The House Energy and Commerce Health Subcommittee had a markup session of proposed surprise-billing legislation July 11 and advanced the bill to the full committee.
The "No Surprises Act" — co-authored by Energy and Commerce Committee leaders Reps. Frank Pallone, D-N.J., and Greg Walden, R-Ore.— is being considered in the House as a fix to unexpected out-of-network surprise medical bills.
Under the measure, healthcare facilities would be required to notify patients at least 24 hours before an elective treatment that an out-of-network provider would be involved in their care, according to NPR.
The bill would also ban healthcare facilities and providers from balance billing patients for that care and would establish rates for payments from commercial health plans to providers based on the local market.
Legislation formally introduced June 19 by Senate Health Committee Chairman Lamar Alexander, R-Tenn., and ranking member Patty Murray, D-Wash., would also require health plans to pay providers the local median contracted commercial amount.
However, the House proposal, unlike the Senate proposal, lacks a process for providers to challenge the basic median reimbursement, NPR reported.
Three quotes from lawmakers during the July 11 markup session:
1. Rep. Anna A. Georges Eshoo, D-Calif.: "The payments that physicians receive have to be balanced. If the payment is too low, there could be physician shortages and patients not being able to get the care they need. That's not an answer. If the payment is too high, the premiums could go up, and it would cost patients and taxpayers more ...There has to be a delicate balance so that patients will end up trusting that the legislation we finally pass will protect them from the high costs and the surprises that they're subjected to now. And hospitals, doctors and insurers have to pull their fair weight in this thing."
2. Rep. Richard Lane Hudson R, N.C.: "While this legislation's a positive first step, I do have concerns that while the policy as written today is good for the insurance industry, it punishes providers. We need to balance this equation and provide an outlet for disputes instead of setting one price for health markets."
3. Rep. Larry Dean Bucshon, R-Indiana: "I believe that without an IDR [independent dispute resolution] process in some form ... it could be a race to the bottom on reimbursement [for physicians]. It could limit patient options to see a physician of their choice with limited networks, and I'm worried about implications in rural areas. I represent a rural district, where it's difficult already to attract physicians."