On Wednesday, September 2, The Michigan Senate Committee on Banking and Insurance held a hearing on surprise billing legislation: HB 4459 and House Bills 4460, 4990, and 4991. These bills make up the surprise billing package, which seamlessly passed through the House with a vote of 101 yeas and five nays in late June.
Prior to today’s Senate hearing, ERIC sent a letter of support for HB 4459, as the bill would ban balance billing for out-of-network services that are delivered at in-network facilities, as well as in emergency rooms, and specifies that providers be reimbursed based on the average negotiated in-network rate in that region, or 150 percent of Medicare rates. These rules would apply to fully-insured plans in Michigan.
During the Senate hearing, amendments in the form of a substitute were offered for all four of the bills. The substitute makes the following changes for HB 4459:
- Includes the definition of “insurer” so that all relevant payers are subject to the law
- It defines “group health plan” as an employer program of health benefits, including an employee welfare benefit plan that provides medical care to employees or their dependents
- It defines “group health plan” as an employer program of health benefits, including an employee welfare benefit plan that provides medical care to employees or their dependents
- Section 24507 (1)(b) changes “and” to “or” in nonemergency situations where the only provider available is nonparticipating
- It should read “the nonemergency patient does not have the ability or opportunity to choose a participating provider”
- It should read “the nonemergency patient does not have the ability or opportunity to choose a participating provider”
- The rate determinations are now based on the median in-network rate, not the average
- Clarifies that the patient is not required to pay any amount other than applicable coinsurance, copayment, and deductibles in the event their insurer and provider come to an agreement through binding arbitration, private negotiation, or internal dispute resolution
- Changes the Department of Insurance and Financial Services (DIFS) binding arbitration requests and departmental review date to July 1, 2021 so that they have more time to set up necessary systems
- DIFS must now issue a report not a study about out-of-network complaints one year after the legislation is law
Substitutes for HB 4460 reflect those made in HB 4459. HBs 4490 and 4991 are technical corrections.
The bills passed out of committee with 7 Yeas, 1 Nay, and 2 passes and are headed to the Senate floor for votes.
ERIC will continue to support the legislation as it proceeds through the legislative process.
Article by James Gelfand, Senior Vice President of Health Policy