Yesterday, the state Office of the Insurance Commissioner (OIC) released stakeholder draft legislation modifying the state’s existing Balance Billing Protection Act (BBPA). The OIC also released a summary table , issue brief and an insurer technical advisory. WSHA and hospital stakeholders have been actively providing input to OIC in advance of the draft legislation. WSHA plans to comment on the stakeholder draft. OIC will be accepting comments at firstname.lastname@example.org through November 16, 2021, to be followed by final legislation. We ask that WSHA members copy WSHA on comments they submit to OIC and to provide input for WSHA’s comments to Andrew Busz, WSHA Policy Director, Finance at email@example.com.
The purpose of the legislation is to align our state’s BBPA with the federal No Surprises Act (NSA), which will go into effect January 1, 2022. The draft legislation includes balance billing protections for some additional services not addressed under the BBPA or NSA. Key provisions of the stakeholder draft:
- Adds behavioral health emergency services facilities, such as crisis triage and evaluation and treatment facilities, as emergency services providers subject to balance billing prohibitions.
- Expands the scope of services protected from balance billing to align with those of the NSA, including post stabilization services provided during an emergency and a broader set of non-emergency out-of-network services provided at in-network hospitals or facilities.
- Aligns the BBPA with the NSA standards regarding payment amounts and the independent dispute resolution process. WSHA had requested that OIC maintain the BBPA payment and arbitration standards for state regulated carriers. The draft legislation contains a provision that affirms an insurer cannot use the BBPA or the NSA’s out-of-network provider payment provisions as a substitute for meeting OIC’s network adequacy standards.
- Requires the OIC, in collaboration with the Health Care Authority and the Department of Health, to submit recommendations regarding potential balance billing provisions for ground ambulance services to the appropriate committees of the legislature by December 1, 2022.