3.0.0 967 2022-11-01T18:47:25Z 2022-11-05T19:28:36Z Senate S 2019-04-01 116 sshr00 Health, Education, Labor, and Pensions Committee Senate Standing Referred to 2019-04-01T21:11:35Z 2019-04-01 sshr00 Health, Education, Labor, and Pensions Committee Senate Read twice and referred to the Committee on Health, Education, Labor, and Pensions. IntroReferral 2019-04-01 Introduced in Senate IntroReferral 10000 9 Library of Congress S001181 Sen. Shaheen, Jeanne [D-NH] Jeanne Shaheen D NH N B001230 Sen. Baldwin, Tammy [D-WI] Tammy Baldwin D WI 2019-04-01 True M001176 Sen. Merkley, Jeff [D-OR] Jeff Merkley D OR 2019-04-01 True Health Congressional oversight Employee benefits and pensions Government studies and investigations Health care costs and insurance Health care coverage and access Health programs administration and funding Insurance industry and regulation Medicare Rural conditions and development State and local government operations Health 00 2019-04-01 Introduced in Senate 2020-03-18T20:01:46Z Reducing Costs for Out-of-Network Services Act of 2019

This bill places limits on the cost to insurance plan holders for out-of-network health care services and on the amount charged for services provided to uninsured individuals. First, each state must select one of the following formulas for determining the maximum cost for a service:

  • 125% of fee-for-service rate under Medicare,
  • the 80th percentile of the cost for such service in the geographic area, or
  • 100% of the allowed charges if the service had been provided in network.

Health insurance issuers must set the cost-sharing amount for out-of-network services at no more than the state-selected rate for such service. Further, out-of-network health care providers may charge plan holders no more than the state-selected rate for a service.

Each state also must set the maximum rate for services that health care providers may charge uninsured individuals at the lower of (1) 125% of the fee-for-service rate under Medicare, (2) the 80th percentile of the cost for such service in the geographic area, or (3) the rate otherwise applicable under state law.

If a state does not select a maximum rate for a service provided to an insured or uninsured individual, the maximum rate a provider may charge is (1) 125% of the fee-for-service rate under Medicare, or (2) the rate established by the Department of Health and Human Services if such service is not covered under Medicare.

]]> Reducing Costs for Out-of-Network Services Act of 2019 Display Title Reducing Costs for Out-of-Network Services Act of 2019 Short Title(s) as Introduced Reducing Costs for Out-of-Network Services Act of 2019 Introduced in Senate IS Official Title as Introduced A bill to amend the Public Health Service Act to establish limitations on cost-sharing for out-of-network services in the individual market, to prohibit balance billing for such services, and for other purposes. Introduced in Senate IS Introduced in Senate 2019-04-01T04:00:00Z https://www.govinfo.gov/content/pkg/BILLS-116s967is/xml/BILLS-116s967is.xml 2019-04-01 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. Congressional Research Service, Library of Congress This file contains bill summaries and statuses for federal legislation. A bill summary describes the most significant provisions of a piece of legislation and details the effects the legislative text may have on current law and federal programs. Bill summaries are authored by the Congressional Research Service (CRS) of the Library of Congress. As stated in Public Law 91-510 (2 USC 166 (d)(6)), one of the duties of CRS is "to prepare summaries and digests of bills and resolutions of a public general nature introduced in the Senate or House of Representatives". For more information, refer to the User Guide that accompanies this file.