House subcommittee advances legislation on surprise medical bills, DSH cut delay

Surprise bills
The health subcommittee of the House Energy and Commerce Committee Thursday advanced 10 healthcare bills to the full committee. (Callie Richmond for Kaiser Health News)

A House panel unanimously advanced a bipartisan measure to tackle surprise medical bills that would use a benchmark to solve billing disputes—an approach favored by payers—despite calls from providers to use arbitration.

The health subcommittee of the House Energy and Commerce Committee Thursday advanced 10 healthcare bills to the full committee. Chief among them are the bill to tackle surprise billing and another to delay cuts to charity care hospitals.

“Our legislation removes the ‘surprise’ from billing by completely protecting patients in emergency situations, patients who did not specifically choose to see an out of network physician for scheduled care, and patients in situations where there is no in-network provider available to treat them,” said Rep. Frank Pallone, R-New Jersey, the committee chairman.

The bill would ban balance billing and prohibit any surprise medical bills from a hospital-based provider that the patient can’t reasonably choose, such as in an emergency room. “For all other scheduled care at an in-network facility, the legislation would require that patients receive a notice and provide their consent to out-of-network care,” according to a committee memo on the bill.

Related: Dueling surprise bill measures were introduced on Capitol Hill. Here’s where they differ

If a patient doesn’t get this notice, then the provider can’t balance bill the patient.

The legislation also creates a payment benchmark that would be used to resolve disputes over the amount for an out-of-network payment.

It's been a central point of contention on Capitol Hill with the Senate advancing surprise billing legislation last month out of committee called the Lower Health Care Costs Act that includes the benchmark solution rather than a competing measure that called for arbitration. Some Senate leaders have indicated the former could change before it advances.

DSH delay

The House subcommittee also passed a separate bill that delays mandatory cuts to disproportionate-share hospitals (DSHs) set to go into effect this fall.

The Community Health Investment, Modernization and Excellence Act would delay the $4 billion in scheduled cuts for fiscal 2020 and 2021.

Related: MACPAC to Congress: Roll out DSH cuts first in states with unspent funds

Without congressional intervention, the cuts will go into effect at the start of the new federal fiscal year Oct. 1. The Affordable Care Act mandated the cuts to DSH hospitals, but they have never gone into effect.

The bill would also lower the scheduled reduction of $8 billion set for fiscal 2022 to $4 billion.

Lawmakers decided to add a recommendation from the Medicaid and CHIP Payment Advisory Commission that called for making the demonstrations of upper payment limits, which is the cap on fee-for-service Medicaid reimbursements, public starting in fiscal 2021.

Other measures

In addition, the legislation extends and reauthorizes funding for community health centers and the National Health Service Corps.

Other bills sent Thursday to the full committee include the:

  • EMPOWER Act that reauthorizes healthcare workforce development programs under Title VII of the Public Health Service Act. The bill also reauthorizes the Tomorrow’s Pediatric Health Care Workforce program that gives loans to pediatric specialists.
  • FAIR Drug Pricing Act that requires certain drugmakers to submit documents to the Department of Health and Human Services 30 days before hiking up the price of a qualifying drug.
  • Autism CARES Act which reauthorizes funding for programs to conduct research on the detection and intervention of autism.