No Surprises Act

Bill: 116-hr-3630
Sponsor: Rep. Pallone, Frank, Jr. [D-NJ-6]
Introduced: 2019-07-09 in the House
Policy area: Health
Subjects: Aviation and airports
Civil actions and liability
Congressional oversight
Emergency medical services and trauma care
Employee benefits and pensions
Government information and archives
Government studies and investigations
Health care costs and insurance
Health care coverage and access
Health facilities and institutions
Health information and medical records
Health programs administration and funding
Health technology, devices, supplies
Hospital care
Transportation costs

Summary:
action_date: 2019-07-09
text: 

No Surprises Act

This bill expands restrictions on charging health care plan holders out-of-network rates for certain services. First, the bill requires insurers offering plans that cover emergency services to bill plan holders no more than the median in-network rate for a particular emergency service, even if the service provider is out of network. The bill further prohibits insurers from billing plan holders more than the median in-network rate for nonemergency services provided by out-of-network providers at in-network facilities.

Out-of-network providers may not bill plan holders for the difference between the in-network and out-of-network rates for emergency services. The bill further prohibits out-of-network providers from billing plan holders for the difference in rates for nonemergency services provided at an in-network facility unless the provider complies with specified notice and consent requirements. Even when complying with these requirements, an out-of-network provider may not charge plan holders for the difference in rates for such nonemergency services if the provider is based at the in-network facility and is the only provider available to deliver the particular treatment or service at the facility.

The Department of Health and Human Services must provide grants to states to establish or maintain All Payer Claims Databases, which publish claims and payment information from insurers.

The bill also requires insurers to publish provider directories and requires the Government Accountability Office and the Department of Labor to report on certain issues related to the commercial health care market. 


Legislative actions:
action_date: 2019-07-11
text: Forwarded by Subcommittee to Full Committee by Voice Vote .
action_date: 2019-07-11
text: Subcommittee Consideration and Mark-up Session Held.
action_date: 2019-07-10
text: Referred to the Subcommittee on Health.
action_date: 2019-07-09
text: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
action_date: 2019-07-09
text: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
action_date: 2019-07-09
text: Introduced in House
action_date: 2019-07-09
text: Introduced in House
action_date: 2019-06-12
text: Hearings Held by the Subcommittee on Health Prior to Introduction and Referral.