Health Care Round-Up: Surprise Billing, Pharmacy Working Conditions, Essential Care Worker Shortage

Big Question Remains with New Federal Surprise Billing Law:

The federal No Surprises Act, passed late last year as part of the Consolidated Appropriations Act of 2021 (HR 133), will allow providers to bill patients for out-of-network care under certain conditions and only after completing a strict “notice and consent” process.

The law, which takes effect in January 2022, makes it clear that patients can’t be coerced into waiving their balance billing protections. The law is a little murkier, however, about whether providers, particularly specialists, can refuse to provide care to patients who refuse to give their consent to be balance billed.

Consequently, the Biden administration is seeking input on that issue.

“HHS seeks comment on striking the appropriate balance between allowing a specialist to refuse to treat an individual unless the specialist can balance bill the individual while ensuring that the individual is not being pressured into waiving the balance billing protections,” stated a recent rule implementing the new surprise billing law.

Adam Buckalew, a former congressional aide who helped draft the law, said it “was always designed to preserve patient choice, not to become a massive loophole for surprise billing.”

“The rule seeks clarity on maintaining balance for both patients and specialists in limited scenarios,” he said. (AXIOS)

MO Investigating Working Conditions at Pharmacies:

Missouri’s Board of Pharmacy is creating a task force to look into working conditions at pharmacies across the state. That action comes after hundreds of complaints from pharmacists saying they’re being overworked and don’t have enough time to safely fill prescriptions.

 “I’ve heard pharmacists say that they don’t drink anything before they go on shift because they’re afraid they may not get a bathroom break,” said Ron Fitzwater, CEO of the Missouri Pharmacy Association. “That’s not even healthy, much less a good business practice.” (ST. LOUIS POST-DISPATCH)

Insurers Get Better Deals on Hospital Care Than Uninsured:

Hospitals often charge patients who pay out of pocket more than insurance companies for the same service, according to analysis by the Wall Street Journal. Under federal regulations that took effect in January, hospitals are now required to disclose the rates they’ve negotiated with insurers as well as the prices they charge cash-paying patients, such as those who are uninsured. (WALL STREET JOURNAL)

Pacific Northwest Heat Wave Overwhelmed Healthcare System:

Over 100 people died in last month’s record heat wave in the Pacific Northwest, with temperatures reaching 108 degrees in Seattle and 116 in Portland. The uncharacteristic heat strained the region’s healthcare system, filling emergency rooms, doubling the number of 911 calls and delaying ambulances. (WALL STREET JOURNAL)

Medicare Spends Billions More than Costco on Generic Drugs:

Medicare spent far more on generic drugs than the warehouse chain Costco spent on the same drugs. Medicare outspent Costco by $1.7 billion in 2017 and $2.6 billion in 2018. (CNN HEALTH)

New ME Law Addresses Essential Care Worker Shortage:

Maine Gov. Janet Mills (D) signed legislation (HB 1170 a) increasing the pay of “essential support workers” who care for the elderly and those with disabilities or behavioral health challenges to 125 percent of the state minimum wage. Jess Maurer, executive director of the Maine Council on Aging, said there’s a growing shortage of such workers in the state. (MAINE PUBLIC, MAINE NEWS CENTER, STATE NET)

NV Law Lets Pharmacists Prescribe HIV Prevention Drugs without Prescription:

Nevada Gov. Steve Sisolak (D) signed a bill (SB 325) last month that will make the state one of the first to allow pharmacists to prescribe HIV prevention drugs without a prescription to patients at risk of contracting the virus. The state has one of the highest HIV diagnosis rates in the country. (NEVADA INDEPENDENT [LAS VEGAS], STATE NET)

— Compiled by KOREY CLARK