Surprise Billing: Expected to Move Through the Senate This Week
EMS Is Not Included
The Texas Senate is expected to consider SB 1264 today. Sen. Kelly Hancock (R-North Richland Hills), Sen. John Whitmire (D-Houston), Rep. Tom Oliverson, MD (R-Spring) and Rep. Trey Martinez Fischer (D-San Antonio) released a committee substitute for SB 1264.
The latest version targets a "narrow" segment of the health care industry, and it would not affect EMS. TEMSA will host a webinar in the near future to outline the legislation for TEMSA members.
It is important that the legislation still has a number of steps to take. While the Texas Medical Association did offer official support (along with a few recommendations) for the latest version, both the Texas Association of Health Plans and Texas Hospital Association registered as "neutral" on the bill.
The Texas Hospital Association expressed a number of concerns regarding the legislation in a recent letter:
"The most recent version of SB 1264, however, has embraced New York’s arbitration-based laws and included government-set parameters for payment amounts between health plans and providers. THA appreciates the environment of compromise surrounding this priority issue for consumers; however, there is a latent, negative impact to negotiated in-network rates between health plans and facilities. There is evidence that reference-based pricing in a similar New Jersey law to combat surprise billing resulted in a marked reduction in health plan reimbursement to hospitals. Hospitals serve as the safety nets for their communities, by, for example, providing lifesaving trauma care – often at a great expense. This care is an outlier to any benchmarking of reimbursement amounts. More, each year, hospitals write off or adjust millions of dollars of unpaid claims from patients and health plans through charity care and other policies, and data suggest that hospitals account for the minority of these billing practices. In fact, New York’s anti-surprise billing legislation purposefully excluded hospitals, largely because they are overwhelmingly in-network with health plans and to avoid unintended negative consequences for hospitals."
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