Less expensive coverage comes with more risks “The administration’s rule change is dangerous for Georgia consumers,’’ said Laura Colbert of Georgians for a Healthy Future
Legislative session is more than half-way complete
The state legislative session is more than half-way over already and the General Assembly has been working diligently to complete its constitutional responsibility to pass a state budget. Thus far the House and Senate have passed their versions of the amended FY2018 budget and are working to come to consensus on a final version. The House is still considering the FY2019 budget. Other bills prioritized by legislative leaders have made their way through the legislative process and await the Governor’s signature.
Action under the Gold Dome
GHF supports legislation that provides important consumer protections within private insurance
The first half of the legislative session has been punctuated by the introduction of many bills that would impact health care and coverage for Georgia consumers. Several of these bills stand out as they align with GHF’s policy priority of facilitating greater access to care and ensuring financial protections for consumers purchasing private insurance. For these reasons, GHF is actively supporting the following bills:
- SB 359–legislation to address surprise out-of-medical billing through improved disclosure, clarification of responsibilities in out-of-network emergency situations, and the opportunity for mediation when a consumer receives a surprise bill. (For more, see our February 5th legislative update.)
- HB 872–would allow consumers to receive services from their preferred provider at an in-network rate for the entire coverage year, if the insurer advertises the provider as being in-network at the time a consumer enrolls in a health insurance plan
- HB 873–would simplify the prior authorization process for providers and patients seeking access to restricted or expensive health services or medications and would clarify and improve the information that insurers must provide to consumers about their prescription drug coverage (Re-visit last week’s legislative update for more information about HB 872 and 873.)
Rural health care bill moves forward
One of the legislature’s biggest efforts in 2017 was the work of the House Rural Development Council which, among other things, studied barriers to health care and possible solutions in Georgia’s rural communities. The result of their studies is HB 769 which creates a Rural Center for Health Care Innovation and Sustainability within the existing State Office of Rural Health. The Center would be responsible for collecting data from the health-focused state agencies and analyzing it for planning purposes, similar to the Health System Innovation Center proposed within SB 357. The bill would also make some changes to the state’s certificate of need program to make allowances for “micro-hospitals”, provides for an insurance premium assistance program for rural physicians, and increases the rural hospital tax credit to 100% of the donation.
The House Health and Human Services Committee approved HB 769 last week and it must be advanced by the House Rules Committee for consideration by the full chamber.
Surprise billing legislation gets more attention
All three bills introduced to address surprise out of network medical billing will receive the attention of the General Assembly this session. HB 678 was passed by the House last Monday and has been referred to the Senate Health & Human Services (HHS) Committee for its consideration. That committee plans to take up another piece of surprise billing legislation–SB 359, which provides the most comprehensive protections to consumers of the three bills–in its hearing today. HB 799, a bill that primarily addresses out of network care in emergency situations, is similarly scheduled for a hearing today by the House Insurance Committee.
Stay up-to-date with the legislative session
As the activity in the General Assembly picks up speed in the second half of this year’s session, it can be hard to keep up. We have the tools you need to stay in touch with health policy under the Gold Dome.
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.