May 17, 2019
The House and Senate released respective bipartisan draft measures this week to eliminate surprise medical bills, with the biggest difference between them being an arbitration approach included in the Senate bill.
How surprise billing occurs: When facility-based physicians decline to participate in networks, the amount they can bill for services is unlimited.
Both bills set a minimum payment standard for out-of-network services at the median rate for what in-network services in the geographic area of the care cost.
The key difference: Under the Senate bill, providers can dispute being paid the median in-network rate and instead choose to initiate an arbitration process. The proposal was introduced after Trump administration officials said last week that they do not support arbitration, which they describe as “disruptive” and could lead to “a lot of potential abuses” that would hurt patients. In a letter submitted for a congressional hearing on the issue, HR Policy urged lawmakers not to create a mandatory binding arbitration process for resolving surprise bills.
Sponsors: The legislation in the House was released by Energy and Commerce Committee Chairman Frank Pallone (D-NJ) and ranking member Greg Walden (R-OR). The Senate effort is being led by Sens. Bill Cassidy (R-LA), Michael Bennet (D-CO), and four others of the Senate Bipartisan Working Group, who have spent eight months refining legislation first introduced in September.