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February 15, 2020 12:00 AM

House committees move surprise billing legislation ahead of May deadline

Rachel Cohrs
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    Modern Healthcare Illustration / Getty Images

    The spring landscape on surprise medical billing action in Congress is taking shape, as all three House committees with responsibility for the issue have advanced legislation.

    Two House panels and the Senate health committee have coalesced around an approach that would blend a benchmark payment for certain emergency services at out-of-network facilities or for out-of-network providers at in-network facilities with a limited arbitration backstop. The House Ways & Means Committee put forth an arbitration-only approach. Each has bipartisan support, as the issue does not divide lawmakers along traditional party lines.

    Still, even if House lawmakers can reach an agreement, Senate Majority Leader Mitch McConnell (R-Ky.) would have to advance a solution and has not committed to doing so. President Donald Trump is imploring lawmakers to act, tweeting Feb. 12, “Ending surprise medical billing moving ahead in Congress! Thanks to Ways & Means and Education/Labor Committees for your work on Bills to protect patients and end medical bill ripoffs! Work with Energy & Commerce, HELP committees to send BIPARTISAN bill to my desk!”

    Lawmakers are working toward a May 22 deadline, hoping to attach language to a funding bill for some expiring Medicare and Medicaid programs.

    Providers and hospitals have rallied around the arbitration-only approach, while insurers, employers and labor unions want some form of benchmark payment.

    Here’s a breakdown of the leading legislative proposals.

    Comparing the bills

    House Energy & Commerce and Education & Labor, and Senate health committees House Ways & Means Committee
    Benchmark payment rate Median in-network payment for geographic area None; 30-day open-negotiation period
    Advance notice of benefits Prohibits certain out-of-network providers from balance billing unless provider gives the patient notice of their network status and an estimate of charges 72 hours before services and the patient consents Health plans would be required to provide an advance explanation of benefits for services scheduled at least three days in advance
    Congressional Budget Office estimates $23.9 billion in federal government savings from 2020 to 2030 $17.8 billion in federal government savings from 2020 to 2030

    Endorsements

    House Energy & Commerce and Education & Labor, and Senate health committees House Ways & Means Committee
    White House Endorsed on Dec. 9 White House statement on Feb. 11 noted concern about costs of arbitration, desire for air ambulance balance billing ban
    Supporters Families USA; AFL-CIO; American Federation of State, County and Municipal Employees; Laborers’ International Union of North America; and American Health Policy Institute. Insurers and employer groups prefer this approach to an arbitration-only bill but are formally advocating for an approach that does not include any arbitration mechanism. American Hospital Association, American Medical Association, Federation of American Hospitals, America’s Essential Hospitals, American College of Surgeons, American College of Emergency Physicians, American Society of Anesthesiologists, Association of American Medical Colleges, Catholic Health Association, Greater New York Hospital Association, Save Our Air Medical Resources coalition
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