House Ways and Means Committee Chair Richard Neal (D-Mass.) and Ranking Member Kevin Brady (R-Texas) recently announced the committee has come up with a compromise bill to address so-called “surprise” medical bills, Modern Healthcare reports. The announcement comes just days after the Senate Health, Education, Labor and Pensions (HELP) Committee and the House Energy and Commerce Committee announced their own bipartisan plan to address surprise medical bills. Analysts say the influx of a new proposal essentially eliminates any chance that Congress will be able to pass a final bill on the issue in 2019.
There are few details on the new proposal, which is still being finalized, but the release indicates the bill could take a different approach to addressing surprise medical bills then what has been proposed in the House Energy and Commerce and the Senate HELP Committees’ compromise bill. For example, the Ways and Means bill would base patient cost-sharing for out-of-network bills on the in-network rate for a given area, while the House Energy and Commerce and Senate HELP Committees’ bill would set payment rates for out-of-network care based on a benchmark of the median in-network rate in a given area. It is not yet clear how the new system proposed in the Ways and Means legislation would function.
The Ways and Means bill would not set a specific threshold at which point providers and insurers could begin the reconciliation process, meaning the process could be triggered over any billing discrepancy. In comparison, the Energy and Commerce-Senate HELP bill would create a baseball-style arbitration process that would allow health care providers and insurers to appeal claims over $750. The Ways and Means bill would aim to avoid overuse of the reconciliation process by penalizing the losing party and requiring them to pay a reconciliation process fee. The bill also would set a pre-determined threshold for use, and providers and insurers that are considered to be overusing the process would face a surcharge. The bill also would require “annual reporting of the decisions rendered through the process.”
The Ways and Means proposal also would preserve existing state laws regarding surprise bills.
