In early September, the U.S. Home Training 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 practising out of a hospital or an unbiased setting, the plan should pay the identical quantity.
Second, because of the Hayes modification, the invoice prohibits hospitals from billing a separate facility payment when the well being care supplier is permitted 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 can pay 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 ought to be shielded from the additional out-of-pocket prices that facility charges typically can generate. They might nonetheless face the chance of stability billing for out-of-network care if suppliers search larger reimbursement than their plan pays (whether or not they’re based mostly at a hospital or not), as is normal as we speak for any providers not protected underneath the No Surprises Act.
Whole spending by group well being plans may go down, however whether or not and the way a lot will rely upon 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 unbiased clinicians, slightly than hospital-controlled suppliers that always negotiate increased charges. As a result of the regulation doesn’t cap reimbursement at this quantity, plans should negotiate for it.
How Does This Invoice Evaluate to Different Industrial Facility Price-Associated Reforms in Congress?
The Transparency Telehealth Payments Act is extra narrowly centered than the opposite business facility payment 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 payment 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 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 convey the idea of site-neutral funds to the business sector. Senator Sanders floated a business site-neutral proposal in 2023, however finally launched his invoice with Senator Marshall that as an alternative prohibited facility payment 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 might negotiate larger 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 comparable) might get integrated into an end-of-year well being care package deal or a telehealth extender invoice. If it does, we shall 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, reminiscent of insurance policies bought by means of Inexpensive Care Act marketplaces, or another modifications are made. To higher perceive the totally different coverage choices lawmakers searching for to handle outpatient facility payment billing could take into account, take a look at our Cheat Sheet for Policymakers. You can even look at our nationwide maps, detailing outpatient facility payment billing legal guidelines throughout the nation which might function a mannequin for federal lawmakers.