Efforts to advance legislation that would curb surprise billing got a boost with House Ways & Means Committee Chair Richard Neal (D-Mass.) coming on board on Friday. A coalition of lawmakers at the center of the negotiations made some provider-friendly tweaks that helped entice the powerful committee chair.
The same group of congressional leaders has been talking in circles on legislation for a year, since a bipartisan, bicameral agreement without Neal's support was left out of a year-end appropriations deal. But a push from House Speaker Nancy Pelosi's office (D-Calif.) pressured lawmakers to resurrect talks in the past week.
The tri-committee group of the Senate health committee, the House Energy & Commerce Committee and the House Education & Labor Committee won the support of leaders of the House Ways & Means Committee, who had their own unique plan. Lawmakers are gathering stakeholder feedback before finalizing the deal blending the two approaches.
"We have reached a bipartisan, bicameral deal in principle to protect patients from surprise medical bills and promote fairness in payment disputes between insurers and providers, without increasing premiums for patients or interfering with strong, state-level solutions already on the books," the eight committee leaders said in a joint statement.
The legislation attempts to protect patients from surprise medical bills in emergencies and non-emergency situations where patients can't choose an in-network provider.
Insurers and providers could negotiate on a payment for the remaining bill. If they can't agree, then they could use an arbitration process where the arbitrator is required to consider the median in-network payment rate for the service, the training of the provider, the parties' market share, prior contracting history, complexity of services, and other information submitted. Providers could batch claims that are paid by the same insurers.
There is no cost threshold to enter arbitration, unlike last year's bill that had a $750 threshold. Arbitration can only occur for the same service every 90 days.
The ban also applies to air ambulance providers. Air ambulance providers and insurers would be required to submit two years' worth of claims data to HHS.
Consumers would have additional protection from surprise medical bills if an out-of-network provider doesn't provide estimated charges and a notification of their status 72 hours before.
The new agreement eliminates a controversial benchmark payment that determined what insurers had to pay providers based on previously negotiated rates. Conservative groups had painted the benchmark payments as government rate setting.
Providers have ramped up lobbying on the issue in recent days working to get favorable policy changes.
It is unclear whether the new agreement will have the support of Senate Majority Leader Mitch McConnell (R-Ky.), but Senate Minority Leader Chuck Schumer (D-N.Y.) endorsed the bill on Friday.
"I am pleased there is an agreement between the House and Senate Committees to end surprise medical billing and deliver real relief for every day Americans. There is now a consensus path forward on how to fix a broken system that harms patients. I hope to see it passed into law as soon as possible," Schumer said in a written statement.
House Democrats will have a narrower majority next Congress, which could make pushing through controversial healthcare legislation difficult.
The bill also includes other transparency provisions, including forcing plans to provide benefit explanations for scheduled services at least three days in advance and keep their directories up-to-date, and timely patient billing requirements.
The ban could extend to uninsured individuals, as the HHS secretary is directed to establish an arbitration for the uninsured by 2022.
Provisions limiting contract gaming tactics between hospitals and insurers were left out of the agreement.
