Comment on FR Doc # 2010-15277

Re: Comment on 45 CFR 147.138(b)(3) Suggested changes: (1) As currently written, the proposed regulations could be construed to impose on plans an obligation to pay more than billed charges to emergency room professional and hospitals. “Or billed charges, if less” language should be added to these regulations --at end of section 147.138(b)(3) -- to clarify this is not intended by these new regulations.. (2) The proposed regulations require a plan to pay at least what Medicare would pay for emergency charges. The Medicare payment number should be increased by a factor that adjusts for the payment rate over-and-above Medicare rates that commercial payers are reimbursing physicians or hospitals. This adjustment-factor can be readily determined (at no cost to a plan or DOL) as such an adjustment-factor is currently being annually calculated and reported by MedPAC. (3) Additional consumer-protection safeguards should be added to minimize the balance billing obligations of consumers for the emergency services covered by these regulations. (i) If a plan uses secondary PPO networks, negotiations, or other arrangements to reduce the amount owed for out-of-network emergency services, any such reduction from billed out-of-network charges will first accrue to the benefit of reducing the consumer’s balance billing obligation before the plan reduces its payment obligation; (ii) a plan will provide beneficiaries with the data-points it uses to calculate it’s out-of-network payment obligation so that the beneficiary might use this data to negotiate a reduction in her/his balance billing obligation. (iii) (iii) If the balance billing obligation is for facility charges, hospitals will provide the beneficiary with an estimate of an amount that is “no more than the lowest amount charged to individuals who have insurance covering such care.” (current data requirement for charity hospitals per Patient Protection and Affordable Care Act(Sec. 9007 (a)(5)(A)