WASHINGTON—U.S. Senator Bill Cassidy, M.D. (R-LA), of the Bipartisan Senate Working Group on surprise medical billing today announced that 24 Senators have signed their names to cosponsor the STOP Surprise Medical Bills Act (S. 1531). This comes before today’s Senate Health, Education, Labor and Pensions Committee hearing on legislation to lower health care costs, including proposals to end the practice of surprise medical billing.
Joining Cassidy and U.S. Senators Michael Bennet (D-CO), Todd Young (R-IN), Maggie Hassan (D-NH), Lisa Murkowski (R-AK) and Tom Carper (D-DE) of the Bipartisan Senate Working Group in cosponsoring the legislation are:
U.S. Senators Dan Sullivan (R-AK), Sherrod Brown (D-OH), Kevin Cramer (R-ND), Ben Cardin (D-MD), John Kennedy (R-LA), Bob Casey (D-PA), Joni Ernst (R-IA), Sheldon Whitehouse (D-RI), Mike Braun (R-IN), Bob Menendez (D-NJ), Lindsey Graham (R-SC), Jacky Rosen (D-NV), Cindy Hyde-Smith (R-MS), Tina Smith (D-MN), Rob Portman (R-OH), Amy Klobuchar (D-MN), David Perdue (R-GA), and Kyrsten Sinema (D-AZ).
“This great showing of support demonstrates a coalescence behind our proposal. It’s exciting to see this large group of senators joining our effort to put patients first and end surprise medical bills,” said Dr. Cassidy. “Patients should be the reason for the care, not an excuse for the bill.”
The STOP Surprise Medical Bills Act is a product of a nearly year-long effort revising proposals and requesting feedback on draft legislation released last September by Cassidy, Bennet, Young and Carper—and legislation introduced last Congress by Hassan.
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The STOP Surprise Medical Bills Act addresses three scenarios in which surprise medical billing (also known as “balance billing”) would be prohibited:
- Emergency services: The bill would ensure that a patient is only required to pay the in-network cost-sharing amount required by their health plan for emergency services, regardless of them being treated at an out-of-network facility or by an out-of-network provider.
- Non-Emergency services following an emergency service at an out-of-network facility: This bill would protect patients who require additional health care services after receiving emergency care at an out-of-network facility, but cannot be moved without medical transport from the out-of-network facility.
- Non-Emergency services performed by an out-of-network provider at an in-network facility: The bill would ensure that patients owe no more than their in-network cost sharing in the case of a non-emergency service that is provided by an out-of-network provider at an in-network facility. Further, patients could not receive a surprise medical bill for services that are ordered by an in-network provider at a provider’s office, but are provided by an out-of-network provider, such as out-of-network laboratory or imaging services.
Providers would automatically be paid the difference between the patient’s in-network cost-sharing amount and the median in-network rate for these services, but providers and plans would have the opportunity to appeal this payment amount through an independent dispute resolution process, should they see fit. This “baseball-style” process would entail the plan and provider submitting offers to an independent dispute resolution entity that has been certified by the Secretaries of HHS and the Department of Labor. This entity would make a final decision based upon commercially-reasonable rates for that geographic area.
The patient is completely removed from this process between the provider and the plan, and regardless of any outcome from a dispute resolution process, the patient still only owes the in-network rate. States that have established an alternate mechanism for protecting patients and determining payment amounts for providers would be able to continue with those systems.
A study from the Georgetown University Health Policy Institute reviewed the implementation of a similar law to address surprise medical billing in New York. New York’s law takes patients out of the middle of payment disputes between providers and plans and uses a “baseball-style” approach to settle payment disputes when the providers and plans can’t reach an agreement on their own.
The study found that state officials have seen a “dramatic” decline in consumer complaints about surprise medical billing since the law went into effect, that independent arbitrator decisions were essentially even between plans and providers, and that the vast majority of cases were resolved before needing to go to arbitration. The study points out that the state law does not cover ERISA plans, underscoring the need for federal action.