Leaders of the House Ways & Means Committee on Friday released bipartisan legislation to ban balance billing that excludes benchmark payment and mediation threshold policies that have drawn ire from hospitals and specialty physician groups.
The Federation of American Hospitals announced its support of the Ways & Means legislation on Friday.
"The plan authored by Chairman (Richard) Neal and Ranking Member (Kevin) Brady provides certainty for patients while enabling the healthcare community to settle payments without unnecessary rate setting," said FAH CEO Chip Kahn.
Ways & Means Chair Richard Neal (D-Mass.) said he thought hospitals would back his approach.
"We think it's a good foundation. We think that it's the patients first. Everybody's got big hospitals. And I think that we want to remind everybody that the issue here is that we believe that the threat of arbitration usually brings people to a meaningful negotiation," Neal said.
The American Hospital Association endorsed the Ways & Means proposal on Monday, and Greater New York Hospital Association President Kenneth Raske called the bill a "significant improvement over the other surprise billing proposals released to date."
A mark-up on the legislation is planned for Feb. 12. A one-page summary of the legislation that was released in December contributed to derailing a bipartisan, bicameral proposal negotiated by leaders of the House Energy & Commerce Committee and the Senate health committee.
Starting in 2022, the Consumer Protections Against Surprise Medical Bills Act would ban balance billing and limit consumer cost-sharing to the in-network rate for emergency medical services provided at out-of-network facilities and for services by out-of-network providers at in-network facilities.
If the insurer and provider could not agree on payment for out-of-network emergency services or services provided by out-of-network providers at in-network facilities, the insurer and provider would enter a 30-day negotiation period.
Insurers would have to disclose the median contracted rate for a service to providers during the negotiation period, and providers would have to share median total reimbursement rates.
If no agreement is reached, both sides would proceed to baseball-style mediation, meaning the mediator would choose one side's offer. The secretaries of HHS, the Treasury Department, and the Labor Department would establish the mediation process.
The mediator would be required to consider a median in-network payment rate for the service for a geographic area and would be prohibited from considering usual and customary charges or billed charges.
American Society of Anesthesiologists President Dr. Mary Dale Peterson said the group "continues to work with" the committee on the requirement that the mediator consider an in-network payment rate and a requirement that patients should be provided with cost estimates for services scheduled at least three days in advance.
There would be no threshold for mediation, and the HHS secretary would be allowed to develop a process for batching claims if it would promote efficiency. The HHS secretary would be required to publish a public report on outcomes of mediation and its impact on consumers, payers and providers.
The legislation would require air ambulance providers to report cost data and plans to report claims data, but does not ban them from balance billing, unlike the Energy & Commerce proposal. State surprise billing laws would remain in place under the Ways & Means proposal.
The Ways & Means Committee has not yet received a Congressional Budget Office score of its legislation. Lawmakers will need offsets to pay for expiring Medicare and Medicaid programs by May 22.
Energy & Commerce leaders estimated their bill would provide nearly $20 billion for five years of funding for community health centers. Funding the health centers for more than a short-term stopgap is a priority, according to Congressional Progressive Caucus leaders.
"Those community health centers do have to be funded and really need a multiyear reauthorization because it's really tough for those clinics to continue their work without knowing what's happening in the next year," caucus Co-Chair Pramila Jayapal (D-Wash.) said Thursday.
Both Neal and House Energy & Commerce Committee Chair Frank Pallone (D-N.J.) have asked for meetings with Jayapal and Progressive Caucus Co-Chair Mark Pocan (D-Wis.) on their surprise billing proposals.
Pallone said he would prefer a benchmark payment approach, but is open to working with the other two House committees and the Senate to find a consensus solution.
"I'm not insisting on anything at this point, other than that we have the savings and then we have this package for the extenders," Pallone said Friday.
The House Education & Labor Committee, the third panel with jurisdiction over surprise medical billing, will on Feb. 11 mark up a slightly altered version of the proposal put forth by the Energy & Commerce Committee.
Rep. Donna Shalala (D-Fla.), a former HHS secretary and member of the Education & Labor Committee who has advocated for a more provider-friendly solution, said she will sign on to the Ways & Means bill and would vote against the Education & Labor proposal if it is not amended.
"I just want more balance. It's not about the doctors, it's about the hospitals," Shalala said.
However, America's Health Insurance Plans decried any bill that does not include a benchmark payment rate.
"The only solution to protect patients is to establish a fair, competitive benchmark based on locally negotiated rates between doctors and health insurance providers, with no need for arbitration," said AHIP spokesperson Cathryn Donaldson.
