As U.S. Sens. Bill Cassidy (R-LA) and Todd Young (R-IN) work to craft bipartisan legislation to improve medical billing and put an end to surprise medical bills while lowering healthcare costs for Americans, the senators this week requested more details from the healthcare industry.
Sen. Cassidy’s office said on Feb. 5 that a letter with numerous questions was sent to healthcare providers and insurers seeking answers to supplement input they previously received for draft legislation offered during the 115th Congress.
“As we continue our bipartisan effort to lower health care costs and improve price transparency, we seek more detailed information in addition to what we have received thus far. Surprise medical billing is a complex problem, and crafting bipartisan, effective legislation to address it will require greater engagement from the private sector,” wrote the lawmakers, who were joined in signing the letter by U.S. Sens. Michael Bennet (D-CO), Tom Carper (D-DE), Lisa Murkowski (R-AK), and Maggie Hassan (D-NH).
The answers received will inform the senators’ work on their discussion draft, the Protecting Patients from Surprise Medical Bills Act, which they released in September 2018.
“We want to protect patients from costly surprise bills while preventing undue disruption in the healthcare system,” according to their letter. “To meet this goal, it is critical that we receive additional data and more complete feedback in order to refine and inform our legislative proposal.”
Specifically, the senators seek state-by-state information and data for those having a balance billing law in effect. They are: Alaska, California, Colorado, Florida, Maryland, New York and Texas.
But the lawmakers also requested an average across the remaining states for those that don’t have an existing balance billing law.
Regarding plan questions, the senators asked for data and feedback on topics such as what is currently paid for out-of-network care on average, broken down by plan type, market type and provider type, as well as how such rates compare to Medicare rates, average in-network rates, and provider charges.
They also want details such as the percentage of a plan’s premiums that are attributable to specialty groups like emergency care physicians, radiologists, anesthesiologists, pathologists, ambulance services and laboratory services.
And for states using independent dispute resolution processes to address balance billing, the senators want to know information such as the effect this process has had on premiums and payment rates to providers in and out-of-network, for example.
The senators also asked for specific recommendations “to facilitate network adequacy and encourage provider participation in health plan networks in the context of federal legislation to address surprise medical billing,” according to their letter.
Regarding provider questions, the senators asked for the average out-of-network payment providers receive for emergency services, how it compares to Medicare, and how that differs by state. They also want to know how the average out-of-network payment for ancillary providers compares with Medicare reimbursement and physician charges.
According to an article published by the Health Care Cost Institute, the senators wrote, emergency room spending per person has risen 98 percent although overall emergency room utilization stayed the same between 2009 and 2016. “How do you explain this trend?” they asked.
Among the more than dozen questions they asked providers, the senators also sought their opinions on a state model that they think has worked well to protect patients from surprise medical billing.
“If so, why has it worked well? Please provide the details of this model, including its impact on contracting rates and out-of-network payment rates, and describe the data and policy rationale underlying this state legislation,” they wrote.
Sens. Cassidy, Young and their colleagues have requested responses to their questions by Feb. 18.