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Surprise Billing Legislation May Be Pushed to 2020

Despite a deal being reached on bipartisan, bicameral legislation, Congress may delay consideration of a measure to protect patients from surprise medical bills until 2020. The House Energy and Commerce Committee (E&C) and the Senate Health, Education, Labor, and Pensions (HELP) Committee recently announced that an agreement had been reached to resolve out-of-network billing disputes between providers and insurance companies. The agreement was the culmination of months of negotiations. It would automatically pay for out-of-network care at the median price of in-network providers in the geographic area. The measure would also lower the threshold for doctors to dispute payments from insurers from $1,250, as outlined in Energy and Commerce’s original bill, to $750. The original Senate HELP legislation had not included an independent dispute resolution (IDR) process. The latest bill includes provisions to raise the tobacco purchasing age to 21 and extend funding for federal health programs like community health centers. Despite an endorsement from the White House, however, the No Surprises Act is not expected to pass this year. Sponsors of the bill had been pushing for its inclusion in a year-end government funding package expected to pass by the December 20 deadline. A rival proposal released by the House Ways and Means Committee on Wednesday is being cited for the delay.

Leadership of the House Ways and Means Committee support delaying the issue of surprise insurance gaps until next year, following the release of a one-page outline of the panel’s own surprise billing fix. Their proposal would set patient cost-sharing for out-of-network bills at the in-network rate for a geographic area. It would allow providers and payers to address billing disputes themselves, but would provide for an outside mediation process if the two parties cannot reach an agreement. The losing party would be responsible or paying a reconciliation process fee. The solution also preserves existing state laws on surprise billing and would set timely billing requirements. It remains unknown when the bill text will be released or when the committee will mark up the legislation.

Members of the House Education and Labor Committee have indicated that they want more time to vet the bicameral surprising billing agreement as well; their panel is also considering introducing its own surprise billing policy for consideration.

In related news, Senate Commerce Committee Chair Roger Wicker (R-Miss.) has expressed opposition to the air ambulance policy contained in the HELP/E&C surprise billing deal, arguing that it could result in shortages in air ambulance bases, limiting patient access to care and reducing the number of providers in rural areas. Wicker’s panel has jurisdiction over the Federal Aviation Administration, and the Chairman is trying to increase support for amending or removing provisions related to air ambulances and surprise medical bills. The current compromise reached by the E&C and HELP committees would set out-of-network air ambulance bills at the median in-network rate for a geographic area, and the threshold for triggering IDR would be set at $25,000. Wicker supports the exclusive use of IDR to settle air ambulance surprise bills while more data is collected on air ambulance payment rates.

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