Two House Committees Pass Surprise Billing Proposals

The Education and Labor Committee combines a market-based benchmark rate with an option for arbitration for bills above $750 in payment disputes. The Ways and Means Committee calls only for arbitration.

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Picking up where Congress left off last year, the two remaining House Committees involved in shaping a surprise billing solution, introduced legislative language and are holding hearings to mark up their bills this week.

The House Education and Labor Committee bill, which passed out of committee with only minor changes, would ban balance billing of patients for emergency care and care at in-network facilities by out-of-network providers (surprise billing), as will all other proposals. In addition, like December’s agreement between the Senate Health, Education, Labor and Pensions (HELP) Committee and the House Energy and Commerce Committee, it would require out-of-network providers and air ambulance services to accept the median in-network rate in the local area as payment for services. For amounts above $750 ($25,000 for air ambulance services), payers or providers may use arbitration to settle the amount. The bill also calls for health plans to maintain accurate provider directories and to provide better information to consumers about cost-sharing in- and out-of-network.

The Ways and Means Committee, which stymied action last year, came out with a different approach that includes no reference to a benchmark rate based on market rates in the local area. Instead, when a surprise bill occurs, either party may begin a negotiation process. After 30 days, if the sides cannot agree, independent mediators will be assigned to resolve payment. Each party can submit a best and final offer. Mediators may not consider billed charges but are required consider the plan-specific median in-network rate for the locality. The bill would also require plans to provide patients with a fair price estimate and whether or not the provider is in-network in advance of the service for non-emergencies. The bill passed without amendments Wednesday.

Business Group on Health joined other employer groups and unions in a joint letter to the Ways and Means Committee expressing concerns about an arbitration-only approach. It’s unclear whether the three House Committees involved can agree on a common approach. However, the Speaker is pushing them hard to agree no later than May. If they do, they will then have to come to agreement with the Senate HELP Committee, which favors a benchmark approach and limits on arbitration.

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