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On the Hill: Draft Bill Aims To Protect Patients from Surprise Billing

Sen. Bill Cassidy (R-LA) is circulating a discussion draft of legislation to protect patients from surprise medical bills for emergency care.

The bipartisan Protecting Patients from Surprise Medical Bills Act, released last week, targets three patient care scenarios:

  1. Emergency services provided by an out-of-network provider in an out-of-network facility: Patients would be required to pay only the cost-sharing amount required by their health plan, and a provider could not bill the patient for an additional payment;
  2. Non-emergency services following an emergency service from an out-of-network facility: Providers would be required to notify patients of higher cost-sharing for non-emergency services after emergency care at an out-of-network facility and give patients the option of transferring to an in-network facility.; and
  3. Non-emergency services performed by an out-of-network provider at an in-network facility: A health plan or out-of-network provider could not bill a patient more than the in-network cost-sharing rate for non-emergency services by an out-of-network provider in an in-network facility.

Cosponsors of the discussion draft include bipartisan members of the Senate health care price transparency working group: Sens. Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), and Claire McCaskill (D-MO). Cassidy plans to formally introduce legislation based on the discussion draft at the start of the next session of Congress in 2019.

Health Care Votes This Week

Meanwhile, Congress this week is expected to vote on several bills of interest to essential hospitals.

Pandemic and All-Hazards Preparedness Act

The House returns from recess this week and is preparing to vote on a final version of the Pandemic and All-Hazards Preparedness Act (PAHPA) of 2018 (H.R. 6378), which would fund several emergency health programs, including the Hospital Preparedness Program (HPP). The bill would authorize a $385 million annual funding level for the HPP for fiscal years (FYs) 2019 through 2023.  The bill is expected to pass and move to the Senate for consideration. The current funding authorization for PAHPA expires at the end of this fiscal year, Sept. 30.

Government Funding

The House also is expected to vote this week on a package to fund government operations for FY 2019, which begins Oct. 1.

The Senate last week passed the bipartisan spending package after negotiating with the House. The legislation appropriates funding for the Defense, Labor, Health and Human Services, and Education departments for FY 2019. The spending bill includes a continuing resolution to temporarily fund the remaining federal agencies until Dec. 7.

Notably, the spending bill directs the Office of Pharmacy Affairs (OPA) within the Health Resources Services Administration (HRSA) to finish “the development of a secure website” and report to Congress on its progress “within 90 days of the enactment.” The secure website could provide covered entities with drug ceiling prices under the 340B Drug Pricing Program.


Congressional negotiators are close to completing work on the long-awaited bipartisan legislative package to combat the opioid crisis, and the House could vote on a final bill later this week.

The final legislation likely will include a five-year repeal of the Medicaid Institutions for Mental Diseases (IMD) exclusion to treat substance use disorders — a provision America’s Essential Hospitals supports. But the legislation likely will omit a provision to align rules on confidentiality of substance use disorder treatment records (42 CFR Part 2) with HIPAA standards. America’s Essential Hospitals has advocated for including the 42 CFR Part 2 provision in the final bill.

Pharmacy Gag Clause

The House will vote on two bills (S. 2553 and S. 2554) the Senate recently passed to end pharmacy contract terms that prevent pharmacists from advising patients in private health plans and Medicare about the availability of cheaper, alternative medications. If passed, both bills will move to the president to be signed into law.

Upcoming Senate HELP Hearings

The Senate Committee on Health, Education, Labor, and Pensions will hold a Sept. 25 hearing on the cost of health care in rural America  and a Sept. 27 hearing on reducing health care costs, with a focus on improving affordability through innovation.


About the Author

Erin Delaney is a former legislative affairs associate at America's Essential Hospitals.

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