House Committees Consider Balance Billing Proposals

This past Tuesday and Wednesday, respectively, the House Ways & Means and Education & Labor Committees marked up their proposals on balance or “surprise” billing. As we reported on Monday of this week, the Ways & Means Committee proposal, the Consumer Protections Against Surprise Medical Bills Act (H.R. 5826), did not include a provision on ground ambulance services. The House Education & Labor proposal, The Ban Surprise Billing Act (H.R. 5800), however, included a provision to create a federal advisory committee to recommend restrictions on the ability of ground ambulance service providers and suppliers to balance bill.

The Ways & Means Committee reported out H.R 5826 favorably by voice vote. While the Education & Labor Committee also reported out H.R. 5800 favorably, the vote was 30 to 13 as a block of its Committee members preferred the approach of the Ways & Means proposal on how to address balance billing for other providers. It is now up to House leadership to determine next steps on how the chamber will approach a final package on balance billing.

While H.R. 5800 as reported out by the Education & Labor Committee still includes the provision on ground ambulance services, Chairman Scott (D-VA) and Ranking Member Foxx (R-NC) prior to mark up had removed the most problematic language in the bill. As introduced, H.R. 5800 would have given the Department of Health and Human Services the authority to issue regulations to restrict balance billing based on the findings of the advisory committee. This would have eliminated federal lawmakers from being able to evaluate the recommendations prior to the changes being implemented. The language was removed in the chairman’s mark of the bill, and thus the Congress would now have an opportunity to debate and craft legislation on the recommendations.

The AAA along with the International Association of Fire Chiefs (IAFC), International Association of Firefighters (IAFF) and National Association of EMTs (NAEMT) had advocated against the ground ambulance provision. We thank Chairman Scott, Ranking Member Foxx and members of the Committee for listening to our concerns and removing the regulation authority language.

Only one of the four pieces of legislation on balance billing reported out by congressional committees includes a provision on ground ambulance services. We will continue to advocate to preserve the ability of local governments to determine the rates and standards for their EMS systems and against the inclusion of a ground ambulance provision in a final package on balance billing.

We will keep you apprised of new developments on the issue.

Balance Billing Update

On Friday, the House Ways & Means and Education & Labor Committees released their respective draft proposals on balance or “surprise” billing. The Ways and Means Committee proposal, the Consumer Protections Against Surprise Medical Bills Act, does not include a provision on ground ambulance services, but the AAA is requesting language to clarify that non-emergency…

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Financial Hardship Policies: Steps for Your Protection [Sponsored]

By Eric van Doesburg, MP Cloud Technologies

In an industry whose sole focus is to help those in need, it’s natural for us to want to assist patients financially when they’re in hardship situations.

Waiving deductibles and copays for patients that have either claimed poverty, or simply for bills that seem too small to make a difference has become common practice. Although this is well-intentioned, it can easily put your company in harm’s way.

“There is no question of if Medicare will audit you, but when.”

The Federal False Claims Act requires businesses to bill patient’s copays and deductibles unless the company puts in place a clearly defined, legally binding policy. Without such a
policy, any actions taken in regard to waiving payments would effectively overbill Medicare, leading to Medicare auditing the company for payment as well as instituting
additional penalties. And in this day and age, there is no question of if Medicare will audit you, but when.

You can still help out the less fortunate while working within the letter of the law, but only with the proper Financial Hardship Policies put into practice. We urge you to seek legal counsel when crafting
and adopting a hardship policy, however, be sure to consider the following points as you get started:

  • Make it clear that you are not offering kickbacks: Clearly state in your guidelines that you do not offer incentives, such as kickbacks, bribes, rebates, or waivers of copayments or deductibles, for anyone bringing your company business.
  • Define your threshold for financial hardship: There is no true definition of financial hardship; every case is different. Most standards suggest waiving copayments and deductibles for patients with a gross family income at or below 200% of the federal poverty guidelines. Your definition should be updated annually to ensure effective practices.
  • Assign a decision-maker: Granting waivers involves state and federal anti-fraud laws, so a compliance officer or administrator would be best suited to assign who is exempt and who is not.
  • Require Documentation: A valid documentation trail is required as evidence for a patient who claims financial hardship, such as W-2 forms, pay stubs, tax returns, or unemployment compensation.

Learn more about MP Cloud Technologies.

House Energy & Commerce Subcommittee Takes Action on Balance Billing

On July 11, 2019, the House Energy and Commerce Committee Health Subcommittee held a markup in which they advanced 10 health care bills, including legislation on surprise/balance billing. This legislation, H.R. 3630, the No Surprises Act attempts to address out-of-network surprise medical bills. The AAA Government Affairs team has been in regular communication with the…

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Member Update on Balance Billing

This morning Ruth Hazdovac and Aidan Camas of AAA staff and Kathy Lester, Esq, Healthcare Consultant to the AAA attended a briefing held by the House Energy & Commerce Committee on the issue of surprise/balance billing. At the briefing, staff for Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR) announced that they would be releasing a bipartisan discussion draft, the No Surprises Act, which would “protect consumers from surprise medical bills and increase transparency in our health care system.”

As of now, ground and air ambulances are NOT included in the discussion draft. However, the committee is asking for comments on ground and air ambulance and recommendations on how to provide relief to the consumer in this area. The AAA has a Balance Billing Work Group that is hard at work developing a policy recommendation that will work for our members.

The House Ways and Means Health Subcommittee Chairman Lloyd Doggett also announced today that the Health Subcommittee will hold a hearing next week entitled “Hearing on Protecting Patients from Surprise Medical Bills.” AAA Staff will be at the briefing and provide a timely update to membership on any developments.

The AAA team will be submitting comments and policy recommendations based off the work of the Balance Billing Work Group to both the Energy & Commerce and Ways & Means Committee to ensure that the views of our members are well represented. We will also be reaching out to AAA members in the states of key policymakers on the Committees to submit comments, as well. The AAA will also provide members with key talking points in the event they are contact by their Members of Congress or their staff.

Questions? Contact Us

If you have questions about the discussion draft or balance billing initiatives being undertaken by the AAA, please do not hesitate to contact a member of the AAA Government Affairs Team.

Tristan North – Senior Vice President of Government Affairs
tnorth@ambulance.org | (202) 802-9025

Ruth Hazdovac – AAA Senior Manager of Federal Government Affairs
rhazdovac@ambulance.org | (202) 802-9027

Aidan Camas – Manager of State & Federal Government Affairs
acamas@ambulance.org | (202) 802-9026

Thank you for your continued membership and support.