July 11, 2019

Surprise Billing Legislation Advances Through House E&C Subcommittee

On Thursday, July 11th, the House Energy and Commerce Health Subcommittee advanced a series of health care bills, including H.R. 3630, the No Surprises Act.

H.R. 3630 aims to shield patients from surprise billing by banning balance billing and limiting patient cost sharing when a patient receives out-of-network (OON) services. If a patient receives scheduled, non-emergency care from an OON provider or facility, the provider or facility must provide the patient with at least 72 hours of advance written and oral notice to specifically consent to receiving OON services.

The No Surprises Act requires OON physicians to accept a benchmark payment of median in network rates adjusted for inflation. The Secretary of Health and Human Services would have the ability to conduct audits of the median contracted rate to ensure accuracy and provide $50 million in grants for states to develop or maintain an all-payer claims database.

The American College of Radiology (ACR) remains committed to protecting patients from surprise medical bills but has serious concerns with any policy that will result in federal government rate-setting in the private market. Rate-setting eliminates any motivation for an insurer to negotiate with a physician, which will ultimately result in market compression and impact all physicians, regardless of their network status.

Several Energy and Commerce Health Subcommittee members on both sides of the aisle voiced concern that the current proposal is too heavily weighted in favor of the insurer and encouraged committee leadership to continue to work toward a solution that contains an independent dispute resolution mechanism prior to full committee markup. Full committee markup is expected next week.

The ACR supports H.R. 3502, the Protecting People from Surprise Medical Bills Act as introduced by Congressman Raul Ruiz, MD (D-CA) and Congressman Phil Roe, MD (R-TN). This legislation, modeled after the New York state surprise billing law, outlines a process for resolving surprise medical bills that takes the patient out of the middle and implements an independent dispute resolution (IDR) system for providers and insurers to resolve payment differences in a fair, evidence-based and independent manner. The bill currently has 47 cosponsors.

The College will continue to provide updates on this issue as it progresses through the legislative process.