‘Surprise’ Medical Billing Fix Emerges as Congress Races to Deal

  • Ban on balance billing, provider fees may ride on funding bill
  • Pelosi pushes health committee leaders into compromise

House and Senate committee leaders have struck a deal on a bipartisan fix for “surprise” medical bills, likely paving the way for its passage soon.

Richard Neal (D-Mass.), chairman of the House Ways and Means Committee, signed onto legislation that would ban balance billing, where a doctor or hospital charges a patient fees their insurer won’t cover, for most out-of-network care. It also seeks to hold patients harmless when they get emergency care from an out-of-network provider.

The bipartisan agreement is between the top Democrats and Republicans on the House Energy and Commerce, Ways and Means, and Education and Labor committees, as well as the leaders of the Senate Health, Education, Labor and Pensions Committee.

“Under this agreement, the days of patients receiving devastating surprise out-of-network medical bills will be over,” the committee leaders said in a joint statement. “Patients should not be penalized with these outrageous bills simply because they were rushed to an out-of-network hospital or unknowingly treated by an out-of-network provider at an in-network facility.”

The lawmakers’ last-minute deal comes as this congressional term wraps up and the balance of power in the Senate next year remains to be determined by two pivotal Senate runoffs in Georgia on Jan. 5. Reaching an agreement on surprise billing shows the committee leaders are eager to clear the decks before the new year. Two of the principal leaders of the effort, Senate HELP Chairman Lamar Alexander (R-Tenn.) and House Energy and Commerce ranking member Greg Walden (R-Ore.), are retiring.

With Neal on board it’s likely the surprise billing package can be attached to the year-end government spending bill, as lawmakers attempted to do late last year.

Andrew Harrer/Bloomberg
House Ways and Means Chairman Richard Neal (D-Mass.)

House Speaker Nancy Pelosi (D-Calif.) pushed Neal and House Energy and Commerce Chairman Frank Pallone (D-N.J.) to reach a compromise ahead of the year-end government spending bill, according to a congressional aide familiar with the discussions. Pelosi said in a statement that the House would push for the deal to be included in a year-end legislative package.

Senate leaders haven’t signed off on the deal, a committee aide said Friday.

The congressional committees with jurisdiction crafted legislation to tackle surprise medical billing in 2019, with the heads of the Energy and Commerce Committee in the House and the HELP Committee in the Senate striking a deal toward the end of the year.

That measure was slated to be a part of a year-end spending bill until Neal stepped in to demand his panel have a say on the issue. Neal offered his own legislation and agreed only Friday to cut a deal.

Billing Disputes

The divide between Neal and the other committee heads centered on how to settle billing disagreements.

The House Energy and Commerce and Senate HELP package would settle billing disputes between providers and insurers by forcing doctors to accept the median in-network rate for their service, a system insurers and employers favored. Neal preferred having a third party decide what rate the provider must accept, a process known as arbitration that provider groups have pushed.

Committee leaders have tried to reconcile the two approaches.

The deal drawn up Friday leans closer to Neal’s bill, allowing providers to enter into arbitration to seek higher reimbursements from insurers. According to an outline of the bill, the legislation would direct the arbitrator to consider a host of factors: median in-network rate, information related to the training and experience of the provider, the market share of the parties, previous contracting history between the parties, complexity of the services provided, and any other information the parties submit.

The agreement would make patients responsible only for their in-network cost-sharing amounts for both emergency services, including air ambulances, and some non-emergency care, according to the outline.

The surprise billing deal also would extend mandatory funding for community health centers, the National Health Service Corps, and the Teaching Health Center Graduate Medical Education Program at current levels through fiscal 2024.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bgov.com

To contact the editors responsible for this story: Robin Meszoly at rmeszoly@bgov.com; Sarah Babbage at sbabbage@bgov.com

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