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On the Hill: PAHPA Advances, Surprise Billing Hearing

The Senate last week passed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPA) of 2019 (S. 1379).

The bill was reintroduced this month by Senate Health, Education, Labor, and Pensions Committee members Sens. Richard Burr (R-NC) and Bob Casey (D-PA). This version of the legislation must pass the House before it can be signed into law.

The legislation would reauthorize certain programs under 2018 PAHPA legislation, which included $385 million annually between fiscal years 2019 and 2023 for the Hospital Preparedness Program. The funding authorization for PAHPA expired on Sept. 30, 2018.

The association earlier this year released a statement supporting a previous House-passed version of the bill and urged the Senate to take swift action to reauthorize PAHPA.

House, Senate Work on Surprise Medical Bills

Last week, House Committee on Energy and Commerce Chair Rep. Frank Pallone (D-NJ) and Ranking Member Rep. Greg Walden (R-OR) released a bipartisan discussion draft of the “No Surprises Act” to address balance billing, or surprise billing, practices.

The proposed legislation includes provisions that would:

  • ban surprise billing for all emergency care and limit patient out-of-pocket costs to their in-network cost-sharing obligation;
  • require non-emergency patients to be notified verbally and in writing of the network status for clinicians, as well as their estimated out-of-pocket charges. The patient must acknowledge and consent to receiving care from an out-of-network provider;
  • end balance billing for services provided by specialists when the patient could have chosen a provider themselves; and
  • establish a benchmark payment rate for out-of-network services as the median in-network rate for the geographic area.

Members of a bipartisan Senate work group released separate, long-awaited legislation to address surprise medical bills: the Stopping the Outrageous Practice of (STOP) Surprise Medical Bills Act. Sens. Bill Cassidy (R-LA), Maggie Hassan (D-NH), Todd Young (R-IN), Michael Bennet (D-CO), Lisa Murkowski (R-AK), and Tom Carper (D-DE) introduced the bill last week.

The STOP Surprise Medical Bills Act would:

  • end balance billing for all emergency services and limit the patient’s share of costs to their insurance plan’s in-network rate;
  • ban balance billing for non-emergency elective care provided by an out-of-network clinician at an in-network facility. The patient would be responsible for their in-network cost-sharing obligation;
  • prohibit balance billing for follow-up care provided at an out-of-network facility after an emergency episode in instances when a patient cannot travel independently without medical transportation;
  • require plans to bill providers at the median in-network rate for services and care provided out-of-network;
  • allow providers to challenge the benchmark rate within 30 days through an independent dispute resolution process. Plans and providers would submit a “final offer” to an independent arbiter, who would decide a “reasonable rate” based on in-network rates for the geographic area; and
  • impose transparency requirements on hospitals, health plans, and clinicians.

Additionally, the House Committee on Ways and Means Subcommittee on Health will hold a May 21 hearing on surprise medical bills. The hearing will have two witness panels: the first will feature testimony from two state lawmakers, and the second will feature hospital and insurance industry stakeholders.

Drug Pricing Legislation Passes House

Last week, the House passed the Marketing and Outreach Restoration to Empower (MORE) Health Education Act of 2019 (H.R. 987), a legislative package to bolster the Affordable Care Act (ACA) and reduce drug prices by lowering market barriers for generic drugs.

The 234-183 vote was mostly along party lines, as the legislation combined partisan bills to protect the ACA with bipartisan drug pricing measures. Senate Republicans signaled they potentially would strip the drug pricing bills from the MORE Health Education Act for their own drug pricing package.

Additionally, the House Committee on Energy and Commerce will hold a May 21 hearing on seven House bills aiming to increase transparency of prescription drug price increases.

Second Medicare for All Hearing

The House Committee on the Budget will hold a May 22 hearing on key elements to consider when transitioning to a single-payer system.

Three senior analysts from the Congressional Budget Office (CB0) will testify. This hearing comes after the House Committee on Rules held the first congressional hearing on a single-payer system last month, specifically on Rep. Pramila Jayapal’s (D-WA) Medicare for All proposal.

Earlier this month, the CBO released a report on transitioning to a single-payer system. It did not include specifics on costs, but focused instead on what policymakers should consider as they develop proposals for establishing such a system in the United States.


About the Author

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

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