NCOIL adopts Improving Affordability for Patients Model Act

Belmar, NJ – At the 2025 National Council of Insurance Legislators Spring National Meeting in Charleston, SC, the organization adopted the NCOIL Improving Affordability for Patients Model Act sponsored by Rep. Tom Oliverson, M.D. (TX), NCOIL Immediate Past President.  The Model was passed by both the Health Insurance & Long Term Care Issues Committee and the NCOIL Executive Committee.

The Model provides states with a framework to prohibit healthcare facilities, including hospitals, from imposing facility fees for outpatient services and requires those facilities to accurately bill for services provided at hospital-owned facilities.  Facility fees refer to any fee charged that is intended to compensate the hospital, healthcare facility, or health system for its operational expenses and that are separate and distinct from fees billed by a healthcare facility for healthcare services.  By prohibiting these fees from being collected for services performed at off-campus locations, patients are not charged higher rates for the same quality of care based on where the services are performed.

Additionally, the Model sets forth transparency requirements for providers that charge a facility fee not prohibited by the Model.  In those instances, facilities would need to give notice in plain language to patients that a facility fee may be charged, indicate in that notice the range of the facility fees that could be charged, and require the healthcare provider to give the notice to a patient at the time an appointment is scheduled and again at the time the healthcare services are rendered.  Providers must also comply with annual reporting requirements and adhere to honest billing guidelines.  Finally, the Model outlines penalties and enforcement mechanisms for non-compliant facilities.

“As an anesthesiologist, I have seen from the ground level how this issue has grown in recent years.  There are instances where patients that went in for a doctor’s visit 20 years ago and paid no facility fee are now going to the same office and receiving the same quality of care but seeing their medical costs unexpectedly increase as a result of these fees being imposed,” said Rep. Oliverson. “It’s important that states address this issue to keep patients protected and I was proud to sponsor this Model to provide important guidance on how states can best do that.”

Rep. Michael “Sarge” Pollock, Chair of the NCOIL Health Insurance & Long-Term Care Issues Committee stated, “the Committee began discussing this topic over a year ago and it was clear from the get-go that many of our members wanted to take action in an effort to lower healthcare costs and protect consumer.  I applaud Representative Oliverson for leading this effort and I know we will all be watching with great interest as bills based on this Model are introduced in legislatures across the country.”

During the drafting and deliberation process, NCOIL legislators and staff heard from a wide array of interested parties including: the American Hospital Association, the BlueCross BlueShield Association, the Center on Health Insurance Reforms at the McCourt School of Public Policy at Georgetown University, the Leukemia & Lymphoma Society, the Texas Hospital Association, United States of Care, and the Utah Hospital Association.

“Making sure our constituents receive the healthcare they need in both an efficient and affordable way is always top of mind for us as legislators,” said Asw. Pamela Hunter (NY), NCOIL President.  “With many individuals and families experiencing rising medical costs, and in many cases accumulating medical debt, it’s important to ease that burden and common-sense solutions like the provisions in this Model go a long way in doing just that.”

NCOIL CEO Will Melofchik said, “The Committee put a significant amount of time and consideration into this issue and I’m thrilled that the organization was able to produce a result that will improve the lives of patients all across the country.  The outcome is a real testament to the hard work of the legislators and interested parties that consistently stay engaged with NCOIL.”

A full copy of the NCOIL Improving Affordability for Patients Model Act can be viewed here: https://ncoil.org/wp-content/uploads/2025/04/NCOIL-Improving-Affordability-for-Patients-Model-Act-Adopted-April-2025.pdf.