Full Committee markup of Surprise Billing Legislation
Wednesday, July 17, 2019
Posted by: DCMS
Please see this important update from the American Medical Association regarding H.R. 360, the No Surprises Act:
This afternoon the full House Energy and Commerce Committee reported out surprise billing legislation on a voice vote.
An amendment offered by Rep. Raul Ruiz MD (D-CA) and Rep. Larry Bucshon MD (R-IN) was adopted to add an appeals provision. Appeals would be restricted to complex cases with a claims threshold of $1,250 (indexed to inflation). The threshold is designed to limit the number of appeals and thereby also retain a higher level of savings to offset the cost of other legislation reported of out of committee today. We are still seeking to clarify how the opportunity to bundle claims on this $1,250 threshold would work. Arbitrators would be permitted to consider median contracted in-network rate, provider’s level of training, experience, quality and outcomes measurements and acuity of care/services rendered. In order to hold down the budget score of the amendment, the arbitrator would be prohibited from considering billed charges.
The addition of an appeals process, albeit imperfect, represents progress. We have opportunities with two other House committees to make further improvements on this and other elements in the legislation as well as subsequent negotiations both before and during floor action in the House and Senate.
Amendments were adopted by the Energy and Commerce Committee for HHS and the Government Accountability Office to conduct studies to assess impact of the legislation on access to providers, network adequacy, premiums and patient out of pocket costs. In addition, a requirement to conduct an audit of at least 25 health plans to assure that in-network median rates are being properly calculated was also adopted.
Patrice A. Harris, M.D., M.A., President of the American Medical Association released a statement following conclusion of the markup.
“The American Medical Association remains committed to protecting patients from surprise bills," said Patrice A. Harris, M.D., M.A, American Medical Association President. "We appreciate the work by Energy and Commerce Chairman Frank Pallone, ranking member Greg Walden, Rep. Raul Ruiz, M.D., and Rep. Larry Bucshon, M.D., and others to add an appeals process for resolving out-of-network payment disputes. This addition represents progress. While we continue to have concerns with elements of the legislation, we remain committed to working with all committee members to secure further improvements to protect patients, preserve access and foster fair payments for out-of-network services.”