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In July, the U.S. House of Representatives opened hearings and introduced legislation to address the issue of surprise billing entitled the “No Surprises Act” (H.R. 3630).  By July 17, the legislation had been subject to mark-up and amendments as well in the House Energy and Commerce Committee, which reported out the proposed legislation to the full House 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 claim’s 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. ISASS is 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.

With the approval by the House Energy and Commerce Committee, the proposed legislation will be marked-up and amended with two other House committees before advancing to the House floor for a full vote by the House of Representatives.

Additional 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.

The legislation being considered by the House will also have to be reconciled with concurrent legislation under review by the U.S. Senate. The Senate legislation is sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), the chairman and ranking member of the Health, Education, Labor and Pensions (HELP) Committee. Given the committee’s influence, and because this legislation has bipartisan support in the Senate where not many bills are moving, industry observers are taking the HELP panel’s proposal very seriously.

Alexander and Murray’s bill lays out three options for paying surprise medical bills but does not specify which path the final legislation should take. The full Senate has yet to vote on the legislation.

Read Federation Sign on Letter Surprise Billing 7-16-19.