Senate, House lawmakers announce a deal to fix 'surprise' medical bills

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    Three federal lawmakers on Sunday announced that the Senate Health, Education, Labor and Pensions (HELP) Committee and the House Energy and Commerce Committee have reached a bipartisan agreement on legislation to address so-called "surprise" medical bills.

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    Background

    Pressure has been mounting in Congress to pass legislation to address surprise medical bills after President Trump in May called on lawmakers to approve such a measure. However, 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.

    Lawmakers say committees have reached a deal

    Senate HELP Committee Chair Lamar Alexander (R-Tenn.), House Energy and Commerce Committee Chair Frank Pallone (D-N.J.), and Rep. Greg Walden (R-Ore.), the House committee's ranking member, on Sunday announced that they have reached an agreement in principle on legislation to address surprise medical bills, but they did not provide extensive details on the deal. House and Senate staffers said the proposal is being finalized and the new bill's text will be released soon, Inside Health Policy reports.

    According to Modern Healthcare, the new bill will be similar to the House Energy and Commerce Committee's No Surprises Act (HR 3630), which included both benchmark-rate setting and an arbitration backstop for providers. For example, the new bill would set payment rates for out-of-network care based on a benchmark of the median in-network rate in a given area, Modern Healthcare reports. In addition, the committee in a release said the bill also would establish an arbitration process for health care providers to appeal the payments for some large claims, though lawmakers did not detail the thresholds for such appeals or which factors arbiters would be directed to consider when reviewing such appeals, according to Modern Healthcare. The arbitration process also would apply to surprise bills stemming from air ambulances, the New York Times' "The Upshot" reports.

    Lawmakers said the legislation also will include some provisions that are not associated with addressing surprise medical bills. For example, the House Energy and Commerce Committee in a release said the legislation will:

    • Increase from 18 to 21 the minimum age at which U.S. residents can purchase tobacco products;
    • Provide about $20 billion over five years to fund community health centers; and
    • Require more transparency and bolster competition in an effort to reduce prescription drug and medical costs.

    The lawmakers said they hope to include the new legislation in an end-of-year government spending bill, which Congress must approve and President Trump must sign by the end of Dec. 20 to avoid a government shutdown, The Hill reports.

    Comments

    Pallone said, "This agreement will make health care and prescription drugs more affordable for the American people. I'm hopeful that this bipartisan, bicameral agreement can be voted on quickly so that it can be signed into law before the end of the year."

    But the agreement does not have sign off from Murray, who indicated that she is working with Senate Democrats on some of the measure's provisions. Helen Hare, Murray's communications director, said Murray did not sign off on the agreement because although she "believes the overall agreement takes important steps forward on a number of issues," she "is [still] working with some members of her caucus on concerns they still have."

    It is unclear whether Senate and House leadership support the agreement.

    Senate Majority Leader Mitch McConnell (R-Ky.) said he is encouraged to see lawmakers included his proposal to increase the minimum tobacco purchasing age in the deal. He added, "I look forward to reviewing the details on this and the other policies included in the package announced today."

    A spokesperson for House Speaker Nancy Pelosi (D-Calif.) did not respond to a request for comment, Modern Healthcare reports.

    The American Hospital Association (AHA) expressed concerns with the coming legislation. Rick Pollack, AHA's president and CEO, said, "Unfortunately, unless this proposal is much improved over previous bills that rely on a benchmark rate, it remains highly problematic and would jeopardize patient access to hospital care, particularly in rural communities" (Cohen, Inside Health Policy, 12/8 [subscription required]; House Energy and Commerce Committee release, 12/8; Cohrs, Modern Healthcare, 12/8; Sullivan, The Hill, 12/8; Ruoff, Bloomberg Law, 12/8; Owens, "Vitals," Axios, 12/9; McIntire, Roll Call, 12/8; Sanger-Katz, "The Upshot," New York Times, 12/8).

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