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Surprise Billing Agreement Reached Between Key Committees

December 18, 2020

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CONTACTS
Allyson Perleoni, Senior Legislative Analyst

The House Ways and Means, Energy and Commerce, and Education and Labor Committees and the Senate Health, Education, Labor, and Pensions (HELP) Committee announced on Dec. 11 that they had reached an agreement to address surprise medical billing. The bipartisan, bicameral legislation reflects months of negotiations between committees of jurisdiction and stakeholders [see Washington Highlights July 31, Feb. 14].

The agreement holds patients harmless for surprise medical bills that they could not reasonably prevent and allows insurers and providers up to 30 days to negotiate an agreement for payment. If an agreement is not reached, the parties have the option to invoke independent dispute resolution (IDR). Through the arbitration process, the IDR entity must consider certain factors, including the median in-network rate, relevant information brought by either party, information requested by the reviewer, the provider’s training and experience, patient acuity and the complexity of furnishing the item or service, and — in the case of a provider that is a facility — the teaching status, case mix, and scope of services of such a facility. The agreement also contains several timely billing and notice and consent provisions.

According to the Congressional Budget Office, the legislation results in savings to the federal government, and consequent funding for certain health care programs, known as “extenders” were addressed in the compromise legislation as well — including $310 million for the National Health Service Corps, $126.5 million for the Teaching Health Center Graduate Medical Education program, and $4 billion for Community Health Centers — funding the programs through fiscal year 2024.

Committee leaders have expressed an interest in including this agreement in their end-of-year legislative package, stating, “We’re hopeful this legislation will be signed into law in the coming days so we can give Americans confidence they will no longer receive financially ruinous surprise out-of-network medical bills.”

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