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House and Senate Committees Announce Surprise Billing Agreements

December 12, 2019

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Allyson Perleoni, Senior Legislative Analyst
Len Marquez, Senior Director, Government Relations

The House Energy and Commerce and Senate Health, Education, Labor, and Pensions (HELP) Committees Dec. 8 issued a joint bipartisan, bicameral statement announcing a revised “Lower Health Care Costs Act of 2019.” The House Ways and Means Committee Dec. 11 also announced a bipartisan agreement. Legislative text was not released by any of the committees.

The Energy and Commerce/HELP proposal largely mirrors HELP’s Lower Health Care Costs Act (S. 1895) and Energy and Commerce’s surprise billing legislation (H.R. 2328), both of which passed out of committee over the summer [see Washington Highlights June 28, July 19]. The legislation includes provisions on prescription drugs, transparency, public health, and health information technology.

The legislation continues to include a benchmark rate for payment, which would be based on a geographic median in-network rate in order to resolve surprise billing disputes. It also includes an option of arbitration for bills over $750, but a summary released by the committees states that, “the party that initiated the arbitration may not take the same party to arbitration for the same item or service for 90 days following a determination by the arbitrator.” The bill also includes provisions that would impose federal regulation on private negotiations between insurers and providers by prohibiting the use of anti-tiering, anti-steering, and all-or-nothing clauses in their contracts.

Following the committees’ press release, AAMC Chief Public Policy Officer Karen Fisher, JD issued a statement which expressed encouragement that the committees were continuing to work to protect patients from surprise medical bills. The statement also reminded Congress that “even paired with arbitration, a benchmark rate could decrease patient access to care by incentivizing the exclusion of teaching hospitals from coverage networks and increasing narrow networks. We continue to believe that arbitration, not rate setting, is the best solution to address billing disputes.” The AAMC also urged Congress to consider input from all committees of jurisdiction before moving forward with surprise billing legislation.

The Ways and Means Committee’s Dec. 11 joint press release states that its agreement would protect patients from surprise medical bills, improve information on provider networks, contain increased consumer protections, and include a robust reconciliation process that “respects the private market dynamics between insurance plans and providers and first allows them to work out differences without interference.” The bill would also discourage “frivolous use” of the reconciliation process.

The AAMC issued a statement in response to the Ways and Means announcement, thanking the committee for reaching an agreement and stating that they would “continue working with all lawmakers and other stakeholders to advance policies that protect patients from surprise medical bills and preserve patient access to the vital services provided by teaching hospitals and physicians.”

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