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Hospital-Supported Legislation Advances to Protect Patients from Surprise Medical Bills

The hospital community expressed support for new legislation that earned bipartisan support in the U.S. House Ways & Means Committee, which is designed to protect patients from surprise medical bills and offer information to patients about their benefits.

Federal lawmakers have been working to build consensus among health care stakeholders on policy to address patients’ exposure to unexpected medical bills. There has been widespread agreement in prohibiting out-of-network facilities and practitioners from sending patients balance bills and limiting patients’ obligation to their in-network cost-sharing responsibilities. Stakeholders and lawmakers have endorsed different approaches to resolve payment disputes between insurers and providers.

At the outset of the policy conversation about surprise balance billing, HAP endorsed key principles released by the American Hospital Association. As the policy debate has advanced to more specific legislative options, HAP has emphasized three guiding priorities:

  • Hospitals are committed to protecting patients by banning balance billing and holding patients to an in-network liability
  • Hospitals are opposed to rate setting that will negatively impact access to care
  • Hospitals have urged Congress to reject policies that interfere with private contractual negotiations and impose new requirements that are not meaningful to patients

This week, the Ways & Means Committee passed legislationH.R. 5826, the Consumer Protections Against Surprise Medical Bills Act of 2020—which is consistent with the principles above. The legislation would protect patients and allow hospitals and health systems to work with health plans to determine appropriate reimbursement. Specifically, the bill would allow out-of-network reimbursement to be determined either through a provider’s acceptance of a health plan’s initial payment, through a period of “open negotiation” or, ultimately, through a mediated dispute resolution process.

Additional information is available in a summary and section-by-section.

The AHA issued a letter of support for the legislation, applauding the committee “for protecting patients from surprise medical bills and for developing a workable approach for determining the patient’s cost-sharing amount so they can be ‘taken out of the middle’ of any discussions between the health plan and the provider regarding reimbursement.”

The U.S. House Education & Labor Committee also advanced legislation this week, which unlike the Ways & Means Committee’s bill, adopts an approach that would determine reimbursement for out-of-network providers based on a median in-network rate. That policy is in alignment with an agreement between the U.S. House Energy & Commerce Committee and U.S. Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN).

HAP will continue to work to advance legislation that protects patients first and reflects the priorities of the hospital community as the four Congressional committees that have a stake in this policy try to reconcile a final product.

Please contact Jeff Becthel, HAP’s senior vice president of health economics and policy, or Laura Stevens Kent, HAP’s senior vice president, strategic integration with questions.

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