The House Ways and Means Committee today favorably reported out, as amended, the Consumer Protections Against Surprise Medical Bills Act (H.R. 5826), AHA-supported legislation to address surprise medical bills. 

The bill prohibits providers from balance billing patients for emergency services or medical care the patient reasonably could have expected to be in-network, and from charging patients more than the in-network cost-sharing amount.  Rather than rely on a benchmark payment rate to determine out-of-network reimbursement, the legislation provides a period for health plans and providers to negotiate out-of-network reimbursement, followed by a mediated dispute resolution process if necessary. The bill also includes other consumer protection and transparency provisions.

“I think the legislation we have before us today is the right approach — it protects the patient, but also recognizes the private market dynamics between insurance plans and providers,” said Committee Chairman Richard Neal, D-Mass.

Ranking Member Kevin Brady, R-Texas, said the legislation “is fair to all parties, favoring no one except the patient.”

In comments submitted Monday, AHA called the legislation “the most effective approach to surprise medical billing introduced to date.” It voiced strong support for the provisions to prohibit balance billing and limit patient cost-sharing responsibilities, and said that “once the patient is protected, hospitals and health systems should be permitted to work with health plans to determine appropriate reimbursement.”

The Congressional Budget Office estimates the legislation would decrease the federal deficit by $17.8 billion. 

The committee also approved legislation that would establish hospice program survey and enforcement procedures under the Medicare program (H.R. 5821); and require private equity firms that own and control medical care providers to report certain information to the Internal Revenue Service (H.R. 5825).

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