Senate HELP leaders release revised health cost legislation

Senate Health, Education, Labor and Pensions Committee leaders today released a manager’s amendment to the Lower Health Care Costs Act of 2019 (S.1895) — bipartisan legislation focused on reducing health care costs — making several updates to the bill.
 
Specifically, the manager’s amendment would require that in-network hospitals notify patients, for non-emergency care, that they may receive out-of-network care within 48 hours prior to the care being provided. The Secretary of Health and Human Services would be required to conduct rulemaking to define stabilization and timing as they relate to notice requirements. The amendment also clarifies the definition of the benchmark payment rate to mean the median in-network contracted rate and directs the HHS Secretary to examine how the benchmark payment rate would affect rural areas. The Secretary is directed to consult with the National Association of Insurance Commissioners before establishing the geographic areas for purposes of the benchmark payment and would be required to examine the effects of the surprise billing provisions on specialty care, rural areas and health professional shortage areas.
 
In addition, the updated language would create a carve out from the prohibition on “anti-tiering” and “anti-steering” clauses when the contract is with certain value-based network arrangements. A new section would require group health plans to submit an annual report to HHS with information on each plan they offer, including detailed information on spending by category of services, such as prescription drugs and hospital services.
 
The manager’s amendment also includes a requirement that states pass laws to raise the legal age for purchasing tobacco products to 21, and incorporates the Creating and Restoring Equal Access to Equivalent Samples Act, AHA-supported legislation that would allow generic drug manufacturers facing certain anticompetitive delay tactics to bring an action in federal court for injunctive relief. 
 
The HELP Committee will mark up the bill on Wednesday, June 26.