Lawmakers Seriously Pursuing “Surprise Medical Bill” Fix

Continuing the bipartisan interest in addressing the issue of surprise medical billing, also known as balance billing, a group of bipartisan senators led by Sens. Bill Cassidy (R-LA) and Maggie Hassan (D-NH) introduced legislation on Thursday. The legislation states that providers would be prohibited from balance billing patients, or charging them for the remaining cost for treatment that insurance would not cover, and would instead pay the in-network rate and cost-sharing for the treatment. The bill addresses three circumstances where providers would be prohibited from giving patients “surprise bills”: emergency services; non-emergency services following emergency care at an out-of-network when the patient cannot be transported to an in-network facility; and care provided by an out-of-network provider at an in-network facility.

In this proposal, providers would automatically be paid the difference between the patient’s in-network cost sharing and the median in-network rate. Providers and insurance companies could then appeal that payment through arbitration, where an independent third party would choose the most reasonable offer based on commercially reasonable rates in that geographic area. This is contradictory to the administration’s choice of mechanism to solve this problem, as the administration said last week that they are not in favor of arbitration. Along with this proposal, Senate Health, Education, Labor, and Pensions (“HELP”) Committee Chairman Lamar Alexander (R-TN) and Sen. Patty Murray (D-WA) are drafting their own measure “as part of a broader package to lower health care costs.” Leaders in the Senate have indicated that surprise billing legislation will be taken up next month along with other drug pricing legislation and is targeted for the president’s desk by July.

On the House side, leaders of the Energy and Commerce Committee prepared a bipartisan measure to tackle surprise medical bills. Their legislation prohibits balance billing for all emergency services and only holds patients responsible for the amount they would have paid in-network. It prohibits balance bills when patients cannot reasonably choose their providers. The measure establishes a minimum payment standard set at the median contracted (in-network) rate for the service in the geographic area the service was delivered. It also preserves a state’s ability to determine their own payment standards for plans regulated by the state. In this legislation, patients receiving scheduled care must be given written and oral notice on the provider’s network status and note that they will be liable for any charges if treated by an out-of-network provider. Lastly, this provides $50 million in grants for states looking to develop or maintain an all-payer claims database. Additionally, the House Ways and Means Committee will hold a hearing on this issue next Tuesday. The hearing will feature two panels, including lawmakers and industry stakeholders.

House Passes Health Care and Drug Pricing Package

On Thursday, the House passed (234-183) a legislation package designed to strengthen the individual health insurance exchanges and lower prescription drug pricing. This is the session’s first legislation passed aimed at lowering drug prices. Prior to the vote, House Speaker Nancy Pelosi (D-CA) stated, “Health care, health care, health care. That is what is of concern to the American people.” The legislation includes three bipartisan drug pricing provisions restricting anti-competitive behaviors by pharmaceutical companies coupled with a group of measures designed to reverse changes that Republicans made to the Affordable Care Act (“ACA”). The drug pricing legislation includes three strategies to boost the availability of generic drugs. The ACA-related legislation includes restoration in funding for advertising and other outreach to assist people signing up for ACA marketplace plans as well as blocking rules meant to encourage individuals to buy short-term, cheaper health plans.

Many lawmakers wanted to separate the drug pricing legislation from the ACA measures in order to avoid partisan fighting. While the drug pricing legislation passed holds a good chance in the Senate, the measures to strengthen the health insurance exchanges will likely not be picked up by lawmakers in that body. According to Senate Finance Chairman Charles Grassley (R-IA), the only aspects of the ACA that could be addressed in the Senate’s summer legislative package are those related to taxes, such as the 2.3 percent excise tax on medical devices. The Senate Finance and HELP Committees are working on packages meant to lower health care costs and prescription drug prices, which is expected to occur in July.

Health-Related Bills Introduced This Week

Rep. Raul Ruiz (D-CA) introduced H.R. 2815 to reauthorize section 340H of the Public Health Service Act to continue to encourage the expansion, maintenance and establishment of approved graduate medical residency programs at qualified teaching health centers.

Rep. Adrian Smith (R-NE) introduced H.R. 2788 to amend Title XVIII of the Social Security Act to modernize provisions relating to rural health clinics under Medicare.

Rep. Jan Schakowsky (D-IL) introduced H.R. 2781 to amend Title VII of the Public Health Service Act to reauthorize certain programs relating to the health professions workforce.

Rep. Debbie Wasserman Schultz (D-FL) introduced H.R. 2777 to amend Title XVIII of the Social Security Act to protect coverage for screening mammography.

Rep. Cathy McMorris Rodgers (R-WA) introduced H.R. 2771 to direct the Secretary of Health and Human Services to revise regulations with respect to payment rates for durable medical equipment under the Medicare program.

Sen. Ron Wyden (D-OR) introduced S. 1497 to amend Title XVIII of the Social Security Act to improve cost and quality transparency under the Medicare program.

Rep. Michael Burgess (R-TX) introduced H.R. 2700 to incentivize low-cost drug options and generic competition and to provide extensions for community health centers and the National Health Service Corps.

Next Week in Washington

Congress returns next week with a lot of health care items on its agenda. On Tuesday, the House Energy and Commerce Health Subcommittee will hold a hearing, “Improving Drug Pricing Transparency and Lowering Prices for American Consumers.” Also on Tuesday, the House Ways and Means Health Subcommittee is planning to call major industry players to testify at a hearing on surprise medical bills. Along with Reps. Katie Porter (D-CA) and Jaime Herrera Beutler (R-WA), industry stakeholders from the American Hospital Association, America’s Health Insurance Plans, American Medical Association, and the ERISA Industry Committee will testify. On Wednesday, the House Budget Committee holds a hearing on “Key Design Components and Considerations for Establishing a Single-Payer Health Care System.”

This Week in Washington in History

1973, 46 years ago this week: The Senate Select Committee on Presidential Campaign Activities, headed by Sen. Sam Ervin of North Carolina, begins televised hearings on the escalating Watergate scandal.