As Congress has been working toward finding agreement on an end-of-year spending deal that includes a $900 billion COVID relief package, bipartisan leaders from the major U.S. House and Senate health committees announced agreement on legislation that would put an end to so-called "surprise billing." Their goal is to have it included in such a package.
Notably, the committee leaders settled on a mechanism that the Wisconsin Hospital Association (WHA) has long requested as the way to resolve billing disputes—independent dispute resolution. This comes after a number of senators, including Wisconsin Senator Ron Johnson, sent a letter to Senate leaders advising them against choosing another mechanism WHA has long opposed that would rely on paying providers a government-set rate.
The new legislation is very similar to legislation WHA endorsed in February 2020 in that it gives health care providers and health insurers 30 days to attempt to work out disagreements in out-of-network billing disputes. After this time period, either party can request taking the issue to a neutral third party that would make a binding decision about payment. Throughout the process, the patient is protected from receiving a bill in excess of the amount they would pay if the provider had been in-network.
While this is a significant win for hospitals and other health care providers, the draft legislation also contained various other provisions in its more than 370 pages of text. WHA alerted Wisconsin's congressional delegation to concerns over a number of issues that, while well intended, could create significant challenges for hospitals should they be required to operationalize them. This includes a requirement that hospitals be responsible for consolidated billing of professional fees in addition to facility fees, even when they do not employ that health care professional. Additionally, WHA raised concerns that requiring bills to be issued in 90 days can be outside of a hospital's control when they are awaiting information from the insurer or resolving coordination of benefits for patients with multiple layers of insurance. Lastly, WHA noted that its members are already preparing to comply with a Centers for Medicare & Medicaid Services Hospital Price Transparency Rule requiring them to display a list of shoppable services, and yet this legislation would create a separate mandate requiring up-front patient estimates, which would create additional work and be of questionable benefit to patients and consumers.
As of press time, leaders on Capitol Hill appear close to a deal, but have not announced details of a final package. With funding for federal programs slated to run out on Dec. 18, Congress seems poised to pass another short-term funding extension as leaders continue to negotiate. Please contact WHA Vice President of Federal and State Relations Jon Hoelter with questions.