February 13, 2020

Two House Committees Make Progress Toward Federal Surprise Billing Solution

The House Ways and Means Committee and House Education and Labor Committee passed separate legislative proposals this week, breaking a logjam blocking federal “Surprise Billing” legislation and setting the stage for the next step for possible congressional passage.

On Wednesday, Feb. 12, the House Ways and Means Committee passed unanimously by voice vote H.R. 5826, its version of legislation to end "surprise" medical bills. Although the measure includes similar provisions to other congressional proposals on banning balance billing, it does not include a federal benchmark rate for resolving disputes between providers and insurers. Rather, the Ways and Means approach features an arbitration process without the minimum threshold required by other committees to move forward. The Ways and Means legislation also would allow physicians to batch arbitration claims to reduce the administrative burden and improve the efficiency of the mediation process.

On Tuesday, the House Education and Labor Committee advanced a different plan (H.R. 5800) by a vote of 32–13 to end "surprise" medical billing. Under the legislation, cost-sharing would be limited to the patient’s insurance plan’s in-network rate and would prohibit out-of-network providers from issuing balance bills that exceed the in-network rate. 

One of the more contentious issues the committee debated focused on details of the bill’s arbitration process to settle disputes between health plans and providers. Despite repeated efforts by some lawmakers on the panel to amend the bill’s arbitration threshold and federal benchmark payment provisions, committee members ultimately determined their plan will utilize a federal benchmark to settle payment disputes, with optional arbitration for bills over $750. The American College of Radiology® (ACR®) and several other medical specialties have opposed a benchmark payment as well as the $750 threshold, as the majority of bills generated by radiologists fall well below the arbitration trigger.

The passage of both bills in key House committees now sets up a showdown among four congressional panels over how to resolve disputes between insurers and providers. The White House will undoubtedly play a role in negotiations as well. 

Lawmakers will have to negotiate among three proposals (Senate HELP and House Energy and Commerce “Compromise Agreement,” the House Education and Labor’s H.R. 5800, and the House Ways and Means’ H.R. 5826), to produce one version by the end of May as part of a package reauthorizing funding for a set of federal health programs.

Negotiations will largely fall to Energy and Commerce Chair Frank Pallone (D-N.J.) and Ways and Means Chair Richard Neal (D-Mass.). Both insist they are not far apart on the issue, though their proposals differ significantly on how to settle pay disputes between insurers and providers. There are no firm plans for the two to start hashing out their differences any time soon.

As congressional negotiations continue, the ACR will continue to work toward a solution that keeps patients out of the middle of billing disputes. We will oppose legislative efforts that may limit radiologists’ efforts to negotiate reimbursement rates with insurers.