In early September, the U.S. Home Schooling and Workforce Committee voted in favor of H.R. 9457, the Transparency Telehealth Payments Act. The invoice, launched by Rep. Aaron Bean (R-FL-04), obtained unanimous, bipartisan assist from committee members following adoption of an modification from Rep. Jahana Hayes (D-CT-05) that Bean welcomed as an “additional blanket of safety” for customers.
What Does the Transparency Telehealth Payments Act Do?
The Transparency Telehealth Payments 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. No matter whether or not a well being care supplier is training out of a hospital or an impartial setting, the plan should pay the identical quantity.
Second, because of the Hayes modification, the invoice prohibits hospitals from billing a separate facility charge when the well being care supplier is allowed to invoice independently for the skilled providers they rendered. This implies telehealth providers may end up in just one invoice.
Collectively, 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 Have an effect on Shopper Out-of-Pocket Prices and Whole Spending?
For in-network care, customers needs to be protected against the additional out-of-pocket prices that facility charges typically can generate. They could nonetheless face the danger of stability billing for out-of-network care if suppliers search higher 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 beneath the No Surprises Act.
Whole spending by group well being plans can also go down, however whether or not and the way a lot will rely on 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 impartial clinicians, somewhat than hospital-controlled suppliers that always negotiate greater charges. As a result of the legislation doesn’t cap reimbursement at this quantity, plans should negotiate for it.
How Does This Invoice Examine to Different Industrial Facility Payment-Associated Reforms in Congress?
The Transparency Telehealth Payments Act is extra narrowly targeted than the opposite industrial facility charge ban proposed in Congress, each with respect to its limitation to telehealth providers and group well being plans solely. Senator Sanders and Marshalls’ Bipartisan Major Care and Well being Workforce Act would prohibit facility charge billing for analysis and administration providers and outpatient behavioral well being providers, along with telehealth providers. This invoice additionally doesn’t embody a distinctive supplier identifier requirement, which has appeared in each Home and Senate payments over the previous yr or so, and seeks to extend transparency concerning the situation of care in well being care claims.
On 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 industrial sector. Senator Sanders floated a industrial site-neutral proposal in 2023, however in the end launched his invoice with Senator Marshall that as a substitute prohibited facility charge billing for the providers recognized with out requiring that the quantity insurers pay for a similar providers be the identical in several settings. (Even when facility charges are prohibited, hospitals with market energy may negotiate higher reimbursement for payments submitted by their suppliers.)
The place Will the Invoice Go from Right here?
Whereas it’s getting late within the yr to see new laws transfer, it’s doable this language (or one thing related) 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 industrial market, equivalent to insurance policies bought by means of Reasonably priced Care Act marketplaces, or some other modifications are made. To higher perceive the completely different coverage choices lawmakers looking for to deal with outpatient facility charge billing might contemplate, try our Cheat Sheet for Policymakers. You may also study our nationwide maps, detailing outpatient facility charge billing legal guidelines throughout the nation which might function a mannequin for federal lawmakers.
