The American Hospital Association reports today that
House Ways and Means Committee Chairman Richard Neal, D-Mass., and Ranking Member Kevin Brady, R-Texas, this morning released legislative text of the Consumer Protections Against Surprise Medical Bills Act of 2020, the committee’s proposal to address surprise medical bills. The legislation prohibits providers from balance billing patients for emergency services or medical care the patient reasonably could have expected to be in-network, and does not allow patients to be charged more than the in-network cost-sharing amount. The proposal does not rely on a benchmark payment rate to determine out-of-network reimbursement, but instead includes a period for health plans and providers to negotiate reimbursement, to be followed by a mediated dispute resolution process should it be necessary. The proposal also includes several other consumer protection and transparency provisions. The committee is expected to mark up the legislation on Wednesday, Feb. 12.
In addition, House Committee on Education and Labor Chairman Robert “Bobby” Scott, D-Va., and Ranking Member Virginia Foxx, R-N.C., this morning unveiled the Ban Surprise Billing Act. The legislation is similar to the bills passed last year by the House Energy and Commerce Committee and Senate Health, Education, Labor and Pensions Committee in that it relies on a median in-network rate to resolve out-of-network payments. For amounts paid above $750 (or $25,000 for air ambulance services), the legislation allows for an independent dispute resolution process to determine the final payment. A summary of the legislation is here, and legislative text was released late this afternoon. The committee is scheduled to mark up the legislation on Tuesday, Feb. 11.
If the arbitration approach becomes law, you can be sure that health plans will restrict out of network coverage as far as they can unless Congress repeals that option. In other words, it appears that the out-of-network providers are looking to squeeze the last golden egg out of the strangled goose. The FEHBlog appreciates in-network providers for helping to control health care spending.
Bloomberg News reports that
AHIP President and CEO Matt Eyles said health insurers should be allowed to classify efforts to address social determinants of health as quality improvements or patient care instead of as administrative costs. Health insurers are uniquely positioned to tackle SDOH, according to Eyles, who said changing how the initiatives are classified “would allow for greater measurement over time to understand how we might we might be impacting cost trends.”
Good recommendation. OPM should take this approach with all FEHB plans.
Modern Healthcare informs us
The novel [or Wuhan] coronavirus that threatens to hobble the global economy, causing travel restrictions and the closure of some U.S. retail stores in China, is expected to stabilize in April, according to a projection from S&P Global Ratings.
S&P’s analysts said a worst-case scenario would involve the virus spreading into late May, with an optimistic prediction calling for an end to transmissions in March. The firm said the impact on economic activity in Asia could peak around the middle of the year before an economic rebound in 2021.
Hope springs eternal.