June 21, 2019

In This Issue
Fast Facts
Senate HELP Committee Releases Legislation on Surprise Billing and Broker Compensation
A Detailed Look at Considerations for the New HRA Options
Healthcare Happy Hour: How to Comply with the HRA Final Rule
State Spotlight: Massachusetts Considers a Single-Payer System
Recess Is Coming: Talk with Your Rep about the Future of Healthcare Reform
Register Now for July’s Compliance Corner Webinar on the HRA Final Rule
Did You Miss the LIVE from NAHU Webinar?
HUPAC Roundup: Supreme Court Sidesteps Gerrymandering Question in Win for Virginia Democrats
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Senate HELP Committee Releases Legislation on Surprise Billing and Broker Compensation
On Wednesday, the Senate Health, Education, Labor and Pensions (HELP) Committee introduced S.1895, the Lower Health Care Costs Act of 2019, updated legislation from discussion draft legislation released late last month. The comprehensive bill is aimed at reducing healthcare costs, to include ending surprise billing, reducing the prices of prescription drugs, creating more transparency, boosting public health and improving the exchange of health information technology. The updated draft incorporates changes requested by NAHU as part of our detailed comments and ongoing collaboration with members of the committee and staff. Updates were specifically included in response to our comments on the section that would require health insurance agent and broker compensation.

NAHU supports transparency for agent and broker compensation, and the legislation includes a section to provide greater transparency of healthcare costs by requiring the disclosure of broker compensation. This would require brokers and consultants to disclose to plan sponsors any direct or indirect compensation the brokers and consultants may receive for referral of services, reported in a format similar to a 2007 proposed regulation for health and pension plan brokers. It also requires brokers to disclose to enrollees in the individual market any direct or indirect compensation the brokers may receive for referral of coverage. NAHU was able to have the updated draft clarify language that establishes a disclosure requirement for indirect compensation that is not known at the time a contract is signed and to prevent duplicity in reporting that is already required by many state laws and the federal Form 5500.

The draft bill also includes a section aimed at addressing surprise medical bills by implementing a federal benchmark of the median in-network rate for a geographic area, a preferred method for surprise-billing resolution by NAHU. This is the same standard supported through draft legislation offered by the House Energy and Commerce Committee and contrary to the leading alternative of establishing an independent arbitration system. Senate HELP Committee Chairman Lamar Alexander (R-TN) initially favored another approach of requiring all providers at the same facility to be in-network, but acknowledged an assessment by the Congressional Budget Office that benchmarking can be the most effective at lowering healthcare costs. NAHU supports using a federal benchmark standard.

The legislation also includes a provision addressing surprise air ambulance billing, stipulating that patients would pay only the amount they would if the air ambulance flight was in-network. If health plans do not have enough internal data to determine the amount, they can use external data sources, such as the state's all-payer claims database. This measure would mark a major advancement from Congress’s last effort to address air ambulance balance-billing, with the enactment of H.R. 302 last October. That law contains a provision to provide consumer protections against surprise air ambulance billing by establishing a council of industry representatives to oversee air ambulances. NAHU is actively working with regulatory agencies to establish this council.

The committee has scheduled a markup hearing on the updated bill for June 26, where it plans to vote to advance it out of committee. NAHU will continue to keep in close contact with members of the HELP Committee and the full Senate to ensure that this legislation remains favorable to you and your clients. 
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