Health Access California Issues Public Comment on Centers for Medicare & Medicaid Services Proposed Rule

WASHINGTON, Oct. 23 -- Anthony Wright, executive director of Health Access California, Sacramento, has issued a public comment on the Centers for Medicare and Medicaid Services proposed rule entitled "Requirements Related to Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement". The comment was written on Oct. 18, 2021, and posted on Oct. 19, 2021:

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Health Access California, California's statewide health care consumer advocacy coalition committed to quality, affordable health care for all Californians, offers comments on the proposed rule, CMS-9907-P, implementing the No Surprises Act, based on our California experience with both surprise medical bills and short-term, limited duration health insurance.

As the four agencies have acknowledged in prior rule-making on surprise medical bills, California as well as other states have existing state law on surprise medical bills. California law has also banned short-term, limited duration health insurance.

Air Ambulance Surprise Medical Bills

In 2019, AB651 (Grayson), Chapter 537 of California Statutes, banned balance billing for air ambulance services for state-regulated health insurance. The law states clearly that the consumer is only liable for in-network cost sharing which also accrues to the deductible, if any, and maximum out of pocket limit, if any. This change in law has been successful in protecting most California consumers from air ambulance surprise medical bills. California is the third largest state, after Alaska and Texas, extending almost 800 miles north to south with many remote rural areas that depend on air ambulance transport often from small, rural hospitals to large, urban hospitals.

Because of federal pre-emption through the Airline Deregulation Act, the California law did not set a payment standard for air ambulances. For this reason and because California law does not reach self-insured plans regulated by the federal Department of Labor, we are pleased to see the additional protections of the No Surprises Act applied to self-insured plans and a payment standard applied to all individual and group coverage.

Short-Term, Limited Duration Coverage

In 2018, Health Access California was the organizational sponsor of SB910, Chapter 687 of California Statutes, which expressly prohibited any insurer from the offer, issue, sale, or renewal of any short-term, limited duration health insurance in California. Other states have also banned or severely limited short-term, limited duration health insurance.

California's successful exchange, Covered California, is a ready source of short-term coverage: about 40% of its enrollees are enrolled for less than a year. As the organizational sponsor of SB910, our experience was that with the options provided by Covered California, there was no need for short-term insurance, especially since that coverage undermined the insurance market rules adopted for the individual market consistent with (and more consumer-friendly) than the Affordable Care Act.

Because of this action by California and other states, we ask that the rule be amended so that it is clear that state action to prohibit short-term, limited duration health insurance is not pre-empted by the proposed federal rule.

We further ask that if any of the federal agencies receives information indicating that a broker or insurer is selling such coverage in violation of state law, that the federal agency inform the California Department of Insurance so that it may take appropriate enforcement action to stop this activity which is illegal in California.

Thank you for your consideration of these comments.

Sincerely,

Sincerely,

Anthony Wright

Executive Director

CC: California Insurance Commissioner Ricardo Lara

Mary Watanabe, Director, California Department of Managed Health Care

Peter Lee, Executive Director, Covered California

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The proposed rule can be viewed at: https://www.regulations.gov/document/CMS-2021-0147-0001

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