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AMA update on H.R. 3630, the "No Surprises Act"

Friday, July 12, 2019   (0 Comments)
Posted by: DCMS
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The following is an update from the American Medical Association (AMA) regarding H.R. 360, the No Surprises Act:


The House Energy and Commerce Health Subcommittee reported out H.R. 3630, the No Surprises Act, by a voice vote without amendment on July 11. The AMA opposed the bill because out-of-network payments would be based on the median in-network median amount.

The AMA urged that surprise billing legislation:

  • Establish benchmark rates that are fair to all stakeholders in the private market; benchmark rates should include actual local charges as determined through an independent claims data base.
  • Establish a fair and independent dispute resolution (IDR) process to resolve disputes about payments from insurers to unaffiliated providers of out-of-network services.
  • Protect patients from out-of-network billing and preserve patient access to care by holding insurers accountable for addressing their own contributions to the problem.

During the Subcommittee mark-up several Democratic and Republican Representatives called for modifications of the bill before the bill is reported out by the full Committee. Rep. Ruiz MD (D-CA) and Rep. Bucshon MD (R-IN) pressed for an independent dispute resolution (IDR) or appeals process to resolve out of payment network rates.  Other Subcommittee members expressing  concerns that the median in network rate would result in access problems for rural and underserved included Rep. Matsui (D-CA), Rep. Shimkus (R-IL), Rep. Bilirakis (R-FL), Rep. Butterfield (D-NC) , Rep. Hudson (R-NC) and Rep. Rochester (D-DE).  Members of Congress acknowledged they have received a significant volume of physician grassroots contacts.  Continued grassroots engagement will be essential.

Rep. Buschon called attention to the AMA’s July 10 letter on the issue during the mark-up and now plans to distribute our letter to all of his GOP colleagues.

Full Committee Chairman Pallone stated that  he is open to further discussion about possible changes in the legislation.  However, he indicated that modifications should not increase health costs or premiums and also suggested that pegging to out-of-network payments to charges was a non-starter (raised costs and lowers savings to offset other spending)

We expect full Committee markup to be held on July 17.


Other House Committees of Jurisdiction

The House Education and Labor and the House Ways and Means Committee also share jurisdiction for surprise billing legislation.  Both committees are not as far along in framing a specific legislative proposal.  With only two weeks left before the August recess it we do not expect either committee to report out bills and House floor action before September at the earliest.