Senate Panel OKs Surprise Medical Bill Reforms But Plans Changes 

Doctor using computer while reviewing records at desk in clinic, individual, woman Mercer
Jun 27 2019

Employer-friendly legislation dealing with the contentious issue of curbing surprise medical bills easily passed a key Senate committee on June 26 as part of a larger bill meant to lower healthcare costs, but senators suggested that changes sought by medical providers are likely before consideration by the full Senate.  Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander, R-TN, and GOP leaders plan to bring the Lower Healthcare Costs Act up for votes in mid-to-late July.

While the bill contains a broad array of reforms aimed at lowering drug prices, increasing transparency, and fostering greater electronic exchange of health information, the provisions targeting surprise medical bills will continue to be the focus of especially fierce lobbying and debate.

Surprise medical bills often happen when a patient receives emergency care at an out-of-network hospital or nonemergency care from an out-of-network doctor who provides services at an in-network facility. The HELP Committee bill would cover not only out-of-network emergency services but also nonemergency services received from out-of-network providers at in-network facilities. The protections would apply broadly to nongrandfathered group health plans - whether insured or self-funded - and individual policies. States could continue to maintain laws addressing surprise bills, but self-funded ERISA plans would be exempt from those laws.

On the central issue of how to resolve payment disputes with providers, employers recently scored a big win when HELP Committee leaders included language that would set a benchmark payment rate based on median in-network rates for the area without any use of arbitration. The bill also extends the benchmark to cover air ambulance bills.

But provider groups and several committee members including Sen. Bill Cassidy, R-LA, a physician by training, are pushing hard to modify the bill to allow some form of arbitration. Cassidy said during the committee’s markup of the bill that the median in-network benchmark would put too much power in payers’ hands and disadvantage doctors and hospitals.

While the HELP-passed bill leaves the employer-friendly language intact, Chairman Alexander and Cassidy say they will work together to modify the language ahead of a Senate vote. That could result in the addition of an independent dispute resolution mechanism the would be available if the provider and insurer or plan can't agree on the benchmarked rate. 

Whatever form it takes, some version of surprise billing legislation has a good chance of clearing Congress this year, perhaps as part of a broader healthcare package. We’ll continue to actively participate in the debate on behalf of plan sponsors and will keep you posted.  

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