In welcomed news, the House Energy and Commerce Committee approved legislation that would address surprise bills by protecting patients when they access care and aren’t aware that a provider is outside of their insurance network.
The No Surprises Act, H.R. 3630, would allow providers to appeal a federal benchmark payment to an arbiter in cases when the median in-network payment to physicians or hospitals exceeds $1,250. This arbitration provision was included in the bill at the last minute by Reps. Raul Ruiz, D-Calif., and Larry Buschon, R-Ind., to address provider concerns. Without an option for arbitration, physicians would be at a severe disadvantage when negotiating contracts with insurers. AGA supports and will continue to advocate for provisions that give physicians an opportunity to go to arbitration similar to the effective New York state model.
The No Surprises Act also requires the Department of Health and Human Services to study the impact of the legislation, including the adequacy of provider networks, and to establish an audit process for medical contracted rates.
Addressing surprise medical bills and protecting patients has been a priority on Capitol Hill and one that has strong bipartisan support in both chambers of Congress and from President Trump. Since this new House bill also has jurisdiction from the Ways and Means Committee and the Education and Labor Committee, both committees will need to address the bill before it can advance. AGA will keep you updated on the status of this important legislation.