CMA Physicians Fight Harmful Surprise Billing Proposal December 19, 2019 CMA 0 CMA Physicians Fight Harmful Surprise Billing Proposal in Final Year-End Legislation Important health care programs funded through 2020 This week the U.S. House and Senate passed year-end legislative packages that would fund the government through the end of the 2020 fiscal year (HR 1865, HR 1158, HR 965) and extend other important health programs until May 22, 2020. All legislation is expected to be signed by the President. Notably missing from the package was legislation to address surprise medical bills which Congress worked on all year. CMA and organized medicine joined together to promote surprise billing legislation that would protect patients from surprise bills but establish a fair process for physicians and insurers to resolve billing disputes with reasonable payment rates to protect long-term access to doctors. In the final weeks of the session, CMA, the AMA, the national specialties, and a handful of state medical associations successfully fought-off the bipartisan, bicameral Senate HELP and House Energy Commerce (E&C) Committee proposals that would have imposed more than 20% payment cuts on non-contracting, as well as contracting physicians, and negatively impacted access to in-network physicians, and on-call physicians specialists caring for patients in emergencies. While CMA successfully fought the Senate HELP/House E&C plan, Congressional leaders have set a May 22, 2020 deadline to address surprise billing. The House Ways and Means Committee just announced plans to move their new proposal in late January. While few details on the plan have been released, the basic framework appears to be an improvement. It does not set a benchmark payment rate but rather allows it to be determined in an independent dispute resolution (IDR) process and without a monetary threshold for accessing IDR. It also addresses network adequacy. Two other committees that hold ERISA self-insured plan jurisdiction may also weigh-in. Once the House Committees finish their work, all of the bills will be reconciled for final passage. CMA will continue to aggressively advocate for a balanced solution. Other Health Care Improvements For the first-time in two decades, the bill includes $25 billion for the National Institutes of Health (NIH) and the CDC to perform firearm violence research related to behavioral, prevention and safety issues. The bill also raises the national legal age to purchase tobacco and e-cigarette- related products to age 21, though unfortunately, it did not include a ban on flavored products which target children. A final provision would make it easier for generic drug companies to access samples of brand-name drugs. The year-end legislation also includes a funding extension until May 22, 2020 for important expiring health care programs, including the community health centers (FQHCs), the Teaching Health Center Primary Care GME Program, the National Health Service Corps, Disproportionate Share Hospital payments, and other programs within Medicare. The grand plan is for all of these programs to be included in one legislative vehicle with a solution to surprise billing and Medicare drug pricing legislation. CMA strongly supports HR 3 (Pelosi) which recently passed the House and would authorize Medicare to negotiate drug prices with the pharmaceutical companies. Democrats won several ACA-related provisions that would protect automatic re-enrollment in plans purchased on the exchanges if a consumer does not select a new plan during open enrollment. It would also allow insurance plans to add costs on to the Exchange silver-tiered insurance plans that are tied to the tax credits that help people afford their premiums. This practice keeps costs lower for patients. However, three ACA taxes that had previously been delayed were fully repealed – the medical device tax, the Cadillac tax on high-benefit health plans, and a fee on insurers. CMA thanks the County Medical Societies and physicians across the state for their work to support these important health care programs and to advocate for a balanced solution to surprise billing Contact: Elizabeth McNeil, Vice President, Federal Government Relations emcneil@cmadocs.org Comments are closed.
