House Committee Moves Surprise Billing Measure after Accepting Sub Bill

Uncategorized  |  May 20, 2020

The substitute version of HB388 (Holmes), which was reported out of the House Finance Committee by a unanimous vote of members present on Tuesday, represents “perhaps the first time in the country where there has been agreement” among major stakeholders on the issue of surprise medical bills, House Speaker Pro Tempore Jim Butler (R-Dayton) said before the committee vote.

Butler thanked Ohio health care providers, the insurance industry and the business community for negotiating in good faith and coming to a reasonable compromise.

“All over the country … there’s really two areas of disagreement. One is with the providers – they think the insurance plans and how they reimburse, that prices are going to spiral down to nothing. Then on the business side, they think just the opposite – that if the bill is not crafted in the right way, that prices will rapidly escalate if the process doesn’t work right. It’s really like the Hatfields and the McCoys all over the country,” Butler said, with the Buckeye State potentially showing a path toward ending the feud, where all sides are working together to solve the problem.

“You don’t see a lot around here. Normally each side is doing their best to advocate for their own position. But everyone really came together because this issue is an important one, especially now,” Butler said.

Butler then explained the following elements of the compromise legislation:

– The provider will send the bill to the insurance plan, and the plan will propose a reimbursement that represents the highest among these three options: their in-network rate, their out-of-network rate or the Medicare rate. The provider could then accept or decline that proposed reimbursement. If they accept it, it’s over. If they reject it, a period of negotiation starts where the plan and the provider discuss what the rate should be, and that is between them. If that doesn’t work out, it goes to arbitration.

– During arbitration, a provider or a practice of providers can bundle up to 15 claims in the same coding set and the same provider license type. Arbitrators can consider documents on four factors, Butler said, comparing it to a house appraisal. “You’re trying to get a fair market value. A lot of people are familiar with that process.”

– First, the provider can provide documents showing what other insurance plans are reimbursing for the same service.

– The plans can submit documents showing payments other providers have agreed to in the network for the same service.

– Each side can present whether the provider or plan was in network before, up to six years in the past.

– The arbitrator can also consider the results of previous arbitration between the parties conducted under the bill, if relevant.

“This is it, there is no other thing that can be submitted to the arbitrator. That’s the key, unique part of this. In most other arbitration situations each side can submit a whole bunch of different things, kind of anything they want,” Butler said. “The prevailing party will pay 30 percent of the fees for the arbitrator, so there’s always skin in the game for both parties. That was certainly important.”

Butler told Rep. Jack Cera (D-Bellaire) that hospitals are still reviewing the language, but doesn’t believe they will be opposed to the bill.

Written proponent testimony was provided by Lora Miller, director of governmental affairs and public relations for the Ohio Council of Retail Merchants; Keith Lake, vice president of government affairs for the Ohio Chamber of Commerce; Mary Haffenbredl, regional director of state affairs for America’s Health Insurance Plans; Barbara Gerken of the Ohio Association of Health Underwriters; and Gretchen Blazer Thompson, director of government affairs for the Ohio Association of Health Plans.

Written opponent testimony was provided by the Ohio Society of Pathologists.

Story originally published in The Hannah Report on May 19, 2020.  Copyright 2020 Hannah News Service, Inc.