Special Bulletin: Text of Bipartisan, Bicameral Surprise Medical Billing Legislation Released

December 12, 2020

AHA summary of provisions included in the bill

Last night, House and Senate Committee leaders announced a bipartisan agreement to address surprise medical bills, the “No Surprises Act.” The bill is supported by House Ways and Means Committee Chairman Richard E. Neal (D-MA) and Ranking Member Kevin Brady (R-TX), House Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-NJ) and Ranking Member Greg Walden (R-OR), House Education and Labor Committee Chairman Robert C. “Bobby” Scott (D-VA) and Ranking Member Virginia Foxx (R-NC), and Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA).

The legislation prohibits providers from balance billing patients for emergency services or medical care the patient reasonably could have expected to be in-network, and does not allow patients to be charged more than the in-network cost-sharing amount. The proposal does not rely on a benchmark payment rate to determine out-of-network reimbursement, but instead includes a period for health plans and providers to negotiate reimbursement, to be followed by a mediated dispute resolution process should it be necessary. The bill also includes several other provisions to help patients access certain types of care and better understand their provider networks and costs.

The legislation may be voted on before the end of the year. The bill would use the savings generated from the surprise medical billing provisions to fund certain expiring public health programs, including Community Health Centers, National Health Service Corps, Teaching Health Centers, and the Special Diabetes Programs.

The Congressional Budget Office has not yet released publicly a score. The legislative text is available here and a summary follows.

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