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119-hr-10908119th CongressWALLET

Ending Patient Runaround Act

Sponsored By: Representative Cloud, Michael [R-TX-27]

Introduced

Summary

This bill would create Universal Savings Accounts as a new tax‑advantaged trust vehicle and would bundle broad health-plan transparency and patient-protection rules for group and individual coverage.

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  • Families and patients would get clearer contract disclosures, a U.S.-based point of contact, and faster prior authorization responses to providers and patients within 30 days. Billing errors must be repaid with at least 110% of the excess if refunded within 30 days and increase if refunded later.
  • Providers and insurers would face payment-parity and review rules. Plans must pay nonparticipating providers at least the same amount they would pay in-network, and peer-to-peer reviews must use a reviewer in the same specialty as the requesting provider.
  • Savers, trustees, and financial firms would gain a new Universal Savings Account structure with a $10,000 annual contribution limit per beneficiary, rollover rules, trustee reporting duties, and taxes and penalties for excess contributions; USA tax rules would apply for taxable years beginning after December 31, 2024.

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 4 benefits, 0 costs, 1 mixed.

Stronger refunds for health billing errors

If enacted, the bill would require plans, issuers, and providers to refund any overcharge to an enrollee with added compensation. You would get 110% of the excess charge if refunded within 30 days, 150% if refunded after 30 but before 60 days, and 150% plus 25 percentage points for each 30‑day period after 60 days. The Secretary would set penalties for providers that fail to comply. These rules would take effect January 1, 2029.

New tax-advantaged Universal Savings Accounts

If enacted, the bill would create Universal Savings Accounts (USAs) for taxable years after December 31, 2024. You would generally be able to contribute up to $10,000 per beneficiary each calendar year. The annual limit would be indexed for inflation after 2026 and rounded down to the nearest $100. Qualified rollovers between USAs for the same beneficiary would be allowed if completed within 60 days. Trustees would have reporting duties and rules on excess contributions, prohibited transactions, and treatment at death.

Expanded access to basic catastrophic plans

If enacted for plan years beginning in 2027, the bill would let more people enroll in a basic catastrophic plan. A qualifying plan would have to cover at least three primary care visits per year. The plan would generally provide no other benefits until you reach the plan’s annual out‑of‑pocket maximum, except for preventive services covered under section 2713. The bill would remove prior statutory restrictions on who may enroll in catastrophic plans.

Faster authorization and steadier coverage

If enacted, the bill would require health plans and insurers to decide prior authorization requests in writing to you and your provider within 30 days. If you request a peer‑to‑peer review after a denial, the reviewer would have to be in the same specialty as your provider. Plans would also have to give each enrollee the name of 1 to 3 U.S.‑based, English‑proficient contacts. Plans could not move a prescription to a more restrictive tier or change the list of services not covered during a coverage term. These rules would take effect January 1, 2029.

More payment parity and price transparency

If enacted, the bill would bar plans from stopping participating providers from treating people who are not enrolled in the plan. If a nonparticipating provider gives you covered care, the plan would have to pay that provider at least what it would have paid an in‑network provider. Plans and issuers would also have to give any copy of a contract or benefits statement the procedure codes, the plan’s listed charge for each procedure, and a full list of covered services. These rules would take effect January 1, 2029.

Sponsors & CoSponsors

Sponsor

Cloud, Michael [R-TX-27]

TX • R

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

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