB 357 and SB 352 received strong support from legislators and stakeholders. GHF’s partners at the Georgia Council on Substance Abuse and Mental Health America of Georgia rose in support of SB 352, which would create a 15-member Commission on Substance Abuse & Recovery supported by a director. Both bills were passed by unanimous voice votes. You can find a description of both bills in last week’s legislative update blog.
Nilofer Chollampat is GHF’s Legislative Advocacy Intern for the spring 2018 semester. In this role, Nilofer will help to monitor the activity of legislative committees, the status of relevant bills, and other legislative activity. Nilofer will also support the Cover Georgia coalition in their advocacy to expand Medicaid in Georgia as well as other legislative and advocacy-related projects.
Nilofer isin her second year at Emory University’s Rollins School of Public Health and holds a bachelor’s degree in Psychobiology and Statistics from UC Davis. She’ll be graduating in May with a degree in Health Policy and Management. Nilofer came to GHF after working on academic research, the Georgia Department of Public Health, and a practicum with a non-profit research organization. Other than her love of health policy work, Nilofer likes to watch all the TV shows.
GHF welcomes Alyssa Green as the organization’s new Outreach & Education Manager. In this role, Alyssa will work with consumers and communities to hear about their experiences with health care and coverage, educate them about how health policy impacts their lives, and provide tools and resources to help them engage in the health policy-making process. Alyssa will also provide strategic direction for GHF’s outreach campaigns in support of policy change and assist in GHF’s coalition building efforts.
Alyssa is a recent graduate of UGA’s Master’s in Public Administration program. She has extensive experience in advocacy, program management, and person-centered approaches to community building. Before joining the GHF team, Alyssa led capacity building efforts for an Atlanta-based research study on trans risk and resilience. In addition to this, she coordinated food and fund campaigns at the Georgia Food Bank Association.
We are pleased that Alyssa has joined our team! You can contact Alyssa at email@example.com or 404-567-5016 ext 2.