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), acquired unanimous, bipartisan assist from committee members following adoption of an modification from Rep. Jahana Hayes (D-CT-05) that Bean welcomed as an “further 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 companies 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, due to 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 companies they rendered. This implies telehealth companies 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 companies and the plan can pay the identical quantity irrespective of the supplier’s location.
How Would This Have an effect on Shopper Out-of-Pocket Prices and Complete Spending?
For in-network care, customers needs to be protected against the additional out-of-pocket prices that facility charges typically can generate. They might nonetheless face the danger of stability billing for out-of-network care if suppliers search better reimbursement than their plan pays (whether or not they’re primarily based at a hospital or not), as is normal in the present day for any companies not protected beneath the No Surprises Act.
Complete spending by group well being plans may go down, however whether or not and the way a lot will rely on the extent at which plans pay for telehealth companies. The best profit will come if plans set their reimbursement degree on the quantity they’ve been paying for telehealth companies 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 Charge-Associated Reforms in Congress?
The Transparency Telehealth Payments Act is extra narrowly centered than the opposite business facility charge ban proposed in Congress, each with respect to its limitation to telehealth companies and group well being plans solely. Senator Sanders and Marshalls’ Bipartisan Main Care and Well being Workforce Act would prohibit facility charge billing for analysis and administration companies and outpatient behavioral well being companies, along with telehealth companies. This invoice additionally doesn’t embrace a distinctive supplier identifier requirement, which has appeared in each Home and Senate payments over the previous 12 months or so, and seeks to extend transparency relating to the placement of care in well being care claims.
On the identical time, this invoice is notable as the primary laws formally launched in Congress to carry the idea of site-neutral funds to the business sector. Senator Sanders floated a business site-neutral proposal in 2023, however in the end launched his invoice with Senator Marshall that as an alternative prohibited facility charge billing for the companies recognized with out requiring that the quantity insurers pay for a similar companies be the identical in several settings. (Even when facility charges are prohibited, hospitals with market energy might negotiate better reimbursement for payments submitted by their suppliers.)
The place Will the Invoice Go from Right here?
Whereas it’s getting late within the 12 months to see new laws transfer, it’s potential this language (or one thing related) might get included into an end-of-year well being care package deal or a telehealth extender invoice. If it does, we can be watching to see whether or not its scope is expanded from solely group well being plans to incorporate the remainder of the business market, resembling insurance policies bought by means of Inexpensive Care Act marketplaces, or some other modifications are made. To raised perceive the totally different coverage choices lawmakers in search of to handle outpatient facility charge billing might take into account, take a look at our Cheat Sheet for Policymakers. You can even study our nationwide maps, detailing outpatient facility charge billing legal guidelines throughout the nation which might function a mannequin for federal lawmakers.
