Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Surprise Billing Legislation Update: Where We Are Now

Surprise Billing Update: Where We Are Now

Surprise billing has been showing up in the 24-hour news cycle for years now, with mainstream media routinely reporting on situations like the $108,951 heart attack or the $17,850 urine test. Since President Donald Trump’s May 9 White House Speech calling for new legislation to end surprise billing, however, everyone’s talking about it. And both the Senate and the House have introduced bills to address it.

In this roundup, we’re hoping to give you the big picture, with who’s proposing what and who’s not happy about it. For all the details, click through to the articles that have all the details.

The Bills

Several bills tackling surprise billing have been introduced in both the House and the Senate:

  • H.R. 861 – “End Surprise Billing Act of 2019” was introduced by Rep. Lloyd Doggett (D-TX) back in January 2019 to require critical access hospitals or other hospitals to comply with out-of-network billing requirements as a condition of participation in Medicare.
  • A discussion draft of the “No Surprises Act” was released on May 14, 2019, by Reps. Frank Pallone (D-NJ) and Greg Walden (R-OR), the Democratic and Republican leaders of the House Energy and Commerce Committee. A hearing on “No More Surprises: Protecting Patients from Surprise Medical Bills” was held Wednesday, June 12, by the Health subcommittee of the House Energy and Commerce Committee.
  • S.1531- “Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019” was introduced on May 16, 2019, by Sens. Bill Cassidy (R-LA), Michael Bennet (D-CO), Todd Young (R-IN), Maggie Hassan (D-NH), Lisa Murkowski (R-AK) and Tom Carper (D-DE), a bipartisan group primarily working on transparency legislation.
  • The “Lower Health Care Costs Act” was floated on May 23, 2019, by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), the top Republican and Democrat on the Senate health committee. The bill covers a wide range of healthcare-related topics in addition to surprise billing.
  • Also on May 23, 2019, Representatives Raul Ruiz, M.D. (D-CA), Phil Roe, M.D. (R-TN), Joseph Morelle (D-NY), Van Taylor (R-TX), Ami Bera, M.D. (D-CA), Larry Bucshon, M.D. (R-IN), Donna Shalala (D-FL), and Brad Wenstrup, D.P.M. (R-OH) released an outline of their “Protecting People from Surprise Medical Bills Act,” with finalized legislation expected to be introduced in the coming weeks.

How They Differ

Most of the House and Senate bills agree on holding patients harmless in the case of emergency out-of-network services. While they may differ slightly in whether patients are held responsible for out-of-network charges for non-emergencies or specialty services, the real differences are in the provisions for payment. Some of the bills (most notably the Pallone-Walden House bill) would require insurers to pay at the median contracted (in-network) rate for the geographic area. At least one of the Senate bills (S.1531), however, starts with payment at the median in-network rate, but includes an independent dispute resolution (IDR) process. The Alexander-Murray Senate bill includes three options for payment, with a plan to select one following input from key stakeholders.

For a more detailed comparison of the bills, check out the following articles:

Industry Response

While the out-of-network bills may be a surprise to patients, and the bi-partisan support for finding a solution may be a bit of a shock to all of us, what isn’t surprising is the way key stakeholders are lining up for and against key provisions of the bills.

Payers want a set rate for these out-of-network bills, akin to the median in-network rate (which provider feel would reduce the incentive for payers to negotiate fair in-network rates); providers want the option for arbitration (which payers fear will cost them too much money and disincentivise providers from coming in-network). Many states also are throwing their hats into the ring with proposed legislation to curb the problem more locally.

A trio of health policy researchers has even suggested we aren’t looking at the issue of surprise billing broadly enough. In their Health Affairs article “Surprise Billing: No Surprise In View Of Network Complexity,” Simon F. Haeder, David L. Weimer, and Dana B. Mukamelt say the industry needs to also tackle the causes of surprise billing, namely inaccurate provider directories and inadequate provider, rather than simply the effects. Addressing these issues will also help patients with out of network bills that aren’t a surprise at all, though just as devastating, the authors say.

For a detailed look at how payers, providers, policy leaders, and others are responding to the House and Senate bills and surprise billing in general, check out the following articles:

—  All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com.


Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

© Copyright 2020