Opioid crisis, 'surprise billing,' insurance mandates & more — 2018 legislative recap

Here's a snapshot of the six legislative issues that dominated healthcare coverage in 2018:

1. Price transparency and 'surprise billing'

  • The New Mexico legislature saw a new bill focused on preventing surprise medical bills introduced in early 2018. The changes would restrict out-of-network billing for some procedures as well as increase provider disclosure requirements.
  • Minnesota Rep. Jeremy Munson, R-Lake Crystal, introduced a bill in the state legislature that would mandate hospitals and clinics to publish price information on their 25 most common procedures.
  • The ASC Payment Transparency Act of 2018 passed in the U.S. House of Representatives and advanced to the U.S. Senate for consideration.
  • A bill introduced in Georgia aimed to promote transparency in medical billing for outpatient procedures. Under House Bill 678, a consumer receiving outpatient services from a hospital, physician practice or treatment facility would, upon request, receive information on whether the providers are in the patient's insurance network, projected costs and what the policy will pay.
  • A proposed bill from New Jersey lawmakers that would protect patients from unexpected healthcare charges is was opposed by physicians, who viewed it as a partial fix. 
  • On Feb. 5, Democratic Oklahoma state senator and anesthesiologist Ervin Yen, MD, introduced the Clinician Out-of-Network Act. Senate Bill 1478 would tackle the much-discussed topic of surprise billing. 

2. The opioid crisis

  • Legislative committees for both U.S. government branches introduced legislation targeting the opioid epidemic. Anesthesia Business Consultants President and CEO Tony Mira estimated 30 bills were introduced related to Medicare and Medicaid coverage and payment, with some having the potential to impact anesthesia and pain medicine practices. 
  • A bill that could reverse reimbursement cuts for post-operative injections in ASCs advanced to the House of Representatives. The House Energy and Commerce Committee approved the Post-Surgical Injections as an Opioid Alternative Act May 17. It was one of 57 measures sent to the House to address the opioid crisis.
  • A bill aimed at addressing opioid prevention, treatment and recovery passed the Senate Oct. 3 and was sent to the White House for President Donald Trump's signature. 

3. Health insurance

  • Sen. Elizabeth Warren, D-Mass., introduced the Consumer Health Insurance Protection Act to increase affordability and competition on the ACA marketplaces March 21. No further action has been taken on it.
  • Sen. Jeff Merkley, D-Ore., introduced the Choose Medicare Act in the U.S. Senate to provide consumers and employers the option to enroll into a newly created universal Medicare option.
  • New Jersey became the second U.S. state to implement a statewide individual mandate pertaining to health insurance. Effective Jan. 1, 2019, every resident in New Jersey will be required to buy health insurance or will be forced to pay a penalty.
  • President Trump signed a $1.3 trillion spending bill passed by Congress March 23. The 2,232-page spending bill included $78 billion in discretionary funding for HHS, a $10 billion increase from fiscal year 2017 level, according to a summary released by the House Appropriations Committee.

4. Medical devices and suppliers

  • In July, the House voted to repeal the ACA's medical device tax. The 2.3 percent tax on sales of medical devices had been enacted to help pay for the ACA and set to go into effect in 2020.
  • Rep. David McSweeney, R-Ill., and Rep. Gregory Harris, D-Ill., proposed new legislation with the potential to end cuts in payments to medical equipment providers and supplies for Medicaid patients in Illinois. House Bill 5930 addressed concerns stemming from the 10 to 50 percent cuts to reimbursements given to medical supply companies.

5. Quality and safety

  • At his confirmation hearing, New Jersey's Health Commissioner Shereef Elnahal, MD, said he'd soon introduce a mandatory adverse event reporting requirement for all surgery centers, including one-room facilities not licensed by the Department of Health.
  • Oregon House Bill 4020 was unanimously passed March 12, allowing extended stay recovery centers in the state. Under the bill, patients can spend 48 hours recovering from procedures at an ASC. Previously, Oregon ASCs were required to discharge patients within 24 hours of admission.
  • State Sen. Jerry Hill, D-Calif., pushed legislation that would make California the first state to require physicians to inform patients if they are on probation for wrongdoing, including sexual misconduct.
  • Rhode Island passed legislation requiring all licensed hospitals and ASCs to implement smoke evacuation system policies for surgical procedures generating plume. Rhode Island is the first state to pass legislation tackling the issue of surgical smoke. Facilities have 90 days to notify the state's health department they've adopted policies addressing surgical smoke ventilation.
  • Virginia legislators introduced a bill that would direct health plans to develop protocols to pay physicians for services performed once a credentialing application is received, instead of waiting until all the paperwork has been received and processed.

6. New developments

  • Georgia is making efforts to overhaul its certificate of need laws. The Georgia House Rural Development Council heard reform proposals in September 2018, and it previously considered proposals to end CON laws in urban areas but uphold them in rural areas. Georgia Lt. Gov. Casey Cagle, R, worked with the state's Senate Study Committee to draft CON reform legislation.
  • Then-New Jersey Gov. Chris Christie, R, signed a long awaited and debated bill that would require licensure of one room surgical centers in New Jersey. Licensure will now be overseen by the New Jersey Department of Health. Previously, one-room centers were overseen by the New Jersey Board of Medical Examiners.
  • A state representative in Vermont introduced a bill to regulate ASCs to the Vermont House eight months after the state granted its second CON to a surgery center.

More articles on turnarounds:
Temple Surgery Center shutters after Little River Healthcare files for bankruptcy
Viewpoint: Site-neutral payments may not benefit ASCs as much as expected
3 changes for ASC leaders to watch in the next 10 years

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