GNYHA submitted a comment letter to the House Energy and Commerce Committee last week on a discussion draft of the No Surprises Act, legislation to address surprise medical bills. We are grateful for the opportunity to comment on this bill, and we commend Committee Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR) for their leadership on this issue. The comment letter is attached.

Separately, the Senate’s Health, Education, Labor and Pension (HELP) Committee has released their own draft legislation, the Lower Health Care Costs Act, and other lawmakers have also released surprise bill proposals. GNYHA is preparing comments on the Senate HELP bill. A chart comparing the No Surprises Act and the Lower Health Care Costs Act is attached.

While GNYHA strongly supports Federal legislation to protect consumers from unexpected medical bills when they inadvertently receive care from out-of-network providers, we are concerned that some of the draft proposals include payment provisions for out-of-network services—such as default rates pegged to median-in-network rates—that negatively impact hospital reimbursement and contract negotiations with insurers. We are working closely with Congressional staff as these draft proposals evolve to ensure that any Federal legislation more closely follows New York’s successful surprise bill law. GNYHA believes that any Federal legislation should be guided by the following general principles:

  • Patients should be held harmless from surprise bills. This means they should not be responsible for costs above their in-network cost-sharing liability in emergency situations when they receive services from out-of-network providers, and in non-emergency situations when they inadvertently receive services from out-of-network providers at in-network hospitals.
  • Patients should not be placed in the middle. Negotiations between insurers and providers over appropriate out-of-network reimbursement should not involve the patient.
  • Determining the appropriate payment for out-of-network services should be left to negotiation between providers and insurers. Government should not dictate a default out-of-network payment amount, as this would have significant unintended consequences in terms of provider/insurer contract negotiations and result in diminished provider networks that would limit consumer choice and access.
  • Reducing the number of surprise medical bills should be an important component of any legislation. This will require the establishment of reasonable disclosure requirements for providers and insurers on network participation and cost expectations, which should take place whenever possible in advance of scheduled services.
  • State laws that address surprise bills should not be preempted by any Federal law. As long as such laws hold the consumer harmless for additional out-of-pocket expenses, state laws should prevail and Federal law should only apply to self-insured, employer-sponsored plans governed by ERISA.

GNYHA encourages our members to engage with lawmakers on this issue, and we will keep our members apprised of any developments related to Federal surprise billing legislation.