The House Energy and Commerce Committee will consider adding an arbitration option to its proposed ban on surprise medical bills above $1,250, congressional sources told Modern Healthcare.
The late-breaking amendment follows months of pressure from hospitals and physicians.
The amendment from Rep. Raul Ruiz (D-Calif.) has been approved by committee leaders even though they originally settled on a cap to out-of-network treatment through payment tied to a median in-network rate.
In both the House and Senate, lawmakers backed by the medical provider community have fought for months to add arbitration to any proposed solution on surprise medical bills. Ruiz has been at the forefront of the debate on the House side.
The vote on the amendment, confirmed by three sources close to discussions, will take place Wednesday along with a swath of healthcare measures including a two-year delay to the disproportionate-share hospital cuts.
"Chairman Pallone's priority is protecting patients and lowering health care costs for Americans and in order to do that he looks forward to passing a strong bipartisan bill out of the Committee tomorrow," a committee spokesperson said in response to a request for confirmation that Chair Frank Pallone (D-N.J.) and ranking member Greg Walden (R-Ore.) have signed off on the amendment.
The original House proposal of the benchmark cap mirrors the rate cap measure from the Senate Health, Education, Labor and Pensions Committee, led by Chair Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.).
That panel passed a broader bill last month aimed at curbing healthcare costs, but there too, lawmakers, including Sens. Bill Cassidy (R-La.) and Maggie Hassan (D-N.H.), have been fighting to include arbitration ahead of a potential floor vote. Alexander has already made changes to mollify some of their demands.
The next step is for a vote by the full Senate, but Majority Leader Mitch McConnell (R-Ky.) has yet to schedule anything on the HELP Committee bill. A spokesperson for McConnell on Tuesday didn't offer any guidance on when a vote could happen.
Meanwhile the Congressional Budget Office published its analysis of the Senate legislation, projecting a total of $7.6 billion in savings.
The proposed ban on surprise medical bills would save the federal government almost $25 billion over 10 years, according to the CBO, both in the federal subsidies paid out for the Obamacare exchanges and downstream effects from reductions in employer insurance premiums.
The CBO said that insurance premiums would see just over a 1% decrease since the median in-network rates hospitals and physicians would have to accept are typically lower than overall average rates.
"Insurers' payments to providers currently commanding in-network rates well above the median would drop to more typical amounts," the analysis said.
The Energy and Commerce legislation on surprise medical bills is wrapped with a big hospital sweetener: a two-year delay of the Medicaid disproportionate-share hospital payment cuts.
But along with that delay, the measure would demand the U.S. comptroller general to come up with policy recommendations to redistribute the payments according to a new, more equitable formula. And DSH payments would see a $4 billion cut starting in fiscal 2022.
Another provision would require states to publish Medicaid supplemental payments to hospitals known as upper payment limits, where, according to congressional advisers, billions of dollars have been overspent.