On February 7, 2020, the Ways and Means Committee of the House of Representatives released the text of the Consumer Protections Against Surprise Medical Bills Act of 2020. The bill is intended to protect patients from “surprise” medical bills, which can occur when patients are treated by an out-of-network provider at an in-network facility.

The bill would limit the amounts patients would have to pay when receiving emergency medical services at a non-participating facility or when receiving medical services from a non-participating provider at a participating facility to their in-network cost-sharing amounts.  In addition, in a provision not seen in other bills intended to address the “surprise” billing issue, the bill would require health plans to provide an Advance Explanation of Benefits for medical services scheduled at least three days in advance.  The goal of this provision is for patients to understand the network status of their treating providers and the expected cost.

The bill would also establish a mediation process for providers and health plans to use when they are unable to agree on reimbursement amounts for an out-of-network service.  Specifically, the parties would first have a 30-day “open negotiation” process, with both parties required to share specified information to facilitate an agreement.  If no agreement is reached during the open negotiation process, either party could initiate a 30-day mediated process administered by an independent entity. This mediation process would be a baseball-style process, in which each side would submit their best and final offers to the independent entity along with supporting information. The independent entity would be required to consider the median contracted rate for the specific service, provider, and geographic location as well as the information submitted by each party and determine which of the parties’ offers should be the reimbursement amount.  The bill specifies that there would be no minimum dollar threshold to use the process and that batching of similar claims would be permitted.

Other provisions included in the bill would require better information on health insurance cards and for health plans to honor assignments of benefits, paying providers directly for their out-of-network services.

In a press release, Chairman Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) stated:  “Our bipartisan solution to end surprise medical bills will protect Americans from unexpected financial burdens when receiving health care.  We are putting patients first, providing unprecedented protections and transparency.”

The Ways and Means Committee is expected to hold hearings to mark up the bill next week.

The attorneys at Whatley Kallas, LLP will continue to follow this and other “surprise” billing bills as they work their way through the legislative process.  For Whatley Kallas’s earlier article on a Health Affairs article demonstrating that health insurance companies are often at fault for the “surprise” billing issue, please click here.  The Consumer Protections Against Surprise Medical Bills Act of 2020 is linked here and the section by section summary of the bill is linked here.