CEO Message

Rate Setting, Front and Center

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Surprise billing continues to garner attention from both federal and state lawmakers — and it’s a vitally important conversation. Patients should not be caught off guard by unexpected bills for out-of-network emergency care. Hospitals have said all along that when patients need emergency care, we support protecting them from surprise bills by limiting their out-of-network cost sharing to no more than the amount for in-network patients.

In fact, when the issue was being discussed in Sacramento, before the bill was even introduced in the state Legislature, we were among its first supporters. However, Assembly Bill 1611 (Chiu, D-San Francisco) included more than patient protection from surprise bills — it included provisions that would have the state set the rates insurance companies pay to hospitals for that care, which benefits insurance companies but does nothing to ensure they pass their savings along to consumers.

Fortunately, the bill’s author has paused efforts on AB 1611 for this year because of the complexities around the hospital rate-setting provision — a strategic shift that you were instrumental in bringing about. Your letters and conversations with legislators made a clear difference.

The hospital voice was heard, and it will be needed again. AB 1611’s author has promised to bring the bill back next year, and lawmakers in Washington, D.C., advanced a similar proposal just this week.

On Wednesday, a bill that aims to set a benchmark rate for provider payments for out-of-network emergency services (with some allowances for arbitration) passed out of the House Energy and Commerce Committee and will now go to the full House for a floor vote. On top of that, other congressional committees may yet release even more, similar proposals.

There’s no question that AB 1611’s pause is a positive development, but we can’t afford to lose any momentum in our efforts to educate elected officials about the risks rate setting carries for your patients and communities.

CHA continues to engage with lawmakers at every level, advocating for change that protects patients without setting payment rates that advantage insurance companies and encourage them not to contract with hospitals and doctors.