October 3, 2019

House committee chair proposes new fix for 'surprise' medical bills

Daily Briefing

    House Ways and Means Committee Chair Richard Neal (D-Mass.) is floating a new plan to reach an agreement on ways to address so-called "surprise" medical bills that would rely heavily on the Trump administration and industry stakeholders, according to a letter Neal sent Friday to Democratic lawmakers that was obtained by The Hill.

    Background

    Federal lawmakers, insurers, and providers have been divided on how to resolve the unexpected bills patients receive after being treated by out-of-network providers. Insurers have called on lawmakers to approve a measure that would establish a benchmark payment rate for out-of-network bills, but hospital groups have pushed for an arbitration process that insurers and providers could use to settle payment disputes. Lobbying efforts from providers have stalled negotiations on legislation to address surprise medical bills, according to The Hill.

    Proposal details

    However, Neal's proposal aims to move negotiations on legislation to address surprise bills forward by establishing a committee made up of administration officials and industry stakeholders to develop regulations to resolve surprise medical bills.

    Under Neal's proposal, the committee would include providers, insurers, and officials from HHS, the Department of Labor (DOL), and the Department of the Treasury (DOT). The group would be tasked with developing recommendations for standards the federal government could use to establish payment rates for out-of-network bills. The committee also would determine whether to recommend a dispute resolution process and define standards for the process to ensure it does not increase health care costs.

    The committee then would send their recommendations to the secretaries of HHS, DOL, and DOT, who would use the recommendations to propose rulemaking, which would be open to public comments.

    What's next?

    According to The Hill, it is unclear whether Neal's proposal will receive support from providers and hospitals. However, Neal noted he is "optimistic" the committee's top Republican, Rep. Kevin Brady (Texas), will support the proposal.

    Shawn Gremminger, senior director of federal relations at Families USA, in an email wrote, "I appreciate Chairman Neal's interest in getting a bill over the finish line. We are concerned, however, that this proposal just punts the critical and difficult decision making to HHS, where we aren't confident the industry stakeholders will be any more likely to come to agreement" (Owens, "Vitals," Axios, 10/2; Sullivan, The Hill, 10/1; King, FierceHealthcare, 10/1; House Ways and Means Committee letter, 9/27).

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