July 25, 2019

House Committee Amends No Surprises Act

The US House of Representatives Energy and Commerce Committee approved an amended version of the “No Surprises Act” last week. The amendment, proposed by Representatives Ruiz and Buschon, includes an arbitration mechanism for certain disputes. The amended bill uses a market-based benchmark as a starting point to resolve out-of-network payment disputes between physicians and payors. The prior version of the bill provided for an automatic reimbursement for out-of-network providers based on the median in-network payment for the same services. The Committee adopted an arbitration backstop by amendment if a physician or facility disputes the automatic median in-network payment for a code amount exceeding $1,250. The amended version of the bill is strongly opposed by certain segments of the health care industry, including America’s Health Insurance Plans