|Senate Transparency Group Proposes Surprise Medical Billing Reform|
On Tuesday, the bipartisan Senate Healthcare Price Transparency Working Group introduced draft legislation aimed at addressing surprise medical bills. The bill would clarify three scenarios of medical billing: emergency services provided by an out-of-network provider in an out-of-network facility; non-emergency services following an emergency service from an out-of-network facility; and non-emergency services performed by an out-of-network provider at an in-network facility. Under the legislation, health plans would be required to charge patients receiving emergency medical care the in-network rates for receiving care from an out-of-network provider, and in non-emergency situations to be offered the choice of transferring to an in-network provider.|
The legislative effort is being led by Senators Bill Cassidy (R-LA), Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN) and Claire McCaskill (D-MO), who comprise the bipartisan Senate health care price transparency working group. While the group may formally introduce legislation at some point in the remainder of the 115th Congress, the issue is more likely to be considered in the 116th Congress that will convene in January. And given the bipartisan interest in addressing the issue, it is among the most likely healthcare items to receive attention in the coming Congress regardless of whether Republicans or Democrats control the House and Senate.
The draft legislation includes measures to target three primary scenarios of surprise medical bills and offers recommendations for each:
1. Emergency services provided by an out-of-network provider in an out-of-network facility: The patient would only be required to pay the cost-sharing amount required by their health plan, and a provider may not bill the patient for an additional payment. Any difference would be paid by the plan based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125% of the average allowed amount for the service.NAHU is committed to working with policymakers at both the federal and state levels to address the issue of surprise and balance medical bills. The NAHU legislative council recently convened a special balance billing workgroup aimed at identifying potential solutions and proposing these to policymakers.
2. Non-Emergency services following an emergency service from an out-of-network facility: The health care facility or hospital will notify the patient, or their designee, that they may be required to pay higher cost-sharing than if they received an in-network service and give the patient an option to transfer to an in-network facility.
3. Non-Emergency services performed by an out-of-network provider at an in-network facility: The health plan or out-of-network provider cannot bill a patient beyond their in-network cost-sharing. Any difference would be paid by the plan based on the greater of the median in-network amount negotiated by health plans and health insurance issuers or 125% of the average allowed amount for the service.
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