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Ways and Means leaders unveil draft measure to address surprise medical bills

February 7, 2020
In The News

The House Ways and Means Committee released a proposal Friday to curb surprise medical bills, offering a new bipartisan plan that the panel is set to mark up next week.

Protecting patients from surprise out-of-network medical bills is a health care issue Democrats, Republicans and President Donald Trump say they want to move this year, but it has proven to be more difficult than many initially expected. The Ways and Means Committee is the second House committee to release its plan, after the Energy and Commerce Committee marked up its  bill last year. The Education and Labor Committee is also poised to get into the mix, with a markup expected on Tuesday.

The Ways and Means Committee draft bill proposes that when a patient receives a surprise bill for out-of-network medical care at an in-network facility or when receiving emergency care, providers and insurers would negotiate payment through a dispute resolution process.

Both sides would first have 30 days to negotiate payment on their own, during which they would be required to share some information about payments to facilitate an agreement. If the sides still disagree, either party could initiate a 30-day arbitration process, in which both sides would propose their last, best offer to an independent mediator.

There would be no minimum charge amount that either side could seek in an arbitration agreement, but the mediator would not be allowed to consider a provider's "usual charges" in determining what the payment should be.

The draft also would require health insurers to tell patients the expected charges for a procedure at least three days before it is scheduled.

The committee's draft bill would not directly address surprise bills received by patients who take air ambulance rides, but would require providers to share cost data and insurers to share claims data to the Department of Health and Human Services.

The measure would take effect beginning in 2022.

"Our bipartisan approach differs from other proposals in that we require — for the first time — that patients receive a true and honest bill in advance of scheduled procedures and we create a more balanced negotiation process to encourage all parties to resolve their reimbursement differences before using the streamlined and fair dispute resolution process," Chairman Richard E. Neal, D-Mass., and ranking member Rep. Kevin Brady, R-Texas, said in a joint statement.

Neal has indicated he wants to mark up the bill Wednesday.

The Ways and Means Committee's proposal differs from the Energy and Commerce Committee and Senate Health, Education, Labor and Pensions Committee bills. The committees adjusted those bills after approving them. The current versions would set a benchmark payment at the median in-network rate for a certain geographic area, and allow either side to resolve further disputes through arbitration if the median in-network rate is above $750.

"Protecting innocent patients has been our top goal throughout this effort, and we appreciate that the other two House committees share this priority," Energy and Commerce Committee Chair Frank Pallone Jr., D-N.J., ranking member Greg Walden, R-Ore., HELP Committee Chairman Lamar Alexander, R-Tenn., and ranking member Sen. Patty Murray, D-Wash., said Friday in a joint statement. "We look forward to working together to deliver a bill to the president's desk that protects patients and lowers health care costs for American consumers."

Members of the Education and Labor Committee have not yet said what their mechanism for deciding payment disputes would be, but Committee Chairman Robert C. Scott, D-Va., said this week he is planning a Tuesday markup.


More lawmakers appear to be getting involved in the issue, which congressional leaders have said could be part of a health care package that would extend funding for health care programs set to expire on May 22. The Congressional Progressive Caucus discussed the issue in a meeting on Thursday.

"We think the Pallone bill is the closest to what we would want to support and we have concerns about weakening that because we really do think that this is a critical issue and we need to keep it as strong as possible," Rep. Pramila Jayapal, D-Wash., one of the group's co-chairs, told reporters.

The mechanism for determining payment has so far been a divisive issue and the subject of intense lobbying, but lawmakers say they hope they can reach an agreement soon.

"For most of us though, the details are important but bigger is just that we can't get caught up too much in any of the nuances," Ways and Means committee member Dan Kildee, D-Mich., told CQ Roll Call this week. "We’ve got to get something done."