May 29, 2019

Bipartisan STOP Surprise Medical Bills Act Introduced By Senator Hassan Reaches 21 Senate Cosponsors

WASHINGTON—Senators Maggie Hassan (D-NH), Bill Cassidy, M.D. (R-LA), Michael Bennet (D-CO), Todd Young (R-IN), Lisa Murkowski (R-AK) and Tom Carper (D-DE) today announced 14 new cosponsors for their bipartisan bill, the STOP Surprise Medical Bills Act (S. 1531). The bill now has 21 bipartisan cosponsors less than two weeks after its introduction.

U.S. Senators Dan Sullivan (R-AK), Sherrod Brown (D-OH), Kevin Cramer (R-ND), Ben Cardin (D-MD), John Kennedy (R-LA), Bob Casey (D-PA), Joni Ernst (R-IA), Sheldon Whitehouse (D-RI), Mike Braun (R-IN), Bob Menendez (D-NJ), Lindsey Graham (R-SC), Jacky Rosen (D-NV), Cindy Hyde-Smith (R-MS), Tina Smith (D-MN), and Rob Portman (R-OH) have now joined the Bipartisan Senate Working Group in cosponsoring the legislation.

“I am encouraged by the significant bipartisan momentum that continues to grow for our STOP Surprise Medical Bills Act, which will help end the absurd practice of surprise medical billing that’s hurting too many families in New Hampshire and across our state,” said Senator Hassan. “I will keep working across the aisle to move this legislation forward as quickly as possible.”

“Patients should be the reason for the care, not an excuse for the bill,” said Dr. Cassidy. “This is a significant showing of support behind our proposal and it’s exciting to see more senators joining our effort to put patients first and end surprise medical billing.”

The bipartisan STOP Surprise Medical Bills Act 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.

Click here to see the section-by-section.

The bipartisan 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.