Healthcare Roundup: Congressional Pushback against Surprise Billing Rule, Hospital Expansion Oversight Bill in MA & More

Biden Administration Rule Spurs Revolt in Congress over Surprise Billing:

Last December Congress passed the No Surprises Act, aimed at protecting patients from being billed directly for out-of-network medical care not covered by their insurance. After lengthy negotiations, healthcare providers, insurers and lawmakers agreed to resolve such claims via a 30-day negotiation period, followed by arbitration if an agreement wasn’t reached.

But a rule implementing the No Surprises Act issued by the Biden administration in September and set to take effect in January has sparked new controversy over the issue. Provisions of the proposed rule make the starting point for arbitration the median rate the applicable insurer pays in-network providers for similar services in the area rather than giving equal weight to such considerations as the relevant provider’s training and quality of outcomes.

That prompted an angry letter to administration officials from a bipartisan group of 157 members of Congress declaring that the provisions “do not reflect the way the law was written, do not reflect a policy that could have passed Congress, and do not create a balanced process to settle payment disputes.”

The lawmakers argued the rule would incentivize insurers to set lower in-network rates to establish lower default rates for arbitration, which would also narrow provider networks and reduce access to care, especially in underserved areas.

It wasn’t clear whether the pushback from the lawmakers would make the administration change course. While some congressional staffers said it was probably too late in the process for that, others, pointing to the fact that over 70 of the lawmakers who signed the letter were from the same party as the president, said such a shift was possible. (KAISER HEALTH NEWS)

MA House Passes Hospital Expansion Oversight Bill:

The Massachusetts House nearly unanimously passed a bill (HB 4253) to provide regulatory oversight of expansions by large healthcare providers into markets served by smaller community hospitals, a policy priority for Speaker Ronald Mariano (D). The measure would broaden the state Health Policy Commission’s authority to investigate the market impact of hospital mergers and acquisitions to include hospital expansions as well. It would require providers seeking a license to expand their operations into a service area that overlaps that of an existing independent community hospital to include a letter of support from a top administration official of that facility. With the state’s Legislature now having just begun a roughly seven-week recess, the Senate is unlikely to consider the measure until 2022. (STATE HOUSE NEWS SERVICE [BOSTON], STATE NET)

MA Senate Passes Mental Health Access Bill:

Massachusetts’ Senate unanimously approved a bill (SB 2572) that would mandate insurance coverage for annual mental health exams just like for annual physicals. The measure also includes provisions aimed at reducing the length of emergency room stays for patients in need of a psychiatric bed, eliminating the need for prior authorization for patients requiring acute mental health treatment, and setting the rate floor for the reimbursement of mental healthcare providers for evaluation and management services at the same level as primary care providers. The House is not expected to take up the bill until after the Legislature’s current recess. (STATE HOUSE NEWS SERVICE [BOSTON], STATE NET)

TN Considering Spending $94 Million to Bring More Dentists to Rural Areas:

The Tennessee Department of Health has proposed a $94 million, five-year pilot project to expand dental school class sizes and provide tuition forgiveness for those who opt to work in high-need areas. Dentists in the state have been flocking to urban areas, where they can see more patients with private insurance, allowing them to pay off their student debt, which can run over $300,000. (WPLN NEWS)

Push for Universal Healthcare in ME:

Nonprofit group Maine Healthcare Action is pushing for a ballot measure directing state lawmakers to create a task force to draft legislation by 2024 implementing universal health care. The organization will have until the middle of January to collect the roughly 63,000 signatures required to qualify the proposal for the state’s November ballot. (BANGOR DAILY NEWS)

-- Compiled by KOREY CLARK