On December 20, 2020, Congressional leaders announced a $900 billion stimulus package and $1.4 trillion government funding deal that includes a long-discussed measure to protect patients from receiving “surprise” medical bills. If the stimulus bill is passed by both chambers of Congress and signed into law by President Trump, the measure would result in major changes for health care providers and payers.

The “surprise” bills targeted by the measure are generally those of out-of-network providers who are unexpectedly involved in a patient’s care at an in-network facility. The measure contained in the stimulus bill would prohibit such billing and require providers to work with payers to settle on a fair price. Patients could be charged only for cost-sharing that they would normally pay for in-network services.

If a provider and payer cannot resolve a dispute informally, the measure would require them to engage in arbitration. The arbiter would define a fair amount for the services based on what other physicians and hospitals are routinely paid for such services. Previous legislation that stalled in Congress would have set benchmark reimbursement rates rather than relying on arbitration.

Another sticking point in previous negotiations over surprise billing measures was whether ambulance services would be included. The stimulus measure would include air ambulance services in the surprise billing prohibition but exclude ground ambulance services.

If the stimulus bill is passed, these changes will take effect in 2022. Bricker & Eckler’s Health Care team will provide further analysis on this topic when new information becomes available.

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