Federal Surprise Billing on NADP Radar Screen

Feb. 2020

Federal Surprise Billing on NADP Radar Screen

Federal lawmakers are negotiating surprise billing legislation for passage before Medicaid and Medicare extenders expire on May 22. Congress has been working on surprise billing reform for more than a year but competing interests and opinions on settling out of network billing disputes have stalled progress.

Although none of the legislation as currently drafted includes dental plans in the surprise billing provisions, several bills do include provisions regarding All Payer Claims Databases (APCD) that may apply to dental plans. Last summer, the House Energy and Commerce Committee passed a surprise billing package that included APCD provisions which provide funds for grants to states to establish or maintain APCDs which may include dental claims. In June 2019, NADP successfully advocated against a proposed amendment to the Senate bill (S. 1895) that would have included dental claims in a new national APCD. The amendment was not introduced.

The House Committee on Education and Labor Bill (H.R. 5800) introduced in February, proposes the Secretary of Labor create a standardized APCD form for use by ERISA plans. Currently, states cannot require ERISA plans to report to APCDs because of the Supreme Court decision in Gobeille v. Liberty. H.R. 5800 would potentially allow states to begin collecting data from ERISA plans so long as they utilize the standardized form created by the Department of Labor. Dental claims could be included in the DOL developed form. NADP is currently determining if the bill would require dental plans to report claims data to states using the standardized APCD form.

Leadership of House Energy & Commerce and Senate HELP committees have indicated their intent to cooperate and reach a compromise between varying proposals this spring. NADP will continue to monitor the development of these and any additional bills regarding surprise billing and APCDs.

For more details on these issues, subscribe to the Advocacy Open Forum and/or contact Director of Government and Regulatory Affairs, Teresa Cagnolatti.