In early September, the U.S. House Education and Workforce Committee voted in favor of H.R. 9457, the Transparency Telehealth Bills Act. The bill, introduced by Rep. Aaron Bean (R-FL-04), received unanimous, bipartisan support from committee members following adoption of an amendment from Rep. Jahana Hayes (D-CT-05) that Bean welcomed as an “extra blanket of protection” for consumers.
What Does the Transparency Telehealth Bills Act Do?
The Transparency Telehealth Bills Act limits telehealth billing in two key ways:
First, the bill imposes a site-neutral billing requirement for telehealth services paid for by group health plans. Regardless of whether a health care provider is practicing out of a hospital or an independent setting, the plan must pay the same amount.
Second, thanks to the Hayes amendment, the bill prohibits hospitals from billing a separate facility fee when the health care provider is authorized to bill independently for the professional services they rendered. This means telehealth services can result in only one bill.
Together, these provisions mean group health plans and their plan members would receive just one bill for telehealth services and the plan will pay the same amount no matter the provider’s location.
How Would This Affect Consumer Out-of-Pocket Costs and Total Spending?
For in-network care, consumers should be protected from the extra out-of-pocket costs that facility fees often can generate. They may still face the risk of balance billing for out-of-network care if providers seek greater reimbursement than their plan pays (whether they’re based at a hospital or not), as is standard today for any services not protected under the No Surprises Act.
Total spending by group health plans may also go down, but whether and how much will depend on the level at which plans pay for telehealth services. The greatest benefit will come if plans set their reimbursement level at the amount they have been paying for telehealth services from independent clinicians, rather than hospital-controlled providers that often negotiate higher rates. Because the law does not cap reimbursement at this amount, plans must negotiate for it.
How Does This Bill Compare to Other Commercial Facility Fee-Related Reforms in Congress?
The Transparency Telehealth Bills Act is more narrowly focused than the other commercial facility fee ban proposed in Congress, both with respect to its limitation to telehealth services and group health plans only. Senator Sanders and Marshalls’ Bipartisan Primary Care and Health Workforce Act would prohibit facility fee billing for evaluation and management services and outpatient behavioral health services, in addition to telehealth services. This bill also does not include a unique provider identifier requirement, which has appeared in both House and Senate bills over the past year or so, and seeks to increase transparency regarding the location of care in health care claims.
At the same time, this bill is notable as the first legislation formally introduced in Congress to bring the concept of site-neutral payments to the commercial sector. Senator Sanders floated a commercial site-neutral proposal in 2023, but ultimately introduced his bill with Senator Marshall that instead prohibited facility fee billing for the services identified without requiring that the amount insurers pay for the same services be the same in different settings. (Even if facility fees are prohibited, hospitals with market power could negotiate greater reimbursement for bills submitted by their providers.)
Where Will the Bill Go from Here?
While it is getting late in the year to see new legislation move, it is possible this language (or something similar) could get incorporated into an end-of-year health care package or a telehealth extender bill. If it does, we will be watching to see whether its scope is expanded from only group health plans to include the rest of the commercial market, such as policies purchased through Affordable Care Act marketplaces, or any other changes are made. To better understand the different policy options lawmakers seeking to address outpatient facility fee billing may consider, check out our Cheat Sheet for Policymakers. You can also examine our nationwide maps, detailing outpatient facility fee billing laws across the country which can serve as a model for federal lawmakers.
