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 fees 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 concerning the development within the quantity and prevalence of those fees has pushed many states to deal with this difficulty of their state legislatures. A number of states pursued reforms that might restrict hospitals’ means to cost outpatient facility charges and higher defend shoppers from such fees. States additionally sought to construct their inner capability to deal with these subjects by requiring larger 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 in the course of the 2024 legislative session.
State Laws to Regulate Outpatient Facility Charges
States Throughout the End Line
Maine, Maryland, and Connecticut efficiently handed laws concerning facility charges this session. Notably, every of those states has enacted some facility charge reforms prior to now, as documented in CHIR’s 2023 report and difficulty 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 12 months, Maryland presently requires hospitals to offer written and oral notices to shoppers when charging a facility charge for outpatient clinic providers, provides, or tools, excluding emergency division providers. This 12 months, Maryland legislators thought of payments that might develop these notification necessities to extra providers 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 Price 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 12 months 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) providers, and can prolong this prohibition to on-campus services in July (topic to some exclusions). Connecticut additionally has a soon-to-expire prohibition on facility charges for telehealth providers that dates to the COVID-19 pandemic. This session, the Connecticut legislature prolonged its prohibition on facility charges for telehealth providers 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 offered in workplace settings for practically 20 years. Following information studies on sufferers dealing with surprising facility charge fees, state legislators revisited the subject final 12 months, in the end making a job drive to judge facility charge billing and make legislative suggestions. This regulation additionally required Maine’s all payer claims database to provide annual studies on facility charge fees. Primarily based on the duty drive’s report, Maine lawmakers handed laws requiring well being care entities to publish 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 fees facility charges. The discover should additionally direct shoppers to a state company web site with extra details about the circumstances through which facility charge fees are permitted. Maine legislators additionally enacted a invoice requiring that well being care facility claims establish the bodily location the place a service was offered, together with hospital off-campus places.
Notable Efforts
Extra legislators throughout the nation launched a spread of measures to reform or make clear facility charge billing, however their payments didn’t cross earlier than their state’s legislative periods ended.
Lawmakers in Washington sought to ban off-campus facility charge billing, along with increasing the state’s shopper notification necessities and introducing clear billing necessities on claims varieties. 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 develop facility charge prohibitions to off-campus drug administration and injection and infusion providers, 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 objects or providers ought to be affected.
Different states centered completely on transparency necessities. Legislators in Florida sought to strengthen their current shopper 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 giant non-profit well being methods in 2023, lawmakers launched a invoice that might require hospitals to report sure possession info 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 info can present necessary insights for state policymakers taken with facility charge reforms. The proposal handed the Home, however in the end died within the Senate.
Nonetheless Working
Three states are nonetheless contemplating facility charge reform payments as their legislative periods stay open.Illinois lawmakers launched a invoice that attracts 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 services. As well as, a number of facility reform payments stay pending in Massachusetts from 2023. These payments have been lately referenced in a invoice that, if enacted, would order the Home Well being Care Financing Committee to check the problems the payments elevate and make suggestions by the tip of the calendar 12 months.
Trying Ahead
States proceed to think about extra reforms for addressing hospitals’ follow of charging facility charges for outpatient providers. When periods convene in 2025, we anticipate there can be extra exercise and continued curiosity on this difficulty. 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 specialists for technical help at FacilityFeeTA@georgetown.edu.