Digital Debut
State Legislatures Tackled Big Healthcare Issues in 2024
Price transparency, prior authorization and CON reform were on the table
BY STEPHEN ABRESCH | OCTOBER 25, 2024
As the year nears its end, ASCA examines the 450 bills that it tracked across the 50 states this year. State legislatures used their 2024 sessions to tackle major issues in healthcare with implications for ASCs, from price transparency and prior authorization to facility fee restrictions.
Facility Fees
State legislators continued to question the existence of facility fees in 2024. Legislation in Massachusetts and North Carolina remained active from 2023, with legislators in North Carolina amending facility fee restrictions into a second bill in 2024. Washington State started the year with a facility fee restriction proposal that received a hearing but had lost steam by the end of January, though there were indications that the introduction was an attempt to test the waters ahead of a more serious effort in 2025. Legislators in Maine adopted a facility fee notification requirement—which does not appear to impact ASCs—after balking at the recommendations of the task force set up in the wake of the debate over legislation in 2023.
A late effort in Ohio saw facility fee restriction language shoved into a bill establishing hospital price transparency requirements. Legislation that had already passed the House in June of 2023 had new facility fee provisions added in the Senate a year later, causing a major disagreement between the two chambers just as the legislature neared the end of its 2024 session. Ultimately, the House refused to concur in the Senate amendments, killing the issue for the year.
Price Transparency
Price transparency requirements for hospitals and ASCs remained a top concern for state legislators in 2024. Seven states—Colorado, Florida, Iowa, Maine, Minnesota, New Jersey and South Carolina—saw new proposals in 2024 that would impose new price transparency requirements on ASCs, such as posting “current standard charges,” providing patients with written estimates or providing patients with itemized bills. Florida, which already requires ASCs to provide patients with good faith estimates of billed charges and an itemized bill, adopted additional requirements mimicking the federal hospital price transparency requirements. Beginning January 1, 2026, ASCs will have to post on their websites a consumer-friendly list of standard charges for at least 300 shoppable healthcare services or for as many services they provide, if less than 300. Maine took a more reasonable approach, adopting requirements that healthcare entities provide uninsured and self-pay patients with good faith estimates of anticipated charges. Colorado opted to focus its efforts on health insurance companies instead of providers, enacting legislation creating state-level carrier price transparency requirements modeled on those in the federal Affordable Care Act (ACA) and the final Centers for Medicare & Medicaid Services (CMS) rule implementing ACA.
Prior Authorization
As insurers have made greater use of prior authorization and utilization review, providers have sought increased help from state policymakers. Nine states—Colorado, Connecticut, Illinois, Maine, Maryland, Mississippi, Oklahoma, Vermont and Wyoming—enacted legislation on the issue during their 2024 legislative sessions. Illinois enacted legislation that reflected concerns about the use of automated processes by insurers, preventing the use of algorithmic automated processes to deny coverage of a procedure. Colorado adopted transparency requirements for insurers that use prior authorization and took the additional step of requiring insurers to annually eliminate prior authorization requirements for procedures that have been approved at rates that demonstrate prior authorization is unnecessary. Connecticut authorized hospitals and ASCs to document the amount of time spent obtaining prior authorizations from insurers so the General Assembly could further study the issue. Maine created reporting requirements for insurers that use prior authorization and limited insurers’ ability to deny claims for emergency and nonemergency services. Vermont and Mississippi implemented new time frames in which insurers must render a decision on prior authorization requests, with Maryland adopting both new time frames and transparency requirements for insurers. Oklahoma and Wyoming adopted requirements along the lines of the American Medical Association’s (AMA) model legislation, Ensuring Transparency in Prior Authorization Act, which includes gold carding requirements along with prescribed approval time frames and prohibitions on retroactive denials of preauthorized care. Gold cards exempt providers from prior authorization requirements if they achieved a specified approval rate for prior authorization requests during a specific period of time.
Each year, ASCA tracks legislation across all 50 states that could impact ASCs and reports on enacted legislation to its members for compliance purposes. ASCA members also can access ASCA’s State Law Database, which contains information for each state on a range of issues, including licensing requirements, certificate of need laws, price transparency requirements and charity care requirements.
Write Stephen Abresch at sabresch@ascassociation.org with any questions.