On June 19, 2019, the US Senate Committee on Health, Education, Labor & Pensions (HELP) released its updated Lower Health Care Costs Act (S. 1895). This new version includes several noteworthy changes, outlined below. Click here for the full legislative text and here for a section-by-section summary.
Surprise Billing Rate: The Committee chose to address surprise billing through a benchmark rate that is pegged to the median in-network rate for a geographic area. (In the discussion draft, the Committee did not pick an option to address how to resolve disputes over surprise billing, and instead laid out three options for consideration.) Health plans would pay providers the local median contracted commercial amount that insurers have negotiated and agreed upon with other providers in that geographic area. Although an official Congressional Budget Office (CBO) report has not yet been released, it has been reported that the CBO estimated that the benchmark proposal would save $25 billion over 10 years—the largest cost saver out of the three proposals considered. The House Energy and Commerce No Surprises Act also uses this approach.
Air Ambulances: The original discussion draft would have required that bills for air ambulance trips be broken out by air and medical charges. In the new version, however, patients are held harmless from surprise air ambulance bills. Patients’ cost-sharing for out-of-network air ambulance services would be equal to the amount if such services were provided by an in-network practitioner, and any coinsurance or deductible shall be based on in-network rates. Additionally, a group health plan or health insurance issuer shall pay out-of-network air ambulance providers at the median in-network rate for that service in the same geographic area.
Drug Pricing: Four new sections were added to Title II, which focuses on prescription drug pricing:
Transparency: There were also a few noteworthy changes within Title III, which focuses on transparency:
Title III: Title III adds three new sections. As outlined in the section-by-section summary, Section 310 requires group and individual health plans to conduct comparative analysis of non-quantitative treatment limitations used for medical and surgical benefits as compared to mental health and substance use disorder benefits. It requires the Secretary of the US Department of Labor to request that a group and individual health plan submit the comparative analysis if it receives a complaint from an enrollee, and requires the Secretary to request random submissions from 50 plans per year. If, upon review of the analysis, the Secretary finds that a plan or coverage is out of compliance with mental health parity law, the Secretary must specify actions for the plan or coverage to come into compliance. The bill also adds technical amendments relating to ERISA (Section 311) and third-party administrators (Section 312).
Titles IV and V: Minor non-substantive changes and clarifying language were added in Titles IV and V. New sections were also added in Title IV that address some of the health care extenders that are up for reauthorization at the end of September 2019. Section 411 adds an extension of mandatory funding for community health centers, the National Health Service Corps and the Teaching Health Center Graduate Medical Education Program at current levels for each of fiscal years 2020 through 2024. Additionally, section 412 extends mandatory funding for the Special Diabetes Program for Type I Diabetes and the Special Diabetes Program for Indians at current levels for each of fiscal years 2020 through 2024.
The Chairman has scheduled a mark-up on this bill for Wednesday, June 26, 2019. We expect more changes to be made before then, including the possibility of new provisions, as Members and stakeholders continue to push for priorities within the bill.