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Congress: Surprise Billing Solution Remains Unclear

Negotiations on a solution to protect patients from surprise medical bills have stalled amidst disagreements on how to resolve billing disputes between providers and payers. However, Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-Tenn.) recently indicated that he and Ranking Member Patty Murray (D-Wash.), along with bipartisan House committee leadership, are nearing a deal on a surprise insurance gap bill that could be attached to year-end spending legislation. While it is ultimately the decision of congressional leadership to determine what is included in the government funding package, Chairman Alexander stated his wish to have reconciled HELP's legislation to address surprise medical bills (S. 1895) and the bill advanced by House Energy and Commerce (H.R. 3630) when the time comes. The legislation advanced by the Senate HELP Committee would base payments for out-of-network bills on the median rates for in-network providers, while the House Energy and Commerce Committee bill would allow an independent dispute resolution (IDR) process for claims above $1,250. Staff for HELP Chairman Lamar Alexander (R-Tenn.) noted the chairman's concerns regarding the inflationary impact of IDR, as well as the importance of addressing air ambulance charges in the final surprise billing solution. Such a provision was not included in the House Energy and Commerce measure.

Meanwhile, Sens. Bill Cassidy (R-La.) and Maggie Hassan (D-N.H.) also referenced the possible inclusion of surprise billing legislation within a year-end package during an event hosted by the Bipartisan Policy Center last week. Sen. Cassidy, who is supportive of adding an IDR process to the HELP bill, noted that one possible compromise could be to allow physicians to combine small out-of-network bills in order to meet the threshold for initiating the IDR process. IDR decisions would then be based on commercially reasonable rates rather than billed charges, in an attempt to prevent the inflation of provider prices. Such a policy could also address stakeholder concerns about the potential administrative costs of IDR for the significant number of smaller medical bills.

Cassidy and Hassan, however, appeared optimistic about the chances of a surprise billing solution becoming law this year. Two other House committees – Ways and Means and Education and Labor – may also want to weigh in but have not yet scheduled a mark-up on the legislation.

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