Surprise billing legislation included in year-end spending deal

A measure to end surprise medical bills for emergency and scheduled care will be included in a $1.4 trillion year-end spending deal, Congressional leaders confirmed Dec. 20. Congress passed the spending deal Dec. 21.

Democratic and Republican leaders of four committees in the House and Senate reached a deal to end surprise medical billing Dec. 11. A group of bipartisan senators urged Congress to add the surprise billing fix into the year-end deal. 

Under the proposal reached by the committees, the measure called for health insurers and providers to negotiate most billing disputes or bring their complaints to outside adjudicators to decide payment rates through arbitration. However, one key change in the proposal included in the year-end deal bans arbiters from taking into account Medicare and Medicaid rates, which are often lower than the rates commercial insurers pay, according to Politico. This is a win for hospitals and providers.

Additionally, the measure also forbids arbiters from considering providers' billed charges, which are usually much higher than insurers or patients end up paying.

The surprise billing fix included in the year-end proposal also weakens a measure that would have required insurers to disclose detailed information about their contracts and payments with pharmacy benefit managers, Politico reported. Instead the language in the measure calls for insurers to submit general information on prescription drug spending and medical costs. 

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