H.R. 10788: Lower Premiums, Faster Payments Act

The bill would change how payments are handled for certain out-of-network medical services under surprise-billing rules. It would end the current independent dispute resolution process used to settle many payment disagreements between health plans and providers, and instead require faster payment to out-of-network providers.

Payment rules for out-of-network services

The bill would revise how insurers calculate the qualifying payment amount used in setting payment levels for out-of-network care beginning in 2028 and later. These calculations would be adjusted for inflation using the Consumer Price Index, and special rules would apply for certain new plans. The bill also directs federal agencies to update related regulations to reflect the new system.

Oversight and reporting

The bill would require audits and reports to monitor how the new payment process is working and how the amounts are being determined. It would also limit court review by barring judicial challenges to the payment methodology itself.

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