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!

The post What’s Going On with the New Legislative Healthcare Updates? appeared first on The Midland Group.

In the context of third-party billing, we believe that it is extremely important for providers to obtain reimbursement for their services within a reasonable amount of time. We also understand the necessity for third-party payers to have the chance to thoroughly scrutinize their responsibility in the payment of the claim and decide if the services provided are truly necessary.

According to the golden rule for third-party billing, there is no obligation to guarantee coverage or any other liability in the event that coverage lapses due to the third party’s failure to submit payment by the due date. Simply put, if a charge is not documented, you can not bill for it. When it comes to private payers, it is important to understand your third-party payer contract so as to avoid any lapses in reimbursement. 

Seven Tips To Understand Your Third-Party Payer Contract

• Know your rights. To avoid delays in payments that would cost you, be sure that you understand your rights when speaking about a contract and request a better explanation of the insurance provider’s payment schedule language if you don’t understand. 

• Define payment period for clean claims. Always make sure that there is a clause that holds the health plan responsible for paying any claims within a specific period of time. Without this clause, there is no obligation on the part of the health plan to pay the claim within a reasonable amount of time. During this step, make sure you ask for clarification on what a payer deems as a clean claim and if there are additional requests for information that is considered reasonable. 

• Define payment period for unclean claims. Make sure that you have a firm definition of the timeframe in which the health plan can return a claim as unclean. This will help avoid the health plan from holding unclean claims to delay any payments. The contract should also specify how much time will be allowed to review this additional information before any payments are made. 

• Address claims considered “not to file.” Your contract should require the health plan to acknowledge receipt of an electronic claim within 24 hours of receiving it. Failure to be acknowledged, the health plan should be contracted and the claim resubmitted. If the health plan states that they never received a claim, you will be able to provide documentation of the original file date and require that they pay within the guidelines that were stated in the contract. 

• Identify penalties. List what penalties are to be addressed when the health plan does not pay according to prompt-payment guidelines. State that participating provider discounts be waived and the health plan will be liable for 100% of billed charges plus interest. If not attainable, the health plan should be obligated for payment of the claim plus pre-set interest. 

• Protect your payment. Your contract should specify that all payments made are considered final unless the provider receives a written request within a specified period of time after receipt of payment. 
• Perform regular reviews. Always be sure to review your contracts regularly as most contracts have an automatic annual renewal. Check with your state regarding prompt-payment laws and request appropriate addendums to your contract before renewing.

Now What?

Providers are becoming better educated in the reimbursement process and state legislation. That’s why it’s crucial that you work with your third-party payers to help negotiate fair and equitable contracts. The Midland Group specializes in Third-Party Billing for Healthcare. As a third-party billing specialist, The Midland Group will submit, process, and collect all third-party liability claims necessary to collect as much revenue as possible for the hospital and to reduce the patient’s personal financial burden. Our trained medical billing professionals can help you optimize your billing system to increase revenue and improve the patient experience. Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

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What’s Causing Large Statement Balances?

A recent study showed that patient statement balances after insurance grew by more than 52 percent between 2012 and 2017. To break that down even further, that is an increase from 8 percent of the total statement to more than 12 percent. Approximately one-third of Americans can’t afford unexpected medical bills over $100 and many hospitals are struggling to find a solution to recuperate costs. 

Individuals who spent any time uninsured or who were underinsured reported to have problems paying large statement balances or said they would pay the medical debt over a long period of time. A quarter of those individuals who were always insured and did not meet the threshold of underinsurance also reported having problems paying their large statement balances.

Attempting to Collect Patient Payments

Many hospitals are attempting to collect payments from the patient at the time of service to address the problem of self-pay balances. The problem with that is that patients are usually at a loss for what their insurance will pay. Patients are typically going through very stressful situations where staff may feel uncomfortable trying to collect large payments. In addition, most hospitals don’t have the appropriate amount of staff or budget to follow up with patients by a phone call or mailing more than a couple of collection letters for their large statement balances. Other hospitals might not even have the technology or familiarity to offer payment plans or online payment options. 

Ways You Can Reduce Your Facility’s Outstanding Balances

One way that hospitals and providers can increase available resources is by participating in third-party early out solutions programs. Early out programs offer customer-oriented proceeding toward collecting balances from patients. Early out programs are very often successful with this because doing so is their main focus. In fact, early out programs are able to center their attention on patient collections at a much lower cost than a hospital trying to do the same. This is because hospitals would have to hire additional staff, pay for statement costs, credit card fees, additional phones and computers, employee benefits, and much more. 

Another way that you can reduce your facility’s outstanding balances is by making sure that the hospital leaders aim to implement a healthcare revenue cycle that is data-driven. This helps revenue cycle leaders to be able to know the hospital’s financial health of the organization. It also allows revenue cycle leaders to see if staff are performing their tasks efficiently to ensure quick reimbursements.

Offering Different Payment Options for Large Statement Balances

Early out solutions programs allow hospitals to offer more than one payment option to patients. Many individuals aren’t able to pay their large balance statements because of poor timing, lack of payment plan options, or having to pay for other bills. In addition, COVID-19 is now playing a huge role in financial hardships for individuals. Some may be experiencing a reduction of hours at their job, or some might be experiencing being unemployed altogether. 

When self-pay patients are notified of all of their options for payment plans, when they are educated about the financial assistance that is available to them, and when they are able to speak to someone on a personal level and someone who takes the time to sympathize with them to find a solution that works for them, they will be more likely pay and reduce large statement balances.

What’s Next?

With The Midland Group’s early-out program, patients are able to pay their financial obligation in full with no negative impact on their personal credit record or credit report. For hospitals, it is an opportunity to collect 100% of charges owed with greatly reduced administrative costs. Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

The post As a Healthcare Facility, How Do I Reduce Large Statement Balances? appeared first on The Midland Group.

It’s no surprise that Critical Access Hospitals nationwide are negatively impacted by COVID-19. As of November 2nd, Kansas has had 89,227 COVID-19 cases, 3,893 hospitalizations, and 1,046 statewide deaths. Just a few weeks ago, a rural hospital in southwestern Kansas was unable to care for a severely ill patient with COVID-19. The patient needed to be treated in the ICU, however, the closest ICU was completely full, and the nearest open ICU was seven hours away. Once there was eventually a spot in the closest ICU, the patient was in desperate need of being intubated and was starting to decline. The coronavirus is starting to get worse, and the Critical Access Hospitals are beginning to struggle.

What’s The Issue With Critical Access Hospitals?

Critical Access Hospitals are struggling the most during this pandemic because they are under the most financial distress. Over the past 15 years, 174 rural hospitals have had to close in the United States and the pandemic is only accelerating this trend. So far, 15 rural hospitals have closed in 2020 due to hospitals being forced to cancel elective surgeries, which is the main source of their revenue. Among the rural hospitals that remain, more than half of them don’t have an intensive care unit.

Before the pandemic hit, smaller hospitals were already unable to maintain their hospital status under the current payment system. “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,” according to Becker’s Hospital Review. Larger hospitals can dedicate individuals to deal with these difficulties of filing rules, which helps decide which facility receives the applicable reimbursement to be in their favor. Critical Access Hospitals lack resources in this department; therefore, they often miss out on various reimbursement opportunities which leads to financial distress.

How Midland On-Call Can Help Critical Access Hospitals

Here at The Midland Group, we believe that Critical Access Hospitals are not only vital in the creation of jobs and opportunities for communities, they also allow businesses to continue opening their doors. That is why we created Midland On-Call: Patient Advocacy and Self-Pay Solutions, which is reserved exclusively for Critical Access Hospitals. The Midland Group believes that Critical Access Hospitals should have the same resources and firepower that is traditionally reserved for large acute care hospitals and multi-provider-based healthcare systems.

Features of Midland On-Call Include:

Public Benefits Eligibility Solutions consisting of Medicaid Screening & Application Processing, SSI/SSDI, Crime Victims Compensation, etc.

Early Out Support which includes prompt-pay and negotiating payment plans.

Managed payment plans at no cost to your hospital.

Financial Assistance Screening and assistance with the application.

Accident Recovery Solutions consisting of 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 get to choose how patient-centered resources are applied to your patient population.

Now What?

If you are part of a Critical Access Hospital and you’re struggling, know that you aren’t alone. The Midland Group has helped large and small facilities increase billing efficiency and maximize reimbursement rates. As a member of the Midland On-Call program, you can ensure that your patients are receiving the advocacy they need to qualify for public healthcare benefits and the information they need to resolve their self-pay balances with your hospital. Book your free assessment today to see how you can maximize all potential revenue surrounding all types of liability claims.​

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