June 27, 2019

Surprise Billing Solutions Take Shape in Congress

On June 26, the Senate Health, Education, Labor and Pensions (HELP) Committee passed an amended version of the Lower Health Care Costs Act (S. 1895) by a vote of 20–3.

The bill, which seeks to reduce cost and increase transparency across the health care delivery system, became the vehicle to advance provisions to resolve out-of-network (OON) payment disputes that often result in surprise medical bills for patients. Despite a period of intense stakeholder engagement, the committee opted to advance a solution to reimburse physicians for OON services at the median in-network rate instead of incentivizing good faith negotiations between providers and insurers via an independent dispute resolution process.

The American College of Radiology (ACR) opposes benchmarked payments for OON services and remains concerned about the policy’s potential impact on current and future contract negotiations between providers and insurers.

Although the HELP Committee has completed its formal work on S. 1895, Chairman Lamar Alexander (R-TN) has indicated a willingness to continue negotiating the surprise billing-related provisions and noted that the legislation will undergo further changes before it is brought to the Senate floor. As such, the ACR and others in the physician community are continuing to collaborate with Sen. Bill Cassidy, MD (R-LA) to seek inclusion of provisions in S. 1895 that reflect his bipartisan STOP Act (S. 1531).

Also this week, Representatives Raul Ruiz, MD (D-CA) and Phil Roe, MD (R-TN), secured formal introduction of the Protecting People from Surprise Medical Bills Act in the House of Representatives. They were joined by 32 original cosponsors from both sides of the aisle on key committees of jurisdiction, including Republicans and Democrats on the Energy and Commerce, Ways and Means, and Education and Labor committees.

This much-anticipated legislation closely mirrors the surprise billing law implemented in New York State and utilizes a ‘baseball-style’* arbitration mechanism to identify a reasonable payment rate when insurers and providers cannot agree on the cost of care. The bill will also improve transparency by requiring health plans to clearly identify in-network providers and patients’ deductibles. The framework put forth by Ruiz and Roe represents the most comprehensive and equitable resolution for the surprise billing issue to date and offers a clear contrast to the benchmarking solution advanced by the Senate HELP Committee.

The ACR supports the Protecting People from Surprise Medical Bills Act and circulated an advocacy “Call to Action” on June 26. The House Energy and Commerce Committee will meet to mark up surprise billing-related legislation in July, with the session occurring as soon as July 10. Given this compressed timeframe, ACR members are strongly encouraged to contact members of Congress to request that they cosponsor this critical legislation. Take Action Now!

* ‘Baseball-style’ arbitration refers to a form of dispute resolution entailing each party providing a proposed “final offer” monetary amount for the claim to the arbitrator(s). The arbitrator(s) will adopt one of the proposed amounts in the award and the “loser” pays for the costs of the proceeding.