ADVOCACY IN ACTION, CONT. Drs. Jim and Diane Baker had no idea they were paying these extra fees and counted on their business manager Madden to solve these issues: “Insurers are making it harder and harder to track hidden fees which lower our reimbursements. We are happy Cindy found this issue and was willing to testify in Salem about it.” Under the new law, insurers will be required to clearly communicate all applicable fees to process any electronic payment, and allow the provider to opt in. If the provider chooses not to accept virtual credit cards, the insurer must provide an alternative form for payment. Changing a process where providers had to pay an extra fee to get paid for services they provided was an easy concept for legislators to want to fix. SB 523 90-Day Grace Period It’s never a good sign when one good deed punishes another. One of the unforeseen side effects created by a rule in the Affordable Care Act (ACA) left providers exposed to potential bad debt related to unpaid premiums by patients. Under the ACA, patients who get their coverage through the exchange and receive some level of premium subsidy are eligible for a 90-day grace period to catch up on their premiums. This is good for the patients as it gives them an additional 60 days to catch up before being dropped from their plans. Thirty days is the general state standard when insurers are permitted to cancel policies for non-payment of premiums. The addition of another 60 days under federally-created exchanges led to an administrative problem: health care providers didn’t know their patients were in the new grace period. The OMA introduced SB 523 as a stopgap to allow providers more transparent access to insurer information. OMA’s Courtni Dresser explains: For health care providers, the grace period presented a problem because the provider took on the risk of non-payment. Usually, it’s the insurer that handles collecting premiums, providing coverage for services that the insured paid, and bearing the risk if an insured fails to pay their premium. It then falls on the provider's office to check on eligibility with the insurer, and then determine the patient's best course of treatment. Unfortunately, under the ACA rule, the changes to the grace period didn’t set requirements on how the provider is notified by the insurer of the patient’s grace period status. This was the problem SB 523 set out to resolve. This administrative confusion led to insurers only covering services provided in the first 30 days of the grace period. This forced the provider to bear the risk of non-payment for services that were expected to be covered by the insurance company. Effective in January, a provider who checks a patient’s eligibility within seven days of the date of service will be notified by the insurer within two days if the patient has missed a premium payment and is in the grace period. If the insurer fails to notify the provider, then the insurer must pay a claim for reimbursement of the service what was performed at any point during the entire 90-day grace period. Rural Health Medical Tax Credit Rural medicine is an issue of vital importance to Oregon. Keeping health care providers in rural and underserved areas is a challenge that OMA and our partners work to address. “Rural medicine needed a win and HB 2171 and HB 3396 both fell short,” said Dresser. The original bill, SB 757, drafted by the OMA, was intended to fund a study on health care provider incentive programs. The bill was well-received in public hearings and before two legislative committees, but late in the session Representative Nancy Nathanson (D-Eugene), co-chair of the Human Services Subcommittee of Ways and Means, introduced an amendment to a different bill, HB 3396, also related to incentive programs. “That amendment included language for the incentive programs for rural and underserved areas, and it reduced the funding for the study we introduced. We felt our bill was no longer going 16 Medicine in Oregon www.TheOMA.org
OMA Medicine in Oregon Fall 2015
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