With extra outpatient care being delivered in hospital outpatient departments (HOPDs) than in earlier years on account of vertical consolidation, shoppers more and more face excessive hospital facility charge expenses on prime of their supplier’s invoice for routine medical care. These facility charges are a profitable income stream for hospitals, however they place a big monetary burden on shoppers.
Rising consciousness in regards to the progress within the quantity and prevalence of those expenses has pushed many states to deal with this challenge of their state legislatures. A number of states pursued reforms that might restrict hospitals’ potential to cost outpatient facility charges and higher defend shoppers from such expenses. States additionally sought to construct their inside capability to deal with these subjects by requiring higher transparency and commissioning research. Hospitals’ opposition to facility charge reforms has been fierce, nonetheless, and solely a handful of states have introduced their payments over the end line through the 2024 legislative session.
State Laws to Regulate Outpatient Facility Charges
States Throughout the End Line
Maine, Maryland, and Connecticut efficiently handed laws relating to facility charges this session. Notably, every of those states has enacted some facility charge reforms previously, as documented in CHIR’s 2023 report and challenge temporary on state regulation of outpatient facility charges. Passage of the most recent laws in these states emphasizes the incremental nature of reform on this space.
As CHIR reported final yr, Maryland at the moment requires hospitals to offer written and oral notices to shoppers when charging a facility charge for outpatient clinic companies, provides, or tools, excluding emergency division companies. This yr, Maryland legislators thought of payments that might broaden these notification necessities to extra companies and suppliers. Legislators, dealing with pushback, in the end handed a invoice that doesn’t change current necessities for hospitals, however duties the Maryland Well being Companies Value Assessment Fee to check outpatient facility charge billing and associated reforms with the purpose of convening a multi-stakeholder workgroup on increasing discover necessities. These efforts are anticipated to generate suggestions to the legislature for future motion later this yr and in 2025.
Each Connecticut and Maine have prohibitions on outpatient facility charge billing already on their books. Connecticut prohibits off-campus HOPDs (excluding freestanding emergency departments) from charging such charges for analysis and administration (E&M) and evaluation and administration (A&M) companies, and can lengthen this prohibition to on-campus amenities in July (topic to some exclusions). Connecticut additionally has a soon-to-expire prohibition on facility charges for telehealth companies that dates to the COVID-19 pandemic. This session, the Connecticut legislature prolonged its prohibition on facility charges for telehealth companies that dates to the COVID-19 pandemic and had been set to run out on the finish of June 2024.
Maine has restricted facility charge billing for care supplied in workplace settings for almost 20 years. Following information stories on sufferers dealing with sudden facility charge expenses, state legislators revisited the subject final yr, in the end making a job pressure to guage facility charge billing and make legislative suggestions. This regulation additionally required Maine’s all payer claims database to provide annual stories on facility charge expenses. Based mostly on the duty pressure’s report, Maine lawmakers handed laws requiring well being care entities to submit facility charge notices on their web site and on-site. These notices should advise sufferers whether or not the entity is a hospital-based facility, and if that’s the case, establish the hospital or well being system that owns or operates the entity and whether or not or not it expenses facility charges. The discover should additionally direct shoppers to a state company web site with extra details about the circumstances during which facility charge expenses are permitted. Maine legislators additionally enacted a invoice requiring that well being care facility claims establish the bodily location the place a service was supplied, together with hospital off-campus places.
Notable Efforts
Further legislators throughout the nation launched a variety of measures to reform or make clear facility charge billing, however their payments did not move earlier than their state’s legislative classes ended.
Lawmakers in Washington sought to ban off-campus facility charge billing, along with increasing the state’s client notification necessities and introducing clear billing necessities on claims types. Different states launched proposals prohibiting suppliers from charging facility charges for a extra narrowly tailor-made set of procedures and care settings. Legislators in Connecticut sought to broaden facility charge prohibitions to off-campus drug administration and injection and infusion companies, and require off-campus HOPDs to accumulate a singular nationwide supplier identifier and use this on all claims. Vermont legislators proposed to restrict sure outpatient facility charge billing, however didn’t specify which gadgets or companies needs to be affected.
Different states targeted completely on transparency necessities. Legislators in Florida sought to strengthen their current client notification necessities for facility charges, which might have continued to be embedded inside good religion estimates for non-emergency procedures.
In Indiana, a state that handed limitations on outpatient facility charge billing at off-campus HOPDs owned by massive non-profit well being techniques in 2023, lawmakers launched a invoice that might require hospitals to report sure possession data to the Division of Well being. As a result of will increase in outpatient facility charge billing are largely pushed by hospital acquisitions of outpatient practices, possession data can present necessary insights for state policymakers desirous about facility charge reforms. The proposal handed the Home, however in the end died within the Senate.
Nonetheless Operating
Three states are nonetheless contemplating facility charge reform payments as their legislative classes stay open.Illinois lawmakers launched a invoice that pulls on Connecticut’s prohibitions on outpatient facility charge billing and notification necessities, whereas Arizona legislators launched a proposal that might prohibit sure outpatient facility charges and create new reporting necessities for hospital-owned or affiliated outpatient amenities. As well as, a number of facility reform payments stay pending in Massachusetts from 2023. These payments have been not too long ago referenced in a invoice that, if enacted, would order the Home Well being Care Financing Committee to check the problems the payments increase and make suggestions by the tip of the calendar yr.
Wanting Ahead
States proceed to think about further reforms for addressing hospitals’ observe of charging facility charges for outpatient companies. When classes convene in 2025, we anticipate there will likely be extra exercise and continued curiosity on this challenge. CHIR’s cheat sheet is a helpful useful resource for policymakers when contemplating completely different facility charge reform methods. Policymakers and advocates contemplating facility charge reforms are inspired to contact CHIR consultants for technical help at [email protected].
