Key committee leaders in both houses of Congress announced an agreement last week on the No Surprises Act, sweeping legislation that would require health plans to hold patients harmless from surprise medical bills.
“We have reached a bipartisan, bicameral deal in principle to protect patients from surprise medical bills and promote fairness in payment disputes between insurers and providers, without increasing premiums for patients or interfering with strong, state-level solutions already on the books,” said the committee leaders in a joint statement released on Dec. 11.
The members included U.S. House Energy and Commerce Committee Ranking Member Greg Walden (R-OR) and Chairman Frank Pallone, Jr. (D-NJ); U.S. House Ways and Means Committee Ranking Member Kevin Brady (R-TX) and Chairman Richard Neal (D-MA); U.S. House Education and Labor Committee Ranking Member Virginia Foxx (R-NC) and Chairman Bobby Scott (D-VA); and U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA).
“Under this agreement, the days of patients receiving devastating surprise out-of-network medical bills will be over,” according to the committee leaders. “Patients should not be penalized with these outrageous bills simply because they were rushed to an out-of-network hospital or unknowingly treated by an out-of-network provider at an in-network facility.”
The agreement for H.R. 3630, introduced in July 2019 by Reps. Walden and Pallone, also would permit insurers to make a payment to the provider that is determined either through negotiation between the parties or an independent dispute resolution (IDR) process. There would be no minimum payment threshold to enter IDR, and claims could be batched together to ease administrative burdens, according to the lawmakers’ agreement summary.
If the parties choose to utilize the IDR process, each would submit an offer to the independent arbiter, who would be required to consider the median in-network rate, information related to the training and experience of the provider, the market share of the parties, previous contracting history between the parties, complexity of the services provided, and any other information submitted by the parties, according to the agreement summary.
“We are pleased to share this language for stakeholder feedback and look forward to continuing to work together to finalize and attach this important new patient protection to the end-of-year funding package,” the members said. “We’re hopeful this legislation will be signed into law in the coming days so we can give Americans confidence they will no longer receive financially ruinous surprise out-of-network medical bills.”
As part of the legislative agreement, the package includes a long-term extension of expiring public health programs, including Community Health Centers, National Health Service Corps, Teaching Health Centers, and Special Diabetes Programs.