As members of Congress negotiate an end of year agreement on Fiscal Year 2021 federal spending and a potential COVID-19 relief package, there is a strong potential that surprise billing legislation may also be included. On Friday, December 11, 2020, the bipartisan, bicameral leaders of the four health committees of jurisdiction announced they had reached a deal, releasing legislative text and a section-by-section summary.

The agreement reached by House Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-NJ) and Ranking Member Greg Walden (R-OR); House Ways and Means Committee Chairman Richard E. Neal (D-MA) and Ranking Member Kevin Brady (R-TX); House Education and Labor Committee Chairman Robert C. “Bobby” Scott (D-VA) and Ranking Member Virginia Foxx (R-NC); and Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) would:

• Establish an independent dispute resolution (IDR) system for out-of-network surprise medical bills and not set benchmark pay rates.
• Hold patients harmless from surprise medical bills, including those from air ambulance providers, by specifying they are only responsible for in-network payment rates.
• Settle disputes between providers and insurers either through negotiation or through an IDR. In the proposed IDR process, the parties would each submit an offer to an independent arbiter, who would consider median in-network rates, information related to the providers’ training an experience, market share of the parties, prior contracting history between the parties, and the complexity of services.
• Prohibit out-of-network providers from billing patients unless they notify patients 72 hours before receiving out-of-network services.
• Direct the Secretary of HHS to establish a patient-provider dispute resolution process for uninsured individuals by January 1, 2022.
• Require health plans to offer a price comparison tool for consumers.

The estimated $16 billion in savings from the surprise billing deal would be used to fund community health centers, the National Health Service Corps, and the Teaching Health Center Graduate Medical Education Program through Fiscal Year 2024.

The White House Press Secretary issued a statement on December 11, 2020 noting “Congress should act swiftly to protect patients from surprise medical and air ambulance bills and send the compromise announced this afternoon to the President’s desk for signature.” House Speaker Nancy Pelosi (D-CA) and Senate Minority Leader Chuck Schumer (D-NY) each issued statements supporting inclusion of the deal in an end of year package. However, Senate Majority Leader Mitch McConnell (R-KY) has not indicated he favors including surprise billing legislation in an end of year package. The American Hospital Association expressed “significant concerns” with the deal and urged lawmakers to make several changes to the IDR as well as raised concerns with the billing process and transparency provisions.

The legislative text of the December 11, 2020 agreement can be found here. The section-by-section summary can be found here. The AHA letter can be found here.