Source: United States Senator for New Hampshire Maggie Hassan
May 20, 2019
WASHINGTON – Six more Senators today cosponsored the bipartisan STOP Surprise Medical Bills Act as momentum builds for the legislation that Senator Maggie Hassan and her colleagues introduced last week. The addition of Senators Kevin Cramer (R-ND), Ben Cardin (D-MD), John Kennedy (R-LA), Bob Casey (D-PA), Joni Ernst (R-IA), and Sheldon Whitehouse (R-RI) as cosponsors brings the total cosponsors of the legislation to 14 senators – seven Republicans and seven Democrats. They join Senator Hassan, Senators Bill Cassidy (R-LA), Michael Bennet (D-CO), Todd Young (R-IN), Lisa Murkowski (R-AK), Tom Carper (D-DE), Dan Sullivan (R-AK) and Sherrod Brown (D-OH).
This legislation is a product of a nearly year-long effort revising proposals and requesting feedback on draft legislation released last September by Senators Cassidy, Bennet, Young and Carper—and legislation introduced last Congress by Senator Hassan.
“Congress must act to end the absurd practice of surprise medical billing, and I am encouraged by the strong momentum for our bipartisan bill,” Senator Hassan said. “I look forward to working with my colleagues on both sides of the aisle to move this bill forward without delay.”
“This legislation protects patients and their pocketbooks from out-of-network bills. Having a medical procedure is stressful enough without getting hit with a surprise bill afterward. I’m happy to join legislation that helps patients,” said Senator Kennedy.
“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.”
“Throughout my 99 County Tour, I consistently hear from Iowans about the rising costs of healthcare, including many who receive unexpected bills following a visit to their doctor or hospital,” said Senator Ernst. “Hard-working folks in Iowa, and across the country, should be able to focus on getting the care they need, instead of negotiating surprise medical bills. This bipartisan legislation will increase transparency and protect patients from burdensome medical expenses.”
“The complexity of our health care system too often results in unexpected out-of-pocket expenses for patients,” said Senator Whitehouse. “I’m glad to join this bipartisan measure to ensure patients can focus on recovering from a health crisis without the looming worry of a surprise, life-altering medical bill arriving in the mail.”
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.