May 29, 2019

Bipartisan STOP Surprise Medical Bills Act Reaches 21 Senate Cosponsors

WASHINGTON — U.S. Senators Ben Cardin (D-Md.), Bill Cassidy, M.D. (R-La.), Michael Bennet (D-Colo.), Todd Young (R-Ind.), Maggie Hassan (D-N.H.), today announced major growth in support for the STOP Surprise Medical Bills Act (S. 1531) with 21 senators already cosponsoring the legislation less than two weeks after its introduction. A section-by-section analysis of the bill can be found here

U.S. Senators Lisa Murkowski (R-Alaska) and Tom Carper (D-Del.), Dan Sullivan (R-AK), Sherrod Brown (D-OH), Kevin Cramer (R-ND), 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), and Rob Portman (R-OH) have now joined the Bipartisan Senate Working Group in cosponsoring the legislation.

“Patients facing an emergency health situation should not be doubly traumatized when they receive a bill for services,” said Senator Cardin. “I’m pleased to join this bipartisan effort.”

“Patients should be the reason for the care, not an excuse for the bill,” said Dr. Cassidy. “This is a significant showing of support behind our proposal and it’s exciting to see more senators joining our effort to put patients first and end surprise medical billing.”

“The last thing a patient should have to worry about is being blindsided by unanticipated, and potentially financially devastating, medical bills. People deserve to know how much they are paying for health care services and procedures at the point of care,” Senator Bennet said. “We are grateful for the broad, bipartisan support we have received for our legislation to protect patients from surprise medical bills and to give much needed relief and predictability to Americans throughout the country.”

“It’s no surprise our bill continues to gain momentum,” said Senator Young. “Hoosier families are worried about financial strain created by unexpected medical bills, and our bipartisan legislation will help address this growing problem.”

“I am encouraged by the significant bipartisan momentum that continues to grow for our STOP Surprise Medical Bills Act, which will help end the absurd practice of surprise medical billing that’s hurting too many families in New Hampshire and across our state,” Senator Hassan said. “I will keep working across the aisle to move this legislation forward as quickly as possible.”

Click here to see the section-by-section.

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.

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