9 things to know about the federal surprise-billing proposals

Congress is looking at several proposals to protect patients from massive unexpected out-of-network medical bills. 

Here are nine things to know about the surprise-billing proposals and where they stand:

1. The No Surprises Act— co-authored by Energy and Commerce Committee leaders Reps. Frank Pallone, D-N.J., and Greg Walden, R-Ore. — is under consideration in the House. 

2. The bill would prohibit healthcare facilities and providers from balance-billing patients for care and would establish rates for payments from commercial health plans to providers based on the health plan's median in-network rates. 

3. The initial No Surprises Act did not include a process for providers and payers to challenge the basic median reimbursement. But on July 17, the Energy and Commerce Committee passed the No Surprises Act, with the addition of third-party arbitration process for resolving some out-of-network payment disputes. It now goes to the full House for a vote.

4. Senate surprise-billing legislation, called the Lower Health Care Costs Act, was formally introduced June 19 by Sen. Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash., and is also advancing. 

5. The Lower Health Care Costs Act addresses surprise medical bills as well as healthcare cost transparency and drug prices. To settle out-of-network surprise-billing disputes, the legislation requires health plans to pay providers the local median contracted commercial amount that insurers have negotiated with other providers and agreed to in that local area. 

6. It passed the Senate health committee June 26, and Mr. Alexander said he hopes the full Senate will pass the bill and send it to President Donald Trump for signing in July. 

7. Also in the Senate, the STOP Surprise Medical Bills Act was introduced by Sen. Maggie Hassan, D-N.H., Sen. Bill Cassidy, R-La., and a bipartisan group of senators.  Like the House's version of the bill, it includes an independent dispute resolution process to resolve out-of-network payment conflicts between providers and payers.  

8. Hospital and physician groups generally have indicated they want a legislative fix that protects patients by ensuring their cost-sharing is based on an in-network rate. Then, with the patient protected, they support an arbitration to settle out-of-network payment disputes between insurers and providers. 

9. Insurers generally have been more in favor of arbitration, though, and a payment benchmark to guarantee that reimbursement for out-of-network care aligns with median payments to in-network providers for the same services.


More articles on healthcare finance:

House surprise-billing proposal passes committee with arbitration amendment
Atrium Health: Partnership with Navicent Health expected to save $30M in first year
5 must-read stories about medical debt

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