Two Bipartisan Surprise Billing Proposals Introduced

May 17, 2019

The House Energy & Commerce Committee and members of the Senate Finance Committee both introduced bipartisan discussion drafts to address surprise medical billing this week.

Both pieces of legislation seek to end the “balance billing” practice, with the House bill subjecting certain providers to civil monetary penalties if they balance bill patients without notice. Both bills also establish default payment rates for out-of-network surprise bills pegged to the insurer’s median in-network rates, and would hold patients accountable only for the amount they would pay if the service was provided in-network.

The most significant difference between the two pieces of legislation is that the Senate bill allows for arbitration if the provider disputes the insurer’s payment. But in making its determination, the arbiter is charged with reviewing typical in-network commercial payment rates, not providers’ usual and customary charges. The House bill does not provide for arbitration at all. However, both bills would allow states some discretion to choose their own method for resolving out-of-network payment disputes involving state-regulated insurance. Self-insured coverage would be subject to the Federal rules.

How out-of-network providers are to be paid for surprise bills will remain a large point of contention in the debate on how to best address surprise bills. GNYHA will submit comments on both pieces of legislation.

The House discussion draft, the No Surprises Act, and additional information on the Senate’s STOP Surprise Medical Bills Act are attached. Additionally, the House Ways & Means Health Subcommittee will hold a hearing on surprise medical bills next week.  More information on the hearing can be found here.

GNYHA will keep its members apprised of any developments related to Federal surprise medical billing legislation, and we will work to ensure that New York State’s existing system is unharmed by Federal efforts.

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