May 31, 2019

In This Issue
Fast Facts
Healthcare Happy Hour: A "Help"ful Discussion to Understand the HELP Committee’s Discussion Draft
NAHU Submits Comments on Draft Surprise Billing Legislation
State Spotlight: New York Holds Hearing on Single-Payer System
Ask Your Chapter about Being a Part of the Summer Recess Meetings
Join Us for “LIVE from NAHU” on June 20
HUPAC Roundup: A First Look at the North Carolina Mulligan
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NAHU Submits Comments on Draft Surprise Billing Legislation
On Tuesday, NAHU submitted comments to the House Energy and Commerce Committee in response to its bipartisan discussion draft of the No Surprises Act. The effort is being led by Committee Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR) and would require insurers to pay providers at in-network rates even if they are out-of-network for emergency care and for hospitals to obtain written permission from patients before allowing an out-of-network physician treat them for a scheduled procedure. Their legislation contrasts with other competing discussion draft proposals, such as the effort led by the Senate Bipartisan Working Group that would force arbitration on billing disputes.

Our comments included a compilation of surprise-billing stories from across the country representing a wide range of balance-billing situations. These included a hospital and out-of-network equipment, laboratory tests read by out-of-network radiologists, a scheduled a test at a network hospital with a non-network laboratory, out-of-network emergency room charges, and out-of-network anesthesiologists at an in-network hospital.

In our comments, we also:
  • support approach to protecting consumers by prohibiting balance-billing for all emergency services and requiring that consumers only be held responsible for the amount they would have paid in-network.
  • support notices at the time of scheduling for patients receiving scheduled care about the provider’s network status and any potential charges they could be liable for if treated by an out-of-network provider.
  • in the case that there is no option for the patient to transfer to an in-network provider, suggest the health plan pay at the in-network level. If there is truly no other choice for the patient, the insured should not be penalized for the lack of providers participating in the network.
  • state that the regulation of networks should be reserved for state regulators who have the most intimate knowledge of the needs of their healthcare consumers.
  • oppose imposing any requirements that ERISA plans comply with to the existing state all-payer databases, and suggest a federal claims database for self-insured ERISA plans to include a single point of entry for uploading information be made available to employer plan sponsors for their utilization of plan development and design.
  • suggest separate legislation to resolve balance billing issues with air ambulances.
  • suggest using some percentage above Medicare rates to determine the maximum amount an emergency out-of-network provider can be reimbursed.
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