Facility Payment State Legislative Roundup: 2024 Session

With extra outpatient care being delivered in hospital outpatient departments (HOPDs) than in earlier years on account of vertical consolidation, customers more and more face excessive hospital facility price prices 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 customers.  

Rising consciousness concerning the development within the quantity and prevalence of those prices has pushed many states to deal with this problem of their state legislatures. A number of states pursued reforms that will restrict hospitals’ capacity to cost outpatient facility charges and higher defend customers from such prices. States additionally sought to construct their inner capability to sort out these subjects by requiring higher transparency and commissioning research. Hospitals’ opposition to facility price reforms has been fierce, nevertheless, 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 concerning facility charges this session. Notably, every of those states has enacted some facility price reforms prior to now, as documented in CHIR’s 2023 report and problem temporary on state regulation of outpatient facility charges. Passage of the newest laws in these states emphasizes the incremental nature of reform on this space.

As CHIR reported final yr, Maryland at present requires hospitals to supply written and oral notices to customers when charging a facility price for outpatient clinic providers, provides, or gear, excluding emergency division providers. This yr, Maryland legislators thought of payments that will develop these notification necessities to extra providers and suppliers. Legislators, dealing with pushback, in the end handed a invoice that doesn’t change present necessities for hospitals, however duties the Maryland Well being Providers Value Evaluation Fee to review outpatient facility price billing and associated reforms with the objective 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 price 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 price billing for care offered in workplace settings for almost 20 years. Following information reviews on sufferers dealing with surprising facility price prices, state legislators revisited the subject final yr, in the end making a process power to guage facility price billing and make legislative suggestions. This regulation additionally required Maine’s all payer claims database to provide annual reviews on facility price prices. Primarily based on the duty power’s report, Maine lawmakers handed laws requiring well being care entities to submit facility price notices on their web site and on-site. These notices should advise sufferers whether or not the entity is a hospital-based facility, and in that case, determine the hospital or well being system that owns or operates the entity and whether or not or not it prices facility charges. The discover should additionally direct customers to a state company web site with extra details about the circumstances during which facility price prices are permitted. Maine legislators additionally enacted a invoice requiring that well being care facility claims determine the bodily location the place a service was offered, together with hospital off-campus places. 

Notable Efforts

Extra legislators throughout the nation launched a variety of measures to reform or make clear facility price billing, however their payments didn’t go earlier than their state’s legislative classes ended. 

Lawmakers in Washington sought to ban off-campus facility price billing, along with increasing the state’s shopper 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 develop facility price prohibitions to off-campus drug administration and injection and infusion providers, and require off-campus HOPDs to amass a novel nationwide supplier identifier and use this on all claims. Vermont legislators proposed to restrict sure outpatient facility price billing, however didn’t specify which gadgets or providers ought to be affected.

Different states targeted solely on transparency necessities. Legislators in Florida sought to strengthen their present 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 price billing at off-campus HOPDs owned by giant non-profit well being techniques in 2023, lawmakers launched a invoice that will require hospitals to report sure possession data to the Division of Well being. As a result of will increase in outpatient facility price billing are largely pushed by hospital acquisitions of outpatient practices, possession data can present essential insights for state policymakers fascinated with facility price reforms. The proposal handed the Home, however in the end died within the Senate. 

Nonetheless Working

Three states are nonetheless contemplating facility price reform payments as their legislative classes stay open.Illinois lawmakers launched a invoice that attracts on Connecticut’s prohibitions on outpatient facility price billing and notification necessities, whereas Arizona legislators launched a proposal that will 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 review the problems the payments elevate and make suggestions by the top of the calendar yr.

Wanting Ahead

States proceed to contemplate further reforms for addressing hospitals’ observe of charging facility charges for outpatient providers. When classes convene in 2025, we anticipate there can be extra exercise and continued curiosity on this problem. CHIR’s cheat sheet is a priceless useful resource for policymakers when contemplating totally different facility price reform methods. Policymakers and advocates contemplating facility price reforms are inspired to contact CHIR consultants for technical help at FacilityFeeTA@georgetown.edu.