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The Center Asks Congressional Delegation to Refrain from Passing New Bicameral Surprise Billing Legislation

The Center for Health Affairs last week asked the Northeast Ohio congressional delegation to refrain from moving forward with the recently announced bicameral surprise billing legislation. On Dec. 8, U.S. Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-Tenn.) and House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) along with Energy and Commerce Republican Leader Greg Walden (R-Ore.) announced they reached a bipartisan, bicameral agreement on legislation to address surprise medical billing.

The issue has received considerable attention this year, with the Senate HELP Committee and the House Energy and Commerce Committee each having developed their own legislative proposals. The most recent bicameral surprised billing legislation is a blend of the two proposals, and contains several provisions objected to by hospitals.

In correspondence with the Northeast Ohio congressional delegation, The Center emphasized that the hospital community is strongly supportive of measures protecting patients from unexpected medical bills resulting from a gap in coverage or emergency care. However, the legislative proposals introduced to date contain troublesome provisions that would have a significant negative impact on hospitals and ultimately on access to care. In particular, The Center highlighted two of the more problematic provisions: rate setting and contracting restrictions.

While the legislative text is still forthcoming, the American Hospital Association has reported that the new proposal calls for any surprise bill up to $750 to be paid at the median in-network rate, with the option of utilizing independent dispute resolution for bills exceeding that threshold. Rate setting, or the use of a benchmark rate, is highly problematic and could negatively impact the healthcare marketplace, forcing artificially low reimbursement rates.

Also troubling are provisions restricting the use of certain clauses in contracts between providers and health plans. The proposal would allow health plans to “cherry pick” providers by choosing to contract with only certain hospitals within a health system. This practice narrows provider networks, compromising access to care in rural and other vulnerable communities.

The Center reached out to Sens. Sherrod Brown and Rob Portman as well as Reps. Marcia Fudge, Bob Gibbs, Anthony Gonzalez, Jim Jordan, Dave Joyce, Marcy Kaptur and Tim Ryan, urging them to reject these provisions and to connect with their leadership, requesting that they refrain from rushing the passage of the proposal before the end of the year.

Activities this week are unfolding rapidly in Congress as lawmakers are working to complete their work before Dec. 20, when the latest budget resolution expires, however it appears that Congress has applied the brakes to the surprise billing issue and will hold off until next year to continue work on it.

MORE: For more on the bicameral surprise billing legislation and The Center’s related advocacy activities, contact us.

TWEETABLE: The Center urged the Northeast Ohio congressional delegation to reject rate setting provisions and contracting restrictions in the recently announced bicameral surprise billing legislation.