In early September, the U.S. House Education and Workforce Committee voted in favor of H.R. 9457, the Transparency Telehealth Bills Act. The invoice, launched by Rep. Aaron Bean (R-FL-04), obtained unanimous, bipartisan help from committee members following adoption of an modification from Rep. Jahana Hayes (D-CT-05) that Bean welcomed as an “extra blanket of protection” for shoppers.
What Does the Transparency Telehealth Bills Act Do?
The Transparency Telehealth Bills Act limits telehealth billing in two key methods:
First, the invoice imposes a site-neutral billing requirement for telehealth providers paid for by group well being plans. Regardless of whether or not a well being care supplier is working towards out of a hospital or an unbiased setting, the plan should pay the identical quantity.
Second, because of the Hayes modification, the invoice prohibits hospitals from billing a separate facility payment when the well being care supplier is permitted to invoice independently for the skilled providers they rendered. This means telehealth providers may end up in just one invoice.
Together, these provisions imply group well being plans and their plan members would obtain only one invoice for telehealth providers and the plan pays the identical quantity regardless of the supplier’s location.
How Would This Affect Consumer Out-of-Pocket Costs and Total Spending?
For in-network care, shoppers must be shielded from the additional out-of-pocket prices that facility charges typically can generate. They should face the chance of stability billing for out-of-network care if suppliers search larger reimbursement than their plan pays (whether or not they’re based mostly at a hospital or not), as is normal at this time for any providers not protected below the No Surprises Act.
Total spending by group well being plans may go down, however whether or not and the way a lot will depend upon the extent at which plans pay for telehealth providers. The best profit will come if plans set their reimbursement stage on the quantity they’ve been paying for telehealth providers from unbiased clinicians, relatively than hospital-controlled suppliers that usually negotiate larger charges. Because the legislation doesn’t cap reimbursement at this quantity, plans should negotiate for it.
How Does This Bill Compare to Other Commercial Facility Fee-Related Reforms in Congress?
The Transparency Telehealth Bills Act is extra narrowly centered than the opposite business facility payment ban proposed in Congress, each with respect to its limitation to telehealth providers and group well being plans solely. Senator Sanders and Marshalls’ Bipartisan Primary Care and Health Workforce Act would prohibit facility payment billing for analysis and administration providers and outpatient behavioral well being providers, along with telehealth providers. This invoice additionally doesn’t embrace a distinctive supplier identifier requirement, which has appeared in each House and Senate payments over the previous 12 months or so, and seeks to extend transparency concerning the placement of care in well being care claims.
At the identical time, this invoice is notable as the primary laws formally launched in Congress to convey the idea of site-neutral funds to the business sector. Senator Sanders floated a commercial site-neutral proposal in 2023, however finally launched his invoice with Senator Marshall that as a substitute prohibited facility payment billing for the providers recognized with out requiring that the quantity insurers pay for a similar providers be the identical in several settings. (Even if facility charges are prohibited, hospitals with market energy may negotiate larger reimbursement for payments submitted by their suppliers.)
Where Will the Bill Go from Here?
While it’s getting late within the 12 months to see new laws transfer, it’s doable this language (or one thing comparable) may get included into an end-of-year well being care package deal or a telehealth extender invoice. If it does, we will likely be watching to see whether or not its scope is expanded from solely group well being plans to incorporate the remainder of the business market, similar to insurance policies bought via Affordable Care Act marketplaces, or some other adjustments are made. To higher perceive the totally different coverage choices lawmakers in search of to handle outpatient facility payment billing might take into account, try our Cheat Sheet for Policymakers. You can even look at our nationwide maps, detailing outpatient facility payment billing legal guidelines throughout the nation which might function a mannequin for federal lawmakers.