AHA urges Congress not to include provisions in year-end legislation that would impact private contract negotiations between providers and health plans

The AHA today urged congressional leaders not include in any end-of-the year legislative package provisions that would impact private contract negotiations between providers – including hospitals and physicians – and health insurance plans.

Congress is currently drafting legislation to fund the federal government beyond Dec. 18, as well as provide additional resources to address the COVID-19 pandemic. They may be considering adding to these legislative packages proposals that would disallow contract terms between providers (both facilities and professionals) and health plans that restrict health plans from directly or indirectly steering patients to particular providers and require health plans to contract with all of a health system’s providers.

“We have repeatedly raised concerns about these provisions on behalf of our members and the patients they serve,” AHA said. “The provisions could undermine value-based care by enabling health plans to negotiate favorable terms under such arrangements only to undermine providers’ performance by then steering patients elsewhere for care. Plans also would be able to cherry-pick certain providers within a system to avoid covering certain communities. We are particularly worried that plans would choose not to contract with rural providers in a system, further reducing health care coverage options and access to care in these communities. Contracting with only some providers in a system also would hurt care coordination as patients would not fully benefit from the integration systems have established across their providers. In addition, these provisions could eliminate access to certain services for enrollees in those plans, as systems generally do not duplicate services at all sites of care.”