Georgia signed out-of-network legislation that stipulates carrier cost-sharing requirements into law. In Maine, licensure boards issued a proposed rule removing physician supervision of physician assistants.
Out-of-Network Billing
Georgia’s Gov. Brian Kemp signed into law. The measure requires the carrier to reimburse the out-of-network provider the greater of:
- The verifiable contracted amount paid by all eligible insurers for the provision of the same or similar services as determined by the department;
- The most recent verifiable amount agreed to by the insurer and the nonparticipating emergency medical provider for the provision of the same services during such time as such provider was in-network with such insurer; or
- Such higher amount as the insurer may deem appropriate given the complexity and circumstances of the services provided.
The contracted amount is defined in the new statute as the median in-network amount paid during the 2017 calendar year by an insurer for the emergency or nonemergency services provided by in-network providers engaged in the same or similar specialties and provided in the same or nearest geographical area. The amount is also to be annually adjusted by the department for inflation which may be based on the Consumer Price Index, and will not include Medicare or Medicaid rates.
The measure also stipulates provisions for arbitration proceedings if the reimbursement amount cannot be agreed upon by the parties. The law goes into effect on Jan. 1, 2021.
Scope of Practice
In Maine, the Board of Licensure in Medicine and the Board of Osteopathic Licensure issued proposed rule modifying amendments to a joint rule pertaining to the practice of physician assistants (PAs). The proposed rule would remove the mandatory physician supervision of PAs and change the current delegation agreement — where the supervising physician delegates the PA’s duties and scope of practice — to a collaboration agreement where a PA would consult with a physician based on the PA’s education, competencies and experience.
Comments on the proposed rule must be received by Aug. 7, 2020.
Correction: Last week’s state legislative update stated that North Carolina’s eliminates all Certificate of Need (CON) provisions including for home dialysis and freestanding dialysis stations for hospitals. While those changes were included in the draft legislative proposal, which sought to repeal the existing CON program in the state, due to successful lobbying efforts of the 黑料网® North Carolina chapter, all of these proposed CON program changes were dropped from the legislation prior to its passage.