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On Dec. 11, the House Ways and Means Committee issued an outline of that panel’s bipartisan proposal for addressing surprise medical bills. Some details are vague, and it could be after the holidays before we see legislative language. Nonetheless, the committee’s approach offers significant differences from the recently issued agreement reached between the House Energy & Commerce Committee and the Senate Health, Labor, Education, and Pension (HELP) Committee.

  • Like other proposals, the Ways & Means plan would limit patients’ out-of-pocket costs to the amounts they would have owed if they had the opportunity to choose in-network physicians and facilities to provide their care.
  • An independent dispute resolution (IDR) system is also included.  However, unlike other proposals, Ways & Means does not restrict IDR to claims above a certain threshold amount, nor does it establish a payment benchmark based on in-network payment amounts.
  • Price and network transparency provisions and protections for patients whose provider networks change during the plan year are also included.  Uninsured or cash-paying patients would also have access to IDR if they are given misleading cost information prior to obtaining services.

After the outline was released, Committee Chair Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) both affirmed their commitment to advancing a balanced approach to address surprise billing early next year, noting that the issue is too complex and important to rush through Congress prior to the holiday recess.

Earlier in the week, Sen. Lamar Alexander (R-TN), the chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, and Rep. Frank Pallone (D-NJ) and Rep. Greg Walden (R-OR), the chairman and ranking member of the House Energy and Commerce Committee announced an agreement on legislation to end surprise medical bills, raise the age to buy tobacco products to 21, and extend funding for federal health programs, such as community health centers.

The Senate bill would protect patients by limiting their out-of-pocket costs to amounts they would have owed if they had been treated by an in-network physicians but also include provisions strongly opposed by ISASS and other specialty societies that would resolve payment disputes between physicians and insurers by using a benchmark rate setting out-of-network payments at the median amount each insurer pays for in-network care. The new agreement includes similar benchmark rate provisions as well as a very limited IDR process with a $750 threshold that would only allow for the consideration of median in-network rates. The Congressional Budget Office estimates this new legislation would produce savings of $22 billion over ten years.

The Senate proposal also includes provisions related to tobacco, prescription drugs, and other issues that are raising significant concerns with many stakeholders.

With the limited legislative time remaining, it will be very difficult for the House and Senate to work through all the issues between the two chambers in time to secure enough support from Congressional leadership for its inclusion in any year-end package. At this time, Congressional deliberations on surprise billing legislation will likely be pushed into early next year.