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119-hr-10788119th CongressWALLET

Lower Premiums, Faster Payments Act

Sponsored By: Representative Pallone, Frank [D-NJ-6]

Introduced

Summary

A shift to a government-defined Qualifying Payment Amount (QPA). This bill would phase out independent dispute resolution for most out-of-network care and replace it with a median-based QPA payment system that applies to services furnished in 2028 and later.

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 1 benefits, 0 costs, 2 mixed.

New QPA benchmark for out-of-network care

If enacted, the bill would replace most out-of-network arbitration with a government-set qualifying payment amount (QPA) for care furnished on or after January 1, 2028. The QPA would include patient cost-sharing, plan payments, and expected incentive or retroactive adjustments. For 2028 the QPA baseline would use the median contracted rate recognized on January 31, 2019 (excluding providers who did not furnish the service in 2019), increased by CPI‑U changes from 2019 through 2027. For 2029 and later years, the QPA would be increased by the year-over-year CPI‑U change. The Secretary must issue or update the methodology within 180 days after enactment, and the methodology would not be subject to judicial review.

Annual audits of insurer payment data

If enacted, the Secretary would audit QPA claims data each year beginning in 2028. Each audit would sample claims from at least 25 group health plans and health insurers offering group or individual coverage. The Secretary would make audit findings public and deliver the findings to Congress. These audits would increase transparency but would not directly change premiums, benefits, or who qualifies.

Faster payments and air-ambulance rules

If enacted, the bill would require certain out-of-network payments or actions to occur within 30 days after the provider or facility transmits the bill when the out-of-network rate is the QPA. The bill would also align air-ambulance rules across the health, labor, and tax laws, keep transitional rules for services before January 1, 2028, and apply the 30-day timing rule where the out-of-network rate is the QPA. The proposal clarifies timing but does not itself set a new out-of-pocket amount that patients must pay.

Sponsors & CoSponsors

Sponsor

Pallone, Frank [D-NJ-6]

NJ • D

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

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