Politics and Money

[PegnVA]

SURPRISE BILLING PROTECTIONS ARE ONE STEP CLOSER TO BECOMING REALITY
By Paige Winfield Cunningham
July 2, 2021

The Biden administration has started putting meat on the bones of a sweeping new measure protecting Americans from surprise medical bills.

Regulations released yesterday are just a start — but they provide some new details about how patients must be protected from these “surprise” bills when they unavoidably get care from an out-of-network emergency room or doctor.

“If we’re going to keep people from being blindsided with some of these charges, we need to make sure it’s straightforward how everyone does this,” Health and Human Services Secretary Xavier Becerra told reporters in a call yesterday afternoon.

The administration has six months to finalize regulations for the “No Surprises Act.”

The bill, passed by Congress in December, stands as an extraordinary example of how Congress can still pass bipartisan legislation if there’s overwhelming consumer — and industry — support behind it.

After 10 years of bitter political battles over the Affordable Care Act, lawmakers closed out the decade with the bipartisan, widely supported legislation sheltering patients from sky-high bills when they’re forced to get care from a provider that isn’t contracted for in-network care with their health insurance plan.

These bills typically result when someone experiencing an emergency must seek care from the closest hospital, or when they visit an in-network hospital but receive care from an out-of-network provider through no fault of their own. Over the last few years, journalists have chronicled enormous surprise medical bills, sometimes landing people in tens of thousands of dollars of medical debt.

The effort to pass surprise billing protections was never guaranteed success; in the months-long process, there were many moments in which the whole thing threatened to crumble. The health insurance industry lined up behind one bill while doctors lined up another, as lobbyists on both sides fought to influence how payment for these bills would be worked out.

Yesterday’s regulation gave more details on how patients should be protected from surprise bills.

The rule, which is open for comment until Sept. 1, spells out how medical services should be determined as emergency or non-emergency for surprise billing protections. It warns that insurance plans can’t retroactively decide an emergency visit wasn’t urgent. It also issues some clarifications around how to determine median in-network rates when pegging out-of-network payments to them.

The Department of Health and Human Services also released a standard notice form to be used by hospitals in letting patients know they’re receiving out-of-network care.

Lobbyists are still working hard to influence the regulations.

Everyone agrees on this: Patients can only be charged the normal, in-network rate for a surprise medical bill, and nothing more.

“No one should ever be threatened with financial ruin simply for seeking needed medical care,” Labor Secretary Marty Walsh said in a statement.

As expected, patient advocacy groups applauded yesterday’s interim final rule.

“The No Surprises Act marked a major breakthrough for patients seeking relief from surprise bills, and we are thoroughly reviewing the rule released today to ensure the intent of Congress is upheld,” the American Heart Association said in a statement.

But behind the scenes, insurers and provider groups have still been trying to influence HHS as it works out the specific mechanics of how the legislation will work.

Under the No Surprises Act, the two parties must spend 30 days trying to negotiate the rest of the bill. If they can’t work it out, an independent arbiter steps in. Both sides must submit a final offer, and the arbiter decides which offer is most reasonable. But there’s been a lot of head-butting over which types of payments the arbiter may take into consideration when making a final call.

More details on exactly how arbitration should work are forthcoming; over the next few months, HHS will be working on additional regulations spelling out procedures for that part of the No Surprises Act.

https://www.washingtonpost.com/politics/2021/07/02/health-202-surprise-billing-protections-are-one-step-closer-becoming-reality/