04/29/2016

Balance Billing Draft Legislation Shelved for Rewrites

Ohio ACEP discussions result in delayed introduction of legislation

Ohio ACEP was recently made aware of legislation that an Ohio legislator intended to introduce to put restrictions on balance billing. As a result of conversations Ohio ACEP had with the prospective sponsor’s office and other interested parties, the legislator agreed to delay introduction of her legislation.

An interested party meeting on the issue was held on March 17. Representing Ohio ACEP at the meeting was Chapter President Dr. Michael McCrea, Ohio ACEP Executive Director Laura Tiberi, and Ohio ACEP lobbyist Amanda Sines. Others in attendance included members of the House of Representatives; the Ohio State Medical Association; health insurance companies; the Ohio Hospital Association, and Legal Aid Society.

Each group was given the opportunity to give their perspective on the issue. Dr. McCrea did a great job representing emergency medicine. It was suggested by health insurers that providers need to do a better job of disclosing whether or not they are in or out of network. Dr. McCrea was quick to point out that EMTALA requires emergency physicians to treat everyone, regardless of their insurance status. The health insurers suggested that hospitals put a sign disclosing that some of their providers may not be in-network. Dr. McCrea pointed out this could be a violation of EMTALA, as it could discourage patients from seeking needed care.

The prospective sponsor expressed special concern for sizeable balance bills generated from transportation services. Parties at the meeting pointed out that the draft legislation did not have language to apply to these services.

The proposal also called for paying all providers at in-network rates for providing services in an emergency, even if the provider or hospital was out-of-network. It was suggested that the representative consider specifying that rates be based on an independent third party. In the end, it was agreed by all that the proposed legislation would improve by being re-drafted.

This is an issue that has gotten attention nationwide. Ohio ACEP will continue to stay actively engaged in any initiatives proposed in Ohio. When the new version of the bill is available, Ohio ACEP will have an opportunity to review.