NC Senate aims to curb Medicaid costs and allow more insight into hospital charges

A state Senate committee advanced a bill Thursday that would limit the fees hospitals can charge Medicaid for outpatient care.

House Bill 727 would prevent hospitals tacking extra fees, called facility fees, to Medicaid bills when patients are treated outside some hospital settings.

To charge a facility fee under the bill, hospital systems will have to have treated patients in a main hospital or nearby building, a building with an emergency department, or an ambulatory surgical center.

Sen. Jim Burgin (R-Harnett) said this week that for years now, hospitals have been adding the fees to bills for outpatient office visits.

This is one of several bills legislators have promised to consider this year as they look to control rising Medicaid costs.

"This is a step toward trying to address fees, and especially facility fees, that are charged at facilities that have either been purchased or that are away from campus," Burgin told members of the Senate Health Care Committee this week.

The proposal is a narrower version of a provision included in a sweeping bill the Senate passed last year aimed at reducing healthcare costs. The Senate initially wanted to curb facility fees for other kinds of insurance, in addition to Medicaid. The state House did not consider that Senate bill.

Hospitals have objected to proposed facility fee limits. Josh Dobson, CEO of the North Carolina Healthcare Association — a group that represents hospitals — told legislators in March that facility fees help pay for medical staff, equipment, and supplies in hospitals and hospital-owned clinics, NC Newsline reported.

NC legislators question hospital fees charged for outpatient care

The Senate Health Care Committee also approved House Bill 390, which would allow the state's Medicaid managed care companies to ask hospitals for itemized bills when a patient's inpatient Medicaid charges top $250,000, or in some cases where a patient's treatment costs more than expected.

Managed care plans can already ask for itemized hospital bills for charges over $250,000, according to the state's guide for managed care billing. The bill the Senate committee endorsed Thursday would allow the managed care companies to ask for detailed hospital bills for unusually high charges even when that $250,000 threshold isn't reached.

Sen. Benton Sawrey (R-Johnston) said the proposals are aimed at controlling costs and providing more transparency "so we have more information about what is, in fact, driving the costs."

With the state looking at paying an additional $1 billion for Medicaid in the next budget year, it's fair to ask why costs are going up, Sawrey said.

Courtesy of NC Newsline