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August 5, 2022

Susan Benz Quoted in Buffalo Business First Article on Health Care Transparency Laws

Susan Benz, partner, was quoted in the Buffalo Business First article “Experts Stress Importance of New Health Care Transparency Laws” about how important it is for local hospitals and health care agencies to comply with recent transparency laws in light of an uptick in enforcement in other regions in the nation.

Regarding the Centers for Medicare & Medicaid Services (CMS) publicly posting their payer-specific rates for 300 services, Susan said, “I think it is such a seismic change for hospitals to post cash prices and negotiated prices with health plans publicly. It’s always been kind of this secret box.”

CMS’s Price Transparency Rule wasn’t enforced until last month, despite having been issued in 2019 and going into effect in 2021. The result was two Georgia facilities being fined nearly $1 million. “That’s a shot heard around the world, because up until now, there’s been huge noncompliance with the price transparency law,” Susan said. “The hospitals were just so upset about it, and they just hoped that there wouldn’t be enforcement and that it would be repealed. But there’s a huge consumer benefit, and I think politically it’s tough to roll this one back.”

The fines hospitals are receiving are often quite high. “They’re big fines in a health care economy where hospitals are really scraping because of pandemic costs,” Susan said.

Susan notes that to remain compliant, hospitals and health facilities in New York State have to post pricing for 300 services, 70 of which are picked by the state—and this is not negotiable.

Posting prices prominently, according to Susan, may be in the best interest of facilities that have high-quality measures and scores. “Unless you pair price with quality, you really can’t be an educated consumer,” she said.

The article also examines the No Surprises Act, a federal law that went into effect in January 2022.

Susan noted that it’s becoming increasingly popular for mental health services providers to implement good-faith estimates for patients not using insurance to pay for their services, which other health care providers are mandated to do under the federal law. “If the charges come through more than $400 higher than the good-faith estimate for a particular service, the patient has the right to contest those charges,” she said.

Susan noted the variable and individualized nature of mental and behavioral health treatment, which ultimately affects the pricing of these services. “The providers don’t necessarily know what the course of treatment will be or how much it will cost,” she said. “So we’re getting questions from clients about how do we frame our good-faith estimate when we don’t even know how long this person will be seeing us for or what they’ll be seeing us for.”

Susan’s recommendation to address the uncertainties and different treatment avenues is for providers to offer a range of pricing for a particular range of sessions. Additionally, including language that makes it possible for patients to add on more sessions and those sessions’ respective added costs “based on evolving treatment needs” will influence how providers frame their good-faith estimates.

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