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News & Press: State Legislation

Disclosure of Health Care Services and Price Information TO BE REQUIRED in 2019!

Thursday, December 27, 2018   (0 Comments)
Posted by: Sheri Ryan
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SB105 - "An Act relating to Disclosure of Health Care Services and Price Information" was introduced 4/4/2017 and signed into law 8/6/2018 with an effective date of 01/01/2019.  What is it and what does it mean to you as a Doctor of Chiropractic and your practice? 

 Download Enrolled SB105

PUBLIC NOTICE of Alaska's Health Care Price Transparency Law - posted 12/21/2018

Alaska’s new health care price transparency law (AS 18.23.400) will be effective in January 2019. The law requires health care providers and facilities to post the prices of their most common procedures. The State of Alaska’s Department of Health and Social Services will allow health care providers and facilities more time to comply with the law.

Pursuant to the enforcement discretion granted to the Alaska Department of Health and Social Services (DHSS) in AS 18.23.400(k), DHSS is announcing the following regarding the posting and publication of health care procedure prices and provision of good faith estimates under AS 18.23.400:

DHSS will not impose a penalty on any health care provider or health care facility for failure to comply with AS 18.23.400(a) – (f), requiring price collection, posting, and reporting to DHSS, beginning January 1, 2019 and continuing until implementing regulations are in effect.

DHSS expects that health care facilities, providers, and insurers will comply with AS 18.23.400(g)-(i), requiring provision of good faith estimates on request to patients, beginning on January 1, 2019. However, DHSS will not impose a penalty on any health care facilities, providers, or insurers for failure to comply with AS 18.23.400(g)-(i) until implementing regulations are in effect. 

 

Here's the Alaska Chiropractic Society's take on the above:  

Section 18.23.400 Disclosure and reporting of health care services, price, and fee information of SB105 brings two items to the table that you as a health care provider in the State of Alaska are now required to adhere to.

A.  You WILL BE required to annually compile, submit to the Department of Health and Social Services AND post a public list in your office of the health care services commonly performed in your chiropractic office by January 31st of each year.  The State of Alaska is currently in the process of implementing regulations regarding this section.   See the list below for the details on the requirements for the posted list from the statute.  Please note - the regulations, once written and put in place, may have changes.  ACS recommendation is to hold on this part of SB105 until the regulations are in place.  ACS will keep you updated when those regulations are in place.

BAs of January 1, 2019, chiropractic offices are now required to provide upon request by a patient, "a good faith estimate of the reasonably anticipated charges for treating the patient's specific condition" within 10 business days after receiving the request.  Pay attention to this part and put an office policy in place NOW.  See details below for specifics of "good faith estimate".

A.  The public notice posted in your office shall include

  • the top 10 commonly performed procedure codes from each of the 6 sections of Category 1, Current Procedural Terminology.  If you perform less than 10 codes from a particular section, include all.   
    • Evaluation and Management (99201 - 99499)
    • Anesthesiology (00100 - 01999, 99100 - 99140)
    • Surgery (10021 - 69990)
    • Radiology (70010 - 79999)
    • Pathology + Laboratory (80047 - 89398)
    • Medicine (90281- 99199, 99500 - 99607)  This would include all your CMT codes and PT/modality codes.  

  • a brief description in plain language that an individual with no medical training can understand of that service
  • the undiscounted price you charge for that service
  • and any facility fees
  • the public notice needs to be printed in a font no smaller than 20 points
  • must be posted in a conspicuous place in your public reception area
  • includes the address for the Department of Health and Social Services internet website of [http://dhss.alaska.gov/Pages/default.aspx] (web address may need to be updated)
  • MAY include a statement explaining that the undiscounted price may be higher or lower than the amount an individual actually pays for the health care services described in the list
  • includes a statement substantially similar to the following:  "You will be provided an estimate of the anticipated charges for your non-emergency care upon request.  Please do not hesitate to ask for information."  
  • lists any insurance companies you are currently have a contract to provide health care services as an in-network preferred provider.  For example, "We are in-network with Premera Blue Cross Blue Shield of Alaska".  

IF you have a website for your chiropractic office, you must also post the list above to your website.

SAMPLE NOTICE<--Download  

B.  The requested good faith estimate

  • shall provide a good faith estimate before the non-emergency health care services are provided and not later than 10 business days after receiving the request
  • be provided in whichever of the following formats the patient requests - orally, in writing, or by electronic means.  If provided orally, you need to keep a record of the estimate given.  
  • you are not required to disclose the charges for the total anticipated course of treatment for the patient, but if the estimate does not include charges for the total anticipated course of treatment, the estimate must include a statement explaining that the estimate only includes charges for a portion o the total anticipated course of treatment
  • may provide an estimate that includes a reasonable range of charges for anticipated health care services if the charges for the services will vary significantly in response to conditions that you cannot reasonably assess before the services are provided
  • must include a brief description in plain language that any individual with no medical training can understand of the the health care services, products, procedures, and supplies that are included in the estimate
  • must include a notice disclosing your in-network or out-of-network status that is "substantially similar to one of the following forms"
    • XYZ Chiropractic Clinic is a contracted, in-network preferred provider for ONLY the following plan networks:  (list each network or state 'NONE.  YOU MAY INCUR OUT-OF-NETWORK CHARGES.')"
    • XYZ Chiropractic Clinic is a contracted, in-network preferred provider for your insurance plan
    • XYZ is NOT a contracted, in-network, preferred provider for your insurance plan
  • must include the procedure code for each health care service included in the estimate
  • must include any facility fees, along with an explanation of the facility fees
  • must include the identity, or suspected identity, of any other person that may charge the patient for a service, product, procedure, or supply in connection with health care services included in the estimate, along with an explanation of whether the charges are included in the estimate

Please note, a health care provider that provides a "good faith estimate" to a patient under (g) and (h) of Section 18.23.400 Disclosure and reporting of health care services, price, and fee information is not liable for damages or other relief if the estimate differs from the amount actually charged to the patient.  

 

Frequently Asked Questions

  1. What's the deadline for posting my fee notice in my office?  Per the signed bill, you had initially until January 31, 2019 to post your fee notice and then annually by 01/31 there after.  BUT the State of Alaska posted a notice on 12/21/2018 that they are still working on the regulations to implement.  See PUBLIC NOTICE OF ALASKA'S HEALTH CARE PRICE TRANSPARENCY LAW.  
  2. How do I submit my list to the Department of Health and Social Services?  The list you submit needs to include the your name and location of your office. The State of Alaska is still working on regulations to implement.  See PUBLIC NOTICE OF ALASKA'S HEALTH CARE PRICE TRANSPARENCY LAW.  
  3. What is the department's internet website to be included in my posted notice?  Right now, I only have main DHSS website address [http://dhss.alaska.gov/Pages/default.aspx].  State of Alaska is still working on regulations to implement.  See PUBLIC NOTICE OF ALASKA'S HEALTH CARE PRICE TRANSPARENCY LAW.  
  4. What's the deadline to submit by fees to the Department of Health and Social Services?  Per the signed bill, you had initially until January 31, 2019 to post your fee notice and then annually by 01/31 there after.  BUT the State of Alaska posted a notice on 12/21/2018 that they are still working on the regulations to implement.  See PUBLIC NOTICE OF ALASKA'S HEALTH CARE PRICE TRANSPARENCY LAW
  5. What if I don't post the notice in my office?  You would be liable for a civil penalty not to exceed $10,000 for each violation.  The Department may impose a penalty of $100 for each day of non-compliance after March 31.
  6. What if I don't submit the list to DHSS?  You would be liable for a civil penalty not to exceed $10,000 for each violation.  The Department may impose a penalty of $100 for each day of non-compliance after March 31.  BUT the State of Alaska posted a notice on 12/21/2018 that they are still working on the regulations to implement.  See PUBLIC NOTICE OF ALASKA'S HEALTH CARE PRICE TRANSPARENCY LAW
  7. What if I don't provide a good faith estimate?  You would be liable for a civil penalty not to exceed $10,000 for each violation.  The Department may impose a penalty of $100 for each day of non-compliance.  
  8. What is "a facility fee"?  A charge of fee billed by your office that is in addition fee fees billed for your professional services and is intended to cover building, electronic medical records system, billing, and other administrative and operational expenses.  
  9. What is the definition of  "health care provider" in this bill ?  An individual licensed, certified, or otherwise authorized or permitted by law to provide health care services in the ordinary course of business or practice of a profession. 
  10. Does my massage therapist have to post their fees?  If your massage therapist is an employee of your clinic - you post those fees on your notice.  If your massage therapist is an independent contractor, they have to submit to DHSS and post their own notice with their fees. 
  11.  I have a group practice.  Do each of my doctors have to submit/post a notice?  No, your facility can post one notice as long as the prices/fees and statements posted are reflected in the list compiled and published.  Please note:  In a group practice, if Doctor A is an Aetna preferred provider and Doctor B is not, you would need to post separate notices for each doctor.  
  12. There are 3 DCs in our office.  They share office space and are not employees of one another. Do I need to post separate notices?  Yes, each doctor needs to submit to DHSS and post their own notice with their fees.  

Have questions or concerns?  Contact Sheri Ryan at ACS at sryan@akchiro.org or 907-903-1350.  


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