Stage is set for action on surprise billing legislation
LEADERS OF the House Ways & Means Committee on Feb. 7 released bipartisan legislation to ban balance billing that excludes benchmark payment and mediation threshold policies that have drawn the ire of hospitals and specialty physician groups.
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.
“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,” Ways & Means Chair Richard Neal (D-Mass.) said, adding that he thought hospital groups would back his approach. At least one did.
“The plan authored by Chairman Neal and ranking member (Kevin) Brady (R-Texas) provides certainty for patients while enabling the healthcare community to settle payments without unnecessary rate-setting,” said Chip Kahn, CEO of the Federation of American Hospitals.
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 outof-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, they would enter a 30-day negotiation period.
Insurers would have to disclose the median contracted rate for a service to providers, and providers would have to share median total reimbursement rates.
If no agreement is reached, a mediator would choose one side’s offer. The secretaries of HHS, Treasury and Labor would establish the mediation process.
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.
Air ambulance providers would have to report cost data, and plans would have to report claims data. But the proposal does not ban air ambulance firms 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 Committee leaders estimated their bill would provide nearly $20 billion to fund community health centers for five years. Funding the health centers for more than a short-term stopgap is a priority, said Congressional Progressive Caucus Co-Chair Pramila Jayapal (D-Wash.).
Committee leaders 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 consensus.
“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.
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 House 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.
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,” an AHIP spokesperson said. ●