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Lawmakers Propose Surprise Medical Bill Legislation

May 17, 2019

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PRESS CONTACTS
Allyson Perleoni, Senior Legislative Analyst

Two legislative proposals aiming to address the problem of surprise medical bills were released this week in both the House and the Senate. This activity follows the White House’s announcement last week of the President’s legislative parameters for legislation on surprise medical bills [see Washington Highlights, May 10].

House Energy and Commerce Committee Chair Frank Pallone (D-N.J.) and Ranking Member Walden (R-Ore.) released May 14 a bipartisan discussion draft proposal to address surprise medical bills. The proposal, titled the “No Surprises Act,” would:

  • Prohibit surprise medical bills and hold patients harmless in emergency situations;
  • Require that patients receiving scheduled care be given notice at the time of scheduling about the provider’s network status and any potential charges they could be liable for if treated by an out-of-network provider;
  • Prohibit balance billing from providers that patients cannot reasonably choose when they are scheduling their care;
  • Resolve disputes by establishing a pricing benchmark based on the median contracted rate for the service in the geographic area the service was delivered;
  • Preserve states’ ability to determine their own payment standards for plans regulated by the state; and
  • Provide $50 million in grants for states to set up an all-payer claims database.

Pallone and Walden have not yet set a timeline for full introduction and consideration of the proposal.

A bipartisan Senate working group including Senators Bill Cassidy, MD, (R-La.), Michael Bennet (D-Colo.), Todd Young (R-Ind.), Maggie Hassan (D-N.H.), Lisa Murkowski (R-Alaska), and Tom Carper (D-Del.) May 15 introduced a bill titled “Stopping the Outrageous Practice (STOP) of Surprise Bills Act of 2019.”

The proposal prohibits providers from sending balance bills in three common scenarios: out-of-network emergency care; additional out-of-network care following an emergency; and when elective care at an in-network facility is performed by an out-of-network provider. Patients would only have to pay their in-network rate.

Under the STOP Act, providers would be paid at the median in-network rate for the procedure. If there is a disagreement between the provider and the plan, the legislation allows for a 30-day period to appeal and initiate a dispute resolution process, which does not include the patient. The Department of Health and Human Services (HHS) and the Department of Labor would certify arbiters to settle any disputes. The entities would base their decisions on “commercially reasonable rates,” which is defined as the in-network rates for that area, and not the billed charges.

Senate Health, Education, Labor, and Pensions Committee Chair Lamar Alexander (R-Tenn.) has expressed concerns with the arbitration model. Additionally, senior White House officials have called the arbitration approach “disruptive.”

The House Ways and Means Committee announced a hearing on surprise medical bills scheduled for May 22. Witnesses will include representatives from the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), the American Medical Association (AMA), and the ERISA Industry Committee (ERIC).

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