Regulatory Dueling Surprise Bill Measures Were Introduced on Capitol Hill. Here’s Where They Differ

Medical Billing

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The House of Representatives and the Senate have unveiled dueling legislation aimed at surprise billing, and the two are split on one key element: arbitration.

The House bill (PDF), which was introduced earlier this week by Reps. Frank Pallone, D-New Jersey and Greg Walden, R-Oregon, would require insurers to cover out-of-network emergency care at in-network rates and would ban balance billing.

Balance billing most often occurs in emergency departments or during elective surgery, when a patient goes to an in-network facility but is treated by an out-of-network clinician, typically an anesthesiologist or radiologist.

Insurers would instead make a minimum payment to out-of-network providers to mitigate these situations, with rates based on regional in-network payments.

The Senate’s bill, however—which is backed by Sens. Bill Cassidy, R-Louisiana, and Maggie Hassan, D-New Hampshire—would include a “baseball-style” arbitration program to mitigate disputes, alongside similar elements to the House iteration.

In a statement, Cassidy, who is a physician himself, said the bipartisan working group has been developing the bill with input from providers, insurers and patient groups for more than a year. “Patients should be the reason for care, not an excuse for a bill,” he said.

The bills were introduced following a call to action from President Donald Trump, who last week gave a speech pushing Congress to address surprise billing. Senior White House officials told reporters that the administration has reservations about arbitration but was open to other solutions, such as using bundled payments.

Trump issued a series of guidelines for legislators to consider when developing bills, such as preventing an increase in healthcare expenditures and ensuring patients aren’t sent for out-of-network elective care without their knowledge.

Arbitration is used in New York, and a recent study found that consumer complaints about balance billing declined significantly in the state as a result. Providers in the state were more enthusiastic about the program than insurers, but case winners were evenly split between the two.

There are still improvements that could be made to New York’s arbitration approach, according to the study. For one, it doesn’t take steps to improve consumer insurance literacy and it also does not apply to self-insured plans, as those are exempted by the Employee Retirement Income Security Act regulations.

Surprise billing has been a hot-button topic in Washington, but work in the federal legislature has been slow-moving amid pushback from the provider and insurance lobbies. Sen. Lamar Alexander, R-Tennessee, who chairs the Senate Health, Education, Labor and Pensions Committee, told the president last week to expect action by July.

Article provided by Fierce Healthcare.

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