House Energy and Commerce Committee leaders today released a discussion draft of bipartisan legislation to address surprise medical bills. According to a summary of the No Surprises Act published by Politico, the draft legislation would:
- Prohibit balance billing for all emergency services; hold patients responsible only for the amount they would have paid in-network; and make balance billing violations subject to federal civil and monetary penalties.
- Require when patients schedule care written and oral notice about the provider’s network status and any potential charges they could be liable for if treated by an out-of-network provider.
- Prohibit balance bills from providers whom patients cannot reasonably choose.
- Establish a minimum payment standard, set at the median contracted (in-network) rate for the service in the geographic area the service was delivered, while preserving a state’s ability to determine their own payment standards for plans they regulate.
- Provide $50 million in grants for states looking to develop or maintain an all-payer claims database.
In February, the AHA unveiled a set of principles to help inform the federal policy debate regarding surprise billing, and joined other hospital groups in sharing a letter with key legislators outlining their position.
“America’s hospitals and health systems are fully committed to protecting patients from surprise bills and have urged Congress to act,” said AHA President and CEO Rick Pollack. “We can achieve this by limiting patients’ out-of-pocket expenses to what they would have incurred from in-network providers. Providers and insurers should then be permitted to negotiate payment rates for services provided without the patient being put in the middle. We strongly oppose approaches that would impose arbitrary rates on providers. Insurers should maintain comprehensive networks and this plan takes us in the opposite direction by removing incentives to contract with providers. We look forward to our continued work with Congress on workable solutions to stop surprise bills.”