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Analysis

House Ways & Means Committee Releases Surprise Billing Legislation

By Jack O'Brien  
   February 07, 2020

Leaders of both the Senate and House health committees commented on the new proposal.

The House Ways & Means Committee released its proposal to curb surprise medical billing Friday morning, which includes a provision to establish an independent mediated negotiation process for billing disagreements.

The Consumer Protections Against Surprise Medical Bills Act of 2020, is a bipartisan proposal to end balance billing and institute consumer protections, according to its cosponsors, and also acknowledge the "importance of the private market dynamics between insurance plans and providers."

The inclusion of language that creates an independent dispute resolution (IDR) process, or 'baseball-style' arbitration, is a major development as emergency care providers have pushed lawmakers to embrace the concept and move away from provisions that set benchmark rates to median in-network rates for a geographic area.

Related: Payers, Providers Butt Heads on Surprise Billing Solutions

Ways & Means Committee Chairman Richard Neal, D-Mass., and Ranking Member Kevin Brady, R-Texas, released a statement calling the proposal a way to empower patients through enhanced price transparency.

"We recognize that any solution to this problem touches every part of our nation's healthcare system. We want to minimize the burden on patients and keep the dispute resolution process neutral," Neal and Brady said in a statement. "Our priority throughout the painstaking process of crafting our legislation has been to get the policy right for patients, and we firmly believe that we have done that."

The announcement came days after The Hill reported that Speaker Nancy Pelosi, D-Calif., entered into negotiations between Neal and House Energy and Commerce (HEC) Committee Chairman Frank Pallone over dueling proposals to stop out-of-network billing practices. 

Related: Eliminating Out-of-Network Billing Could Reduce Spending by $40B

In a joint statement Friday morning, leaders of both the Senate and House health committees commented on the new proposal.

Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander, R-Tenn., and Ranking Member Patty Murray, D-Wash., along with Pallone and HEC Committee Ranking Member Greg Walden, R-Ore., issued a statement on the latest policy proposal to halt what they deemed an "egregious billing practice."

"Protecting innocent patients has been our top goal throughout this effort, and we appreciate that the other two House committees share this priority," the statement read. "We look forward to working together to deliver a bill to the president’s desk that protects patients and lowers health care costs for American consumers."

In early summer, both the Senate HELP Committee and the HEC Committee passed surprise billing solutions.

However, when lawmakers returned from summer recess, the momentum behind the proposals stalled in the face of multimillion-dollar efforts to stifle the plans.

A key point of opposition from emergency care providers was that both proposals included language to have benchmark rates set to median in-network rates for a geographic area.

Dr. Rebecca Parker, chief medical affairs officer at Envision Physician Services, a subsidiary of Envision Healthcare, and former president of American College of Emergency Physicians, told HealthLeaders that such proposals would decrease access to care and put hospitals at financial risk.

"[For] any hospital that is in that safety-net [space], barely making it, if those rates gets dramatically cut, the hospitals will have to supplement and hospitals will close," Parker said. 

Ultimately, a bipartisan plan to lower out-of-pocket spending costs, end surprise billing, and introduce a mechanism for arbitration was not included in a year-end government funding package.

Related: 'Network Matching' Offers Surprise Billing Solution

However, in mid-December, congressional leaders announced the expansion of a bipartisan investigation into surprise billing practices by both providers and payers.

The probe, led by leaders from the Senate HELP Committee and the HEC Committee, is focused on Envision Healthcare, TeamHealth, Anthem Inc., Cigna Corp., CVS Health, Health Care Service Corporation, Highmark, and UnitedHealth Group.

During his State of the Union address earlier this week, President Trump said patients should never be "blindsided" by medical bills but did not specifically discuss the issue of surprise medical billing.

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.


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