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NASH Endorses Surprise Medical Bills Legislation

The National Alliance of Safety-Net Hospitals has endorsed the Consumer Protections Against Surprise Medical Bills Act of 2020, surprise medical bills legislation developed by the House Ways and Means Committee.

In a letter to the committee’s chairman and ranking member, NASH wrote that

NASH supports the bill’s protection of patients from surprise medical bills for care they receive from out-of-network providers; we support the concept of patients receiving an “Advance Explanation of Benefits”; and most of all, we support a mediation process to be used when insurers and providers do not agree on appropriate payments that requires those parties to engage in good-faith negotiations; that employs mediated dispute resolution when those negotiations do not lead to agreement on payments; and that excludes from that mediation the use of specific, standard benchmark rates.

See the entire NASH letter here.

A Look at Surprise Medical Bill Legislation

While Congress’s decision this week to put off addressing the surprise medical bill challenge until next year has disappointed many, that decision did not reflect any lack of ideas for what to do.

At last count, various parts of Congress were considering four major surprise medical bill proposals:  one from the Senate Health, Education, Labor and Pensions Committee, one from the House Energy and Commerce Committee, one from the House Ways and Means Committee, and a compromise proposal from the Senate HELP and House Energy and Commerce committees.  Some have been around for some time while one emerged only in the past week.

The Commonwealth Fund has prepared a summary of the four proposals that includes a chart that compares where they stand on six major aspects of surprise billing legislation:

  • The medical settings to which the legislation would apply.
  • Whether they hold consumers harmless for surprise bills.
  • Whether they ban balance-billing.
  • How – or if – they establish standard rates.
  • How they resolve disputes between insurers and providers.
  • How they interact with existing state surprise medical bill laws.

NASH conveyed its perspective on surprise medical bills in a message to Congress last week.

Learn more from the Commonwealth Fund report “Update on Federal Surprise Billing Legislation: Understanding a Flurry of New Proposals.”

NASH Takes First Position on Surprise Medical Bills

Congress should address surprise medical bills in a manner that protects patients from such bills and establishes a fair negotiating process between providers and insurers, the National Alliance of Safety-Net Hospitals declared in its first public statement about the surprise medical bill issue.

The statement, developed to coincide with NASH Advocacy Day in Washington, D.C. last week, explains that the biggest challenge in developing a means of addressing this problem is forging a solution that ensures that providers, including private safety-net hospitals, can negotiate adequate reimbursement for care they deliver outside of the provider networks of their patients’ insurers.

With this in mind, NASH encourages Congress to pursue a solution that follows four basic principles:

  • Surprise billing legislation should protect patients from surprise medical bills and balance billing for out-of-network services.
  • Insurers and providers should be required to negotiate, without a federal role or involvement, for payment for services provided to insured individuals by out-of-network providers.
  • Insurers should uphold the “prudent layperson standard” and provide emergency care for any condition that a prudent layperson would reasonably believe requires emergency care.
  • Federal policies should preserve rather than supersede existing state policies that meet federal minimum patient protections for insurance products that are within states’ jurisdiction.

Learn more from NASH’s new position statement on surprise medical bills.

NASH Advocacy Day

Friday September 20, 2019 is NASH Advocacy Day in Washington, D.C.

Today, leaders of private safety-net hospitals have traveled to the nation’s capital from across the country for NASH Advocacy Day, during which members will meet with members of Congress and congressional and committee staff to discuss federal health care policy issues that affect the ability of private safety-net hospitals to serve their communities.

For the occasion, NASH has introduced three new policy position statements:  on the importance of delaying Medicaid disproportionate share (Medicaid DSH) cuts, surprise medical bills, and the new federal regulation governing so-called public charges.  See the new position papers here.

In addition, the National Alliance of Safety-Net Hospitals is presenting its “Champion for Health Care Award” to Representative Joe Kennedy III (D-MA) for “his tireless advocacy of access to care for his constituents, the residents of Massachusetts, and all Americans.”  See the news release announcing the award here.

Surprise Medical Bills Lead Patients to Change Hospitals

Patients who receive surprise medical bills are more likely to change hospitals than those who do not, a new study has found.

According to an analysis of behavior by obstetrics patients,

…11 percent of mothers experienced a surprise out-of-network bill with their first delivery, and this was associated with an increase of 13 percent in the odds of switching hospitals for the second delivery, compared to mothers who did not experience a surprise bill.

The study found that this switching often paid dividends for those who switched:

Mothers who switched hospitals after a surprise out-of-network bill reduced their relative risk of receiving a second surprise medical bill by 56 percent, compared to mothers who did not switch after receiving their first surprise bill.

NASH staff recently met with staff of the Senate Health, Education, Labor and Pensions (HELP) Committee to share private safety-net hospitals’ views on this emerging issue.

Learn more about the implications for hospitals when they send surprise medical bills in the Health Affairs study “Consumers’ Responses to Surprise Medical Bills in Elective Situations.”