I am from Lawrence Kansas and I have worked at Midland for about 11 months as a Public Benefit and Accident Recovery Specialist. I have two little sisters Peyton (12) and Ellie (10), and my hobbies outside of work include baseball, fishing, and golf.

Tell me how you first got involved with The Midland Group.

My mom, Libby, has been working at Midland for five and a half years. When I found out the Midland OneClaim team was hiring, I applied! I couldn’t wait to get started.

What has surprised you most about working with Midland?

I’ve been so impressed at how hard everyone works to provide benefits for the patients we work with. It is really special to be able to help someone who genuinely needs help in order to get the assistance they need.

What is your job title and how do you like being in this role?

My job title is Public Benefit and Accident Recovery Specialist. I really enjoy being in this role because I get to help people where it is most needed. I spend time screening self-pay patients and accident-related accounts.

What do you like most about your job? 

I enjoy the family environment that Midland has created and even carried over itno remote work. It really makes a difference in the way our team operates. And like I said, I really enjoy helping people – it’s so rewarding.

Can you share a few moments that were impactful to you? 

One time, a patient told me about the struggles they were going through in life – and it was a lot! The fact that I was able to get them applied for Medicaid and provide coverage for their bills that they otherwise couldn’t pay off, was incredibly impactful.

What is your biggest achievement to date – personal or professional?

I mentioned earlier that I love playing baseball. Well, I was able to come back to playing baseball 11 months after having Tommy John Surgery, whereas the normal recovery time is 12-14 months.

Tell me about some of the people you’ve met while working in your role?

Everyone that I have met while I’ve been employed at Midland has made me feel like I belong in my role. Everyone is incredibly respectful and really helped me get settled into my current role.

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I was raised in the Carolinas but now consider Oklahoma to be home. I am happily married with three grown children: a preschool teacher, a US Marine, and a firefighter. Not only that, I am a full-time college student and a grandmother to a precious two-year-old. I have been with The Midland Group since 2014.

Tell me how you first got involved with Midland.

When I got married, my husband suggested I get out of the hectic catering/restaurant business I was running and consider an office position…I whole-heartedly agree. Midland was a wonderful find. I had been in nursing when I was much younger, so I felt right at home visiting patients in different hospitals.

What has surprised you most about working with Midland?

I was most surprised by the unbelievable lack of health care options in America and how unaware people are that there is help out there. Midland provides a service not only to the patients also to our community hospitals. Working with Midland has made me realize just how the hundreds of thousands of dollars unpaid to hospitals really affect the entire dynamic of our local communities. 

What’s it like to be a public benefits screener?

Personally, I think a public benefits screener has the best job. We get to visit patients in their hospital rooms after what may have been their first, or tenth, a big health scare and really just be there to help them. Most of the time, people are scared because they think the hospital will kick them out because they don’t have the money to pay for the treatments. Every time we explain that we are really there to help, the relief expressed on their faces makes our jobs so rewarding. We have literally been there to hold their hands, give them a hug, and even cried with the patients and family members as we help them navigate the financial challenges of healthcare. 

What does a typical day look like for you and what are you currently working on?

Typically, our mornings start by visiting patients before they get discharged. In-person, of course — we know how much they have gone through and find that having them see a smiling face makes a world of a difference than having them receive just another phone call. After we complete our visits, we enter all the information we gathered that day into Midland’s system and start following-up with our other patients from weeks prior. We then file the patients’ Medicaid applications with the state’s Department of Human Services and we follow up on different health claims, such as Indian Health Services, VA, and COBRA. Our afternoons also include working with Disability Professionals, which is another division of our company, to take care of patients needing to file for long-term disability with the Social Security Administration.

What do you like most about your job?

For me, I enjoy the advocacy part of the job the most. I genuinely find joy in working with patients and experiencing their gratitude and relief when we are able to assist them through the red tape of the healthcare system. As a somewhat competitive person, I also thrive at the end of the month in my “productive mad dash” to complete as many successful accounts as possible and go over my set productivity goals.

Can you share a few moments that were impactful to you?

One of my patients was brought in unresponsive and was subsequently ventilated. I visited with his mother at her bedside a few times and we quickly became acquainted with one another. At one point, she even held my hand as we sat side by side as she talked about how the patient used to play with toy trucks on the front porch. The mother, who was fairly older than me, called me “kiddo” every time I spoke to her. I felt for her as a mother and also as a child. Every time I spoke to her on the phone, she always asks me how I was doing. She didn’t do that just to make polite conversation, but genuinely wanted to know how I was, what I was doing, and even what my life plans looked like. Eventually, when I told her we were able to get her son’s hospital bills covered, she was so incredibly thankful and relieved. Then she said, “I guess our business is finished, isn’t it?” to which I replied, “You can call me anytime.” Before she hung up, she said to me, “Live your best life kiddo.” What profound advice… Live your best life.

What is your biggest achievement to date – personal or professional?

To be honest, my biggest achievement is still a work in progress. Quite recently, I had the opportunity to return to university to finish my degree in Management with two concentrations in Human Resources and Organizational Development. But I guess to date, one of my biggest achievements is that I made the Dean’s List last semester.

Tell me about some of the people you’ve met while working in your role?

Wow. Through this job, I have been given the chance to interact with people who are in the trenches of our nation’s health care: nurses, DHS caseworkers, IHS workers, and VA employees. To me, they are the unsung heroes that keep our nation’s healthcare moving even if they may be underpaid and often overworked.

What do you do when you aren’t working?

You can most likely find me studying any other time I am not at work. One of the perks of being a non-traditional student is that I have been in business for over thirty years now. This means that I can see the practical applications of what I am learning much more clearly than I would have as a traditional student. 

Where do you see yourself in 5 years?

By then, I will have graduated and probably have a Master’s Degree under my belt as well. I would like to put what I am learning to use within the Midland Group, living my best life. 

Anything else you’d like to share?

One of my current university projects focuses on building employee manuals and job descriptions. I have learned the importance of employees knowing what is expected of them with clear instructions on how to perform those duties. My supervisors Margie Garrison and Ellen Karpen have been great sounding boards and very supportive of my continuing education. I’m so grateful for The Midland Group and the way I get to use what I’m learning as a student in my day-to-day job.

The post Midland Minute: Angie Atkins appeared first on The Midland Group.

There are many states that have requested additional flexibilities in order to focus their resources on slowing down the impact of the coronavirus outbreak and providing the best possible care to Medicaid enrollees in their states. Unfortunately, this is a situation that is still ongoing, and regulations will continue to be updated frequently. Click here to read the current CMMS state-by-state 1135 waiver updates. 

States Approved to Address COVID-19

Currently, there is tracking information on approved Medicaid emergency authorities to address COVID-19 emergencies. This includes the latest healthcare legislative updates and details on Medicaid Disaster Relief State Plan Amendments, other Medicaid and CHIP SPAs, and other state-reported administrative actions; Section 1115 and Section 1135 Waivers; and 1915 © Waiver Appendix K strategies. 

Benefits and Billing Legislation Assignment

Arkansas — AR S 512 – Assignment of benefits to a Healthcare Provider

• Regardless of whether the provider is in-network or out-of-network, enrollees of a healthcare plan may assign, through an assignment of benefits, their right to receive reimbursement for any healthcare service given by a healthcare provider.
• Providers that receive the assignment of benefits can issue a notice to the payer of the assignment of benefits with a claim for payment for the services issued to the enrollee. The notice must be followed by the detailed copy of the assignment of benefits with the enrollee’s signature and date of execution, if the provider is out-of-network,
• Payers who receive proper notice of the assignment of benefits and revoke payment to the enrollee or fail to pay are liable for payment to the healthcare provider and revoke payment to the provider for incorrect payment within 10 days of receiving notice from the provider. Went into effect on March 1, 2020. 

Colorado — CO H 1174 – Out of Network Health Care Services

• Health insurance carriers, health care providers, and health care facilities can supply patients covered by health benefit plans with information concerning the delivery of services by out of network providers, and in-network and out of network facilities. 
• It layouts the disclosure requirements, and the claims and payment process for the provision of out-of-network services. This Act went into effect on January 1, 2020.

Minnesota — MN S 131 – Health Care Facility Fee Disclosures

• Facility fee disclosure before treatment for non-emergency services. This Act took effect on August 1, 2019.

Nevada — NV A 469 – Emergency Services Billing

• Amount a provider of health care may charge a person who has health insurance for certain medically necessary emergency services provided when the provider is out-of-network. 
• Requires an insurer to schedule for the transfer of a person who has health insurance to an in-network facility under certain circumstances. This Act went into effect on January 1, 2020.

New Mexico — NM S 337 – Surprise Billing Protection Act

• Requires insurance to reimburse an out-of-network provider for emergency care necessary to evaluate and stabilize a patient. It also prevents balance billing of an individual at an in-network facility who receives treatment by an out-of-network provider when they do not have the option or ability to choose their provider or treatment by an out-of-network provider is medically necessary. 
• Also sets out reimbursement and overpayment procedures for surprise medical bills. This Act took effect on January 1, 2020.

Tennessee — TN H 1342 – Patient Billing Notices

• Individuals are entitled to benefits under their healthcare policy and have the right to assign their benefits to a healthcare policy and such rights must be clearly stated in the policy. 
• Notice of an assignment must be in writing to the insurer in order to be effective unless otherwise stated in the policy. 
• Out-of-network facility-based physicians may have a right of indemnification or private cause of action against the facility for an insurer’s disregard of an assignment of benefits should they provide detailed notices to the patient.
• Healthcare facilities are also prohibited from collecting out-of-network charges from an insured in excess of cost-sharing amounts unless a detailed written notice is provided prior to treatment. This Act went into effect as of April 30, 2019.

Texas – TX S 1264 – Consumer Protections Against Billing

• Consumer protections against medical and health care billing by out of network providers; provides the procedure for an injunction for balance billing and provides for enforcement by regulatory agencies.
• Provides for balance billing prohibition notices and expands the mandatory coverage of emergency care. Effective September 1, 2019.

Virginia — VA H 2538 – Balance Billing

• Dealing with elective treatment, the facility must post a notice that health care services provided by a provider group will be billed separately from the facility and that some services may not be provided by an in-network provider. 
• The facility must inform the insured person or their representative of the names of the provider groups providing treatment at the facility, that the insured should contact their insurer to determine if the providers are in-network, that the covered person may be financially responsible for services should the provider be out-of-network, and any cost-sharing requirements. This Act went into effect on July 1, 2019.

Washington — WAH 1065 – Health Care Services

• Protects patients from charges for out-of-network health care services. It includes mental health and substance use disorders to the definition of emergency medical conditions and defines balance bill, in-network, and out-of-network. This Act went into effect on January 1, 2020.

Child Health Care Coverage Legislation

Illinois – IL H 2894 – Covering All Kids Health Insurance Program Act

• Amends the Covering All Kids Health Insurance Act and extends the repeal date for the act. Went into effect on August 9, 2019.

Michigan – MI H 4304 – Child Health Care Coverage

• Provisions and enforcement of support, health care, and parenting time orders with respect to divorce, separate maintenance, paternity, child custody and support, and spousal support. Went into effect on June 20, 2019.

New Hampshire – NH S 274 – Newborn Home Visiting Program

• Newborn Home Visiting Program to be available to all Medicaid eligible families. Went into effect on September 17, 2019.

New York – NY A 8053 – Child Health Insurance Plan

• Public Health Law; extends the expiration date for the Child Health Insurance Plan. Went into effect on July 3, 2019.

Texas – TX S 750 – Maternal and Newborn Health Care

• The quality of services provided to women under certain health care programs; provides for the application for funding to implement a model of care for Medicaid recipients; provides for referrals from the Healthy Texas Women Program to the Primary Health Care Services Program; provides for enhanced prenatal and postpartum care services and provides for postpartum depression. Went into effect on June 10, 2019.

Health Insurance Legislation

Arizona — AZ H 2494 – Health Care Service Contracts

• Provides a contract between a health insurer and a health care provider that is issued, amended, or renewed on or after a certain date to provide health care services to the health insurer’s enrollees. 
• Restricts the method of payment from the health insurer to the health care provider in which the only acceptable payment method is a credit card payment or an electronic funds transfer payment. Will take effect on the 91st day after session adjournment.

California – CA S 260 – Automatic Health Care Coverage Enrollment

• Health Care Exchange must enroll an individual in the lowest costs silver plan or another plan upon receiving the individual’s electronic account from a county, or upon receiving information from the State Department of Health Care Services regarding an individual terminated from department-administered health coverage. Went into effect on January 1, 2020.

California – CA A 1802 – Health Care Service Plans: Claim Reimbursement

• Provides that the obligation of a health care service plan to comply with specified portions of the Knox Keene Health Care Service Plan Act reimbursement provisions is not deemed to be waived if the plan requires its medical groups, independent practice associations, or other contracting entities to pay claims for covered services. 
• Updates the information a health care service plan is required to provide. Went into effect on January 1, 2020.

California – CA A 414 – Health Care Coverage

• Office of Statewide Health Planning and Development to annually prepare a report on community benefits.
• Post the report and the community benefit plans submitted by the hospitals on their website. 
• The office to impose fines not to exceed $5,000 on hospitals that fail to adapt, update, or submit community benefit plans. Went into effect on January 1, 2020.

California – CA A 1309 – Health Care Coverage: Enrollment Periods

• For policy, years beginning on or after a certain date, to provide a special enrollment period to allow individuals to enroll in individual health benefit plans through the Health Benefit Exchange in a specified timeframe. Went into effect on January 1, 2020.

Colorado — CO H 1004 – Affordable Health Coverage

• Implementing a competitive state option for affordable health care coverage. 
• The state must seek authorization to use existing federal money for the proposed state option and requires the state to complete studies to determine the feasibility and requirements to implement a state plan. It was enacted on May 17, 2019.

Delaware – DE H 193 – Health Insurance Individual Health Insurance

• Creates the Health Insurance Individual Market Stabilization Reinsurance Program and Fund. Went into effect on June 20, 2019.

Delaware – DE S 35 – Insurance Code

• Amends the Insurance Code relating to health insurance contracts.
• Revises provisions relating to the individual and group health insurance markets to directly incorporate into state law the Patient Protection and Affordable Care Act’s consumer protections, including the prohibition of pre-existing condition provisions, guaranteed asset and availability of coverage, and permissible rating factors. Went into effect on August 6, 2018.

Illinois – IL S 1580 – Healthcare Disability Benefits

• State Employee Article of the Pension Code; allows licensed health care professionals to make certain disability determinations.
• Defines licensed health care professional; requires a licensed health care professional to submit his or her registration number on all reports submitted to the System.
• Eliminates the application deadline for certain disability benefits and makes changes to provisions concerning when a nonoccupational disability benefit begins to accrue. Went into effect July 12, 2019.

Illinois – IL H 2438 – Insurance Code

• Amends the Insurance Code; provides that mental, emotional, nervous, or substance use disorder or condition includes any mental health condition that occurs during pregnancy or during the postpartum period. Went into effect on August 16, 2019.

Illinois – IL H 3487 – State Health Insurance Marketplace

• Each hospital must post, in each facility that has an emergency room, a notice in a conspicuous location in the emergency room with information about how to enroll in health insurance through the State Health Insurance Marketplace. Went into effect on January 1, 2020.

Illinois – IL H 3509 – Donated Breast Milk

• State Employees Group Insurance Act, the Insurance Code, and the Public Aid Code; provides that donated breast milk must be prescribed by a licensed medical practitioner.
• Provides that milk must be obtained from a human milk bank that meets quality guidelines established by the Human Milk Banking Association of North America or is licensed by the Department of Public Health.
• Removes a requirement that the infant must be critically ill. Went into effect on January 1, 2020.

Illinois – IL S 174 – In-Office Membership Care Agreements

• Provides that an in-office membership care agreement provided under the Act is not insurance. Went into effect on August 2, 2019.

Michigan – MI H 4397 – Personal Protection Insurance

• Amends insurance laws.
• Requires insurers that offer automobile insurance to file premium rates or personal protection insurance coverage for automobile insurance policies effective after a specified date. Went into effect on June 11, 2019.

Michigan – MI S 1 – No-Fault Auto Insurance

• Makes miscellaneous changes to the Insurance Code related to no-fault automobile insurance coverage and benefit. Went into effect on June 1, 2019.

Michigan – MI S 362 – Healthy Plan Recipients

• Provides general assistance, hospitalization, infirmary, and medical care to poor or unfortunate persons; provides for compliance by this state with the Social Security Act.
• Provides protection, welfare, and services to aged persons, dependent children, the blind, and the permanently and totally disabled.
• Administers programs and services for the prevention and treatment of delinquency, dependency, and neglect of children. Went into effect on September 23, 2019.

Mississippi — MS H 628 – Health Insurance Late Payment Penalties

• Accident and health insurance policies to include additional provisions that penalize the late payment of claims by an insurer to a healthcare provider or insured party. Went into effect on July 1, 2019.

New Mexico — NM H 436 – Health Insurance Law

• Amends the Insurance Code, the Small Group Rate and Renewability Act, the Health Insurance Portability Act, the Health Maintenance Organization Law, and the Nonprofit Health Care Plan Law to align provisions relating to the accessibility of health care coverage to federal law. Went into effect on June 14, 2019.

Rhode Island – RI S 1038 – Insurer Payments on Access to Health Care Study

• Creates a Special Legislative Commission to Study the Impact of Insurer Payments on Access to Health Care. Enacted June 28, 2019.

Vermont – VT H 524 – Health Insurance and the Individual Mandate

• Health insurance and the individual mandate; clarifies who is exempt from the requirement to maintain minimum essential coverage, including certain religious, immigrant, or incarcerated individuals. Went into effect June 17, 2019, July 1, 2019, and January 1, 2020.

The Latest Healthcare Legislative Updates – Liens

Arkansas — AR S 542 – Medical and Hospital Service Liens

• Adds orthotists, prosthetists, and perdorthists as parties that can file a lien. Effective as of July 24, 2019.

Mississippi — MS S 2012 – Lien for Burn Care

• Creates a lien for causes of action accruing to an injured party for unpaid traumatic burn care. Went into effect on July 1, 2019. 

South Dakota — SD S 70 – Hospital Lien Law

• Requires hospitals that receive notification of a third-party payer of healthcare benefits for an injured person to submit to the payer for payment any reasonable and necessary charges for treatment, care, and maintenance before filing a hospital lien. 
• A lien may be filed by a person, association, limited liability company, corporation, county, or other institution, including a Municipal corporation, maintaining a hospital licensed under the laws of the state that furnish care. Effective July 1, 2019.

Utah — UT S 51 – Hospital Lien Law

• Requires that hospitals execute and file, at the expense of the hospital, a release of the lien and mail it to the injured patient, or representative upon receipt of the payment of the lien or the portion recoverable under the lien. Effective May 14, 2019.

Medicaid Programs Legislation

California – CA A 1088 – MediCal: Eligibility

• Requires the State Department of Health Care Services to seek a Medicaid state plan amendment or waiver to implement an income disregard that would allow an aged, blind, or disabled individual who becomes ineligible for MediCal benefits. Effective January 1, 2020. 

California – CA A 1642 – MediCal: Managed Care Plans

• Provide information in a request for alternative access standards and to demonstrate the delivery of MediCal services to enrollees. 
• The information must be compiled by the EQRO to include the extent to which each MediCal managed care plan uses clinically appropriate telecommunications technology to meet established time and distance standards. Effective January 1, 2020.

Connecticut – CT S 1052 – Medicaid Coverage of Telehealth Services

• Expands Medicaid coverage of telehealth services.
• Requires the Commissioner of Social Services to expand Medicaid coverage of telehealth services statewide whenever such coverage meets federal Medicaid requirements for efficiency, economy, and quality of care. Effective July 1, 2019.

Georgia — GA S 106 – Submission of Waiver Requests and Proposals

• Department of Community Health to submit a Section 1115 waiver request, which may include an increase in the income threshold; authorizes the Governor to submit an innovation waiver (Section 1332) proposal with respect to health insurance coverage or health insurance products. Passed on March 27, 2019.

Illinois — IL S 1321 – Child Care Assistance Program

• Amends the Procurement Code; directs the Chief Procurement Officer to work with the Department of Healthcare and Family Services to identify an appropriate method of source selection.
• Revises eligibility for the Children’s Health Insurance Program and other similar programs.
• Establishes a dispute resolution process. Effective August 5, 2019.

Iowa — IA H 625 – Medicaid Integration

• Integrates Medicaid and the Healthy and Well Kids in Iowa program eligibility payment and administrative functions under the Department of Human Services. Effective July 1, 2019.

Louisiana – LAH 211 – Medicaid

• Provides relative to Medicaid coverage of certain behavioral health services.
• Limits the number of reimbursable service hours per day for providers of certain behavioral health services.
• Requires release of certain information on claims for payment for behavioral health services. Effective August 1, 2019.

Louisiana – LAH 424 – Medicaid Program

• Revises provisions relating to the Medicaid program.
• Provides for denials of provider claims and prior authorization requests by Medicaid managed care organizations; requires Medicaid managed care organizations and the Department of Health to take certain actions pursuant to the denial of prior authorization requests by healthcare providers; requires publication of information related to prior authorization requirements on certain websites. Effective August 1, 2019.

Maryland — MD H 814 – Easy Enrollment Health Insurance

• Easy Enrollment Health Insurance Program, which allows the state to use tax return forms to identify uninsured residents and refer them to no-cost or low-cost health insurance. Went into effect on June 1, 2019.

Montana — MT H 658 – Healthcare Laws and Medicaid Revisions

• Extends the Medicaid Expansion Program by revising the termination date of the state Health and Economic Livelihood Partnership Act. 
• Establishes community engagement requirements for Help Act participants, ensures Medicaid eligibility verification procedures, and establishes the Help Act Employer Grant Program. Fully effective on January 1, 2020.

New Jersey – NJ A 4744 – Medicaid Medication-Assisted Treatment Benefits

• The Department of Human Services requires medication-assisted treatment benefits under the Medicaid program. Went into effect on October 13, 2019.

New Jersey – NJ S 499 – Medicaid and FamilyCare

• Provides for an improved system for eligibility determination for Medicaid and FamilyCare. 
• Relates to the time between the individual of an application and a request for verification letters sent to an applicant.
• The Department of Human Services must publish certain metrics and performance evaluation results on its website. Went into effect on August 23, 2019.

North Carolina – NC H 656 – Medicaid Transformation

• Laws pertaining to Medicaid and State Health Choice Managed Care Programs are modified as needed for the implementation of the Medicaid transformation.
• Regulations and requirements are established for dis-enrollment from prepaid health plans; revises provisions relating to the appeals process. Full in effect on October 1, 2019.

Nevada – NV S 198 – Medicaid Eligibility

• All provisions relating to Medicaid are revised. 
• The Division of Welfare and Supportive Services must analyze and report certain information concerning the eligibility of children for Medicaid. Went into effect on June 12, 2019.

Nevada – NV S 174 – Autism Spectrum Disorders Services

• Various changes relating to services provided to persons with autism spectrum disorders are modified.
• The Legislative Auditor must conduct an audit of the Medicaid program concerning the delivery of such services. Went into effect on June 7, 2019.

Texas – TX H 72 – Medicaid Benefits for Adopted Children

• Relates to the continuation of Medicaid benefits provided to certain children adopted from the conservatorship of the Department of Family and Protective Services. Went into effect on September 1, 2019.

Benefits and Billing Legislation

Colorado — CO H 1174 – Out of Network Health Care Services

• Health insurance carriers, health care providers, and health care facilities must provide patients covered by health benefit plans with information that is concerning services by out of network providers, and in and out of network facilities. Went into effect on January 1, 2020.

Nevada — NV A 469 – Emergency Services Billing

• The amount a provider of health care can charge a person is limited if they have health insurance that is for a certain necessary medical emergency when the provider is out of network. 
• An insurer must arrange the transfer of an individual who has health insurance to a facility that is in-network when necessary. Went into effect on January 1, 2020.

New Mexico — NM S 337 – Surprise Billing Protection Act

• Insurance is required to reimburse out-of-network providers for emergency services where evaluating and stabilizing a patient is necessary and prior authorization is not required with emergency situations.
• Cost-sharing is limited to the same co-payments, co-insurance, or limitations of benefits to the same extent. 
• Balance billing of an individual at an in-network facility who receives treatment by an out-of-network provider when they do not have the option or ability to choose their provider or treatment by an out-of-network provider is medically necessary is prohibited. Individuals who knowingly select an out-of-network provider may be held responsible for full charges.
• The bill also sets out reimbursement and overpayment procedures for surprise medical bills. Took effect on January 1, 2020.

Tennessee — TN H 1342 – Patient Billing Notices

• Individuals have the right to assign their benefits to a healthcare policy and those rights must be stated clearly in the policy. 
• There must be a notice of an assignment in writing by the insurer, otherwise, it isn’t effective. 
• Prior to treatment, the facility must provide a written notice to the individual or representative that includes required statements in the act.
• If a facility is out-of-network, the physicians may have a right of indemnification against the facility for an insurer’s disregard of an assignment of benefits should they provide detailed notices to the patient.
• Healthcare facilities are not able to collect out-of-network charges from an insured containing large amounts of cost-sharing unless it is in a written notice before treatment. Prior notice is not required when treatment is through an emergency department and the patient is unconscious or incapacitated but must be provided following stabilization. Went into effect on April 30, 2019.

Texas – TX S 1264 – Consumer Protections Against Billing

• Consumers are protected against medical and health care billing that is out of network.
• The procedure is provided for an injunction for balance billing.
• Enforcement by regulatory agencies is provided.
• Balance billing prohibition notices are provided and mandatory coverage of emergency care is expanded. Went into effect on September 1, 2019.

Washington — WAH 1065 – Health Care Services

• Consumers are protected from charges that are out-of-network health care services.
• Mental health and substance use disorders are added to emergency medical conditions and define balance bills, in-network, and out-of-network. Went into effect fully on June 30, 2019.

Child Health Care Coverage Legislation

Illinois – IL H 2894 – Covering All Kids Health Insurance Program Act

• Amends the Covering All Kids Health Insurance Act. 
• The repeal date for the act is extended. Went into effect on August 9, 2019.

Michigan – MI H 4304 – Child Health Care Coverage

• Provisions and enforcement of support, health care, and parenting time orders dealing with divorce, separate maintenance, paternity, child custody and support, and spousal support are provided.
• Prescribes the powers and duties of the circuit court and friend of the court.
• Prescribes certain duties of certain employers and other sources of income. 
• Provides for penalties and remedies. Went into effect on June 20, 2019.

New Hampshire – NH S 274 – Newborn Home Visiting Program

• Newborn Home Visiting Program shall be available to all Medicaid eligible families. Went into effect on September 17, 2019.

New York – NY A 8053 – Child Health Insurance Plan

• Amends the Public Health Law. 
• The expiration date for the Child Health Insurance Plan is extended. Went into effect on July 3, 2019.

Texas – TX S 750 – Maternal and Newborn Health Care

• Relates to the quality of services provided to women dealing with maternal and newborn health care.
• An application for funding to implement a model of care for Medicaid recipients is provided.
• Provides for referrals from the Healthy Texas Women Program to the Primary Health Care Services Program
• Provides for enhanced prenatal and postpartum care services, including postpartum depression. Went into effect on June 10, 2019.

Health Insurance Legislation

Arizona — AZ H 2494 – Health Care Service Contracts

• A contract between a health insurer and health care provider must be issued, amended, or renewed on or after a specific date to provide health care services to health insurer’s enrollees. 
• Can not restrict the method of payment from a health insurer to health care provider if a credit card payment is the only acceptable method or an electronic funds transfer payment. Will take effect on the 91st day after session adjournment.

California – CA S 260 – Automatic Health Care Coverage Enrollment

• Requires the Health Care Exchange to enroll an individual in the lowest costs silver plan or another plan upon receiving the individual’s electronic account from a county, or upon receiving information from the State Department of Health Care Services regarding an individual terminated from department-administered health coverage. Went into effect on January 1, 2020.

California – CA A 1309 – Health Care Coverage: Enrollment Periods

• A health care service plan and a health insurer are required for a policy beginning on or after a specific date, to provide an enrollment period to allow individuals to enroll in individual health benefit plans through the Health Benefit Exchange in a specified timeframe. Went into effect on January 1, 2020.

Delaware – DE S 35 – Insurance Code

• The Insurance Code relating to health insurance contracts is amended.
• Provisions relating to the individual and group health insurance markets that work directly with the Patient Protection and Affordable Care Act are revised. Went into effect on August 6, 2018.

Illinois – IL H 3487 – State Health Insurance Marketplace

• Amends the University of Illinois Hospital Act and Hospital Licensing Act.
• Each hospital must post in each emergency room, a notice in a location that can be seen easily about how to enroll in health insurance through the State Health Insurance Marketplace. Went into effect on January 1, 2020.

Illinois – IL S 174 – In-Office Membership Care Agreements

• The In-Office Membership Care Act is amended.
• Provides that an in-office membership care agreement provided under the Act is not insurance. Went into effect on August 2, 2019.

Maine — ME S 10 – Consumer Protections for Health Coverage

• The consumer is protected in relation to health insurance coverage included in the federal Patient Protection and Affordable Care Act.
• Individuals and group health plans can not impose any pre-existing condition exclusion on an enrollee and carriers are restricted to enrollment in individual health plans to open enrollment and special enrollment periods established in the rule. Went into effect on March 19, 2019.

Michigan – MI H 4397 – Personal Protection Insurance

• Insurance laws are amended.
• Insurers are required to offer automobile insurance to file premium rates or personal protection insurance coverage for automobile insurance policies effective after a specified date.
• Relates to transportation network companies. Went into effect on June 11, 2019.

Mississippi — MS H 628 – Health Insurance Late Payment Penalties

• Accident and health insurance policies require additional provisions that penalize late payments of claims by an insurer to a healthcare provider or insured party. Went into effect on July 1, 2019.

Nevada — NV A 170 – Health Insurance Coverage

• The insurer must provide information that is related to accessing health care services to the Office of Consumer Health Assistance, the Governors Consumer Health Advocate to submit a report of such information to the Legislature, an insurer to offer a health benefit plan regardless of health status, and an Advocate to take certain actions to assist consumers in accessing health care services. It incorporates ACA protections on a state level. Went into effect on January 1, 2020.

New Jersey – NJ A 5499 – Health Benefit Plan State-Based Exchange

• The Department of Banking and Insurance is authorized to establish an exchange for certain health benefits in-state.
• The Department of Health Services is required to apply for federal funds for integration of Medicaid eligibility platforms and exchange. Enacted June 28, 2019. 

New Mexico — NM H 285 – Short-Term and Limited Benefit Plan Act

• Establishes guidelines relating to a short-term health and excepted benefit coverage.
• No longer able to sell and issue unlicensed and unapproved health benefits plans.
• Amends sections of the New Mexico insurance code, the health maintenance organization law, and the nonprofit health care plan law to establish direct-service ratio applicability for short-term plans. Went into effect on June 14, 2019.

The Latest Healthcare Liens Legislation

Arkansas — AR S 542 – Medical and Hospital Service Liens

• Orthotists, prosthetists, and perdorthists are added as parties that can now file a lien. Went into effect on July 24, 2019.

Mississippi — MS S 2012 – Lien for Burn Care

• Lien is created for the cause of actions occurring to injured individuals for traumatic burn care that is uncompensated. Went into effect on July 1, 2019.

South Dakota — SD S 70 – Hospital Lien Law

• Amends the hospital lien law. 
• Requires that hospitals receive notification of a third-party payer of healthcare benefits for an injured individual to submit to the payor for payment any reasonable and necessary charges for treatment, care, and maintenance before filing a hospital lien.
• If a lien has already filed, they will then need to submit a request for payment to the payer. If the payer fails to pay, the hospital can file a lien or enforce the existing lien. Went into effect on July 1, 2019.

Utah — UT S 51 – Hospital Lien Law

• At the expense of the hospital, hospitals must execute and file a release of the lien and mail it to the individual that is injured, their heirs, or representative upon receiving the payment of the lien or the portion recoverable under the lien. Went into effect May 14, 2019.

Medicaid Programs Legislation

California – CA S 78 – Health

• Certain health information is allowed to be shared that is related to lead screening for children enrolled in MediCal.
• Minimum Essential Coverage Individual Mandate is created to require individuals to maintain minimum essential coverage.
• Individual Market Assistance is created to be able to provide healthcare coverage assistance.
• Vocational rehabilitation programs are provided for. Enacted June 27, 2019

California – CA A 1088 – MediCal: Eligibility

• The State Department of Health Care Services must seek a Medicaid state plan amendment or waiver to implement income disregard that allows aged, blind, or disabled individuals who become ineligible for MediCal benefits to remain eligible for the MediCal program if their income resources otherwise meet the rest of the eligibility requirements. Went into effect on January 1, 2020.

Connecticut – CT S 1052 – Medicaid Coverage of Telehealth Services

• The Commissioner of Social Services requires Medicaid to expand coverage of telehealth services statewide when coverage meets federal Medicaid requirements. Went into effect on July 1, 2019.

Hawaii – HI H 1453 – Emergency Ambulance Services

• The Department of Health is authorized to establish fees for transportation to medical facilities for emergency medical services.
• Transportation by ambulance to other medical facilities that are not hospitals under emergency circumstances are also authorized.
• Medicaid and private insurances are required to cover ambulance services.
• Medicaid programs and private insurers are required to provide coverage for statewide community paramedicine services rendered by emergency medical technicians or paramedics. Went into effect on June 25, 2019.

Illinois — IL S 1321 – Child Care Assistance Program

• The Procurement Code is amended.
• The Department of Healthcare and Family Services is required to work with the Chief Procurement Officer to identify a method of source selection for the proper techniques required to be able to implement the Integrated Eligibility System.
• Eligibility for the Children’s Health Insurance Program is revised. Went into effect on August 5, 2019.

Iowa — IA H 625 – Medicaid Integration

• Medicaid and the Healthy and Well Kids in Iowa program eligibility payment and administrative functions are integrated. Went into effect on July 1, 2019.

Louisiana – LAH 211 – Medicaid

• Medicaid coverage of specific behavioral health services is provided.
• The number of reimbursable service hours a day is limited for providers with specific behavioral services. 
• Requires inclusion of certain information on claims for payment for behavioral health services. Went into effect on August 1, 2019.

Maryland — MD H 814 – Easy Enrollment Health Insurance

• The Easy Enrollment Health Insurance Program is established. Went into effect on June 1, 2019.

New Jersey – NJ A 4744 – Medicaid Medication-Assisted Treatment Benefits

• The Department of Human Services is required to ensure that medication treatment benefits are provided under Medicaid programs without prior authorization. Went into effect on October 13, 2019.

New Mexico — NM S 41 – Medicaid Providers Due Process

• Preserves access to Medicaid services and Medicaid providers and subcontractors are provided with due process.
• Provides for hearing officers and judicial review of credible allegations towards fraud determination.
• Hearing officers are provided for. Went into effect on January 1, 2020.

North Carolina – NC H 656 – Medicaid Transformation

• Laws pertaining to Medicaid and State Health Choice Managed Care Programs are modified for implementation of Medicaid transformation.
• Regulation and requirements for dis-enrollment from prepaid health plans are established.
• Provisions related to the appeals process are revised. Went into effect fully on October 1, 2019.

New Hampshire – NH S 290 – State Granite Advantage Health Care Program

• Changes to the State Granite Advantage Health Care Program were made including: 
  • Beneficiaries that are subject to the work and community engagement requirements.
  • The number of hours for work and community engagement requirements are reduced.
  • Exemptions for certain individuals are added.
  • Circumstances for the elimination of the requirements are added. Went into effect on July 8, 2019.

Nevada – NV S 198 – Medicaid Eligibility

• Provisions relating to Medicaid are revised.
• The Division of Welfare and Supportive Services are revised to ensure specific information dealing with the eligibility of children for Medicaid. Went into effect on June 12, 2019.

Nevada – NV S 174 – Autism Spectrum Disorders Services

• Changes were made relating to services provided to individuals with autism. 
• The Legislative Auditor requires an audit of Medicaid programs that concern the delivery of services. Went into effect on June 7, 2019.

Texas – TX H 72 – Medicaid Benefits for Adopted Children

• Medicaid benefits are provided to specific children that are adopted from the conservatorship of the Department of Family and Protective Services. Went into effect on September 1, 2019.

What’s Next?

To learn more about how The Midland Group stays informed about the latest legislative healthcare updates that are related to our revenue cycle management services, contact us today!

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What’s the Problem?

While the issue at hand is multi-factorial, one of the biggest causes of these closures and losses is revenue pressure. According to Becker’s Hospital Review, “rural areas have fewer commercial payers than more urban markets, which means these hospitals have a higher volume of state-funded healthcare with lower reimbursement rates.” To add to that issue, we also know from experience that many Critical Access Hospitals struggle to secure reimbursement when patients are transferred to the larger Acute care facilities not long after they arrive. Larger facilities have dedicated personnel to deal with the complexities of filing rules, which tends to affect which facility receives the applicable reimbursement to be in their favor. With their comparative lack of resources, it’s easy to understand why Critical Access Hospitals often miss out on various reimbursement opportunities and thus have significant financial struggles.

Introducing Midland On-Call

Here at The Midland Group, we believe in the importance of helping Critical Access Hospitals not only survive, but thrive. We understand that, unlike many of the larger hospitals, Critical Access Hospitals hold up an important pillar of the economy in many rural areas. In fact, we believe that not only are Critical Access Hospitals vital in the creation of jobs and opportunities for its communities, they also act as incentive for businesses to open their doors and for families to move to these counties. As the NRHA puts it, “without a rural hospital, a community will crumble.”

That’s where we step in.  After many long months spent on careful development, The Midland Group is pleased to announce our latest program, Midland On-Call: Patient Advocacy and Self-Pay Solutions reserved exclusively for Critical Access Hospitals.  This membership program offers Critical Access Hospitals the same resources and firepower traditionally reserved for large acute care hospitals and multi-provider based healthcare systems in a way that is effective and financially makes sense for any CAH facility.

Features of Midland On-Call include:

• Public Benefit Eligibility Solutions including Medicaid Screening & Application Processing, SSI/SSDI, Crime Victims Compensation, etc.
• Early Out Support including prompt-pay and payment plan negotiation.
• Managed payment plans at no cost to your hospital.
• Financial Assistance Screening and application assistance
• Accident Recovery Solutions including PIP/Med-Pay capture, hospital lien filing, and Workers’ Compensation follow-up.
• Annual 501(r) compliance consultation & legal review, ongoing business office training & support, and much more.
• You choose how patient-centered resources are applied to your patient population.

Now What?

We understand the confusion and difficulty in navigating the financial landscape of healthcare these days. If you are part of a Critical Access Hospital, know that you are not alone. As a community-minded partner, The Midland Group has helped countless facilities–small and large alike–to increase billing efficiency and maximize reimbursement rates. As a member of the Midland On-Call program, our participating CAH partners ensure that their patients receive the advocacy they need to qualify for public healthcare benefits and have the information they need to resolve their self-pay balances. Book your free assessment today to learn more about the program and find out how you can secure an On-Call membership. Let us deal with the hard stuff so that you can focus on what matters.

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Here at The Midland Group, it is our mission “to improve access to healthcare for the low income and disadvantaged” and protect the financial health of hospitals across the nation. Why? It’s simple: we have seen time and time again that success in one naturally leads to success in the other. By offering a personal approach to hospital revenue cycle solutions, we equip our network of hospital clients with greater control over their cash flow while helping their patients resolve their bills in a reasonable and dignified manner. There is nothing more we love doing than to help hospitals advance their mission and build a healthier future for their communities.

As you know, the healthcare environment in 2019 underwent significant changes. Yet, by streamlining the process of cash-conversion and offering personal dedication to each patient’s case, we were able to provide on-demand solutions to those issues — I am proud to say that despite the external challenges presented, the Midland team was able to overcome and continue what we do best: reduce hospital bad debt and secure hard-to-capture dollars for our clients, all while offering a win-win solution for both patient and hospital receivables.

This year, my goal is to ensure that our team continues to grow in our ability to provide exactly what our clients need and anticipate those needs even before they arise. We have been blessed to welcome Disability Professionals into our Midland family and I firmly believe that the DP team will add exceptional value to those seeking disability benefits.  In addition, I am thrilled to announce that The Midland Group is set to introduce several new programs in 2020 that have been under careful development, and I look forward to seeing our community benefit from those programs.

As a 501(c)(3) charitable trust-owned-and-managed company, The Midland Group was founded with a vision to serve the needs of the community, and I consider it a privilege to be a part of such an exceptional team of individuals who are passionate about providing the most excellent tools and genuine care for our hospitals, patients, and their families.

Thank you to everyone who have partnered with us as we step into this new year – I certainly look forward to working with you as we add value to our surrounding community together.

Roger McCollister
Founder & Chief Executive Officer
The Midland Group

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