Surprise Billing Advocacy Updates

Lawmakers Urge Regulators to Implement No Surprises Act Dispute Resolution as Intended.

The American Hospital Association looks forward to working with CMS on implementing the good faith estimates and advanced explanation of benefits (EOB) required by the No Surprises Act.

The AHA offers initial recommendations to the departments of Health and Human Services, Treasury and Labor as they develop guidance to implement the No Surprises Act.

AHA urges the Centers for Medicare & Medicaid Services to align the Hospital Price Transparency Rule with new transparency requirements included in the No Surprises Act.

On Dec. 27, 2020, the No Surprises Act was signed into law as part of the Consolidated Appropriations Act of 2021 (H.R. 133; Division BB – Private Health Insurance and Public Health Provisions).

AHA letter to Ways & Means Chairman Neal and Ranking Member Brady thanking them for addressing surprise medical billing as part of the Consolidated Appropriations Act of 2021

The Honorable Richard E. Neal Chairman Ways & Means Committee U.S. House of Representatives

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 Ch

As Congress continues to negotiate a year-end spending package and more COVID-19 relief, we’re continuing to keep you updated on the latest issues. This is our third Action Alert related to the lame-duck session, and information and resources related to our priority issues are included below.

Congress is back in Washington, D.C., for its “lame-duck” session, in which lawmakers will take up pressing, end-of-year business. Funding for the federal government, as well as other key health care provisions, are set to expire Dec. 11. It is imperative that we work to ensure that hospitals and health systems — and their front-line caregivers — receive additional federal support as we continue to navigate public health and financial challenges due to COVID-19.

Hospitals and health systems are deeply concerned about the effect of unanticipated medical bills on our patients, which could impact their out- of-pocket costs. Protecting patients from surprise medical bills is a top priority for the AHA and all of our members. However, we oppose legislative proposals that set a default payment rate for out-of-network services. Recently, an agreement was announced that would address surprise medical bills. While no legislative language has been provided, we understand the proposal would include a prohibition on balance billing and rely on rate setting to establish an initial payment, with an opportunity for providers to dispute the payment.

The AHA and other national organizations representing the nation’s hospitals and health systems today urged congressional leaders not to include in the next COVID-19 relief package any surprise medical billing legislation that could further destabilize hospitals’ finances as they work to recover from an unprecedented public health emergency.

Urge Your Representative to Cosponsor Surprise Medical Billing Legislation Approved by the House Ways and Means Committee

The Senate and House are both considering legislation to address surprise medical bills that patients may incur as a result of unexpected gaps in insurance coverage or medical emergencies. Below are brief summaries of the proposals under consideration. A

Two House committees – Ways and Means, and Education and Labor – this week advanced separate legislation to address surprise medical bills. These pieces of legislation also are different from a December agreement between leaders from the Senate Health, Education, Labor and Pensions (HELP) Committee and House Energy and Commerce Committee on legislation to address surprise medical bills.

AHA Ask: AHA supports protecting patients from surprise medical bills. Policymakers should focus on assisting rural hospitals in their negotiations with payers and providing the incentives and resources needed to maintain local access to care and not undermine these communities with potentially harmful national policy changes.

The AHA supports protecting patients from surprise medical bills and improving patient access to meaningful pricing information. The following resources provide more information on the AHA’s position, including in response to regulatory and legislative proposals.

The one issue that all stakeholders – hospitals, physicians, insurers and consumers – agree on is that patients should not be balance billed for emergency services, or for services obtained in any in-network facility when the patient could reasonably have assumed that the providers caring for them were in-network with their health plan.

Patients should not be balance billed for emergency services, or for services obtained in any in-network facility when the patient could reasonably have assumed that the providers caring for them were in-network with their health plan.

House Ways and Means Committee Chairman Richard Neal, D-Mass., and Ranking Member Kevin Brady, R-Texas, this morning released legislative text of the Consumer Protections Against Surprise Medical Bills Act of 2020, the committee’s proposal to address surprise medical bills.