H.R. 10788
Lower Premiums, Faster Payments Act
Summary:
• The bill, called the "Lower Premiums, Faster Payments Act," eliminates the independent dispute resolution (IDR) process for surprise medical billing for services furnished on or after January 1, 2028, making the qualifying payment amount (QPA) the mandatory out-of-network rate going forward.
• Starting in 2028, the QPA is recalculated using median contracted rates as of January 31, 2019, adjusted upward by the Consumer Price Index (CPI) for all urban consumers through 2027, then increased annually by CPI thereafter; the methodology for determining the QPA is explicitly shielded from judicial review.
• The bill requires annual audits of claims data from at least 25 health plans/insurers beginning in 2028, with audit findings made publicly available, and mandates updated rulemaking within 180 days of enactment.
---
• Starting in 2028, the QPA is recalculated using median contracted rates as of January 31, 2019, adjusted upward by the Consumer Price Index (CPI) for all urban consumers through 2027, then increased annually by CPI thereafter; the methodology for determining the QPA is explicitly shielded from judicial review.
• The bill requires annual audits of claims data from at least 25 health plans/insurers beginning in 2028, with audit findings made publicly available, and mandates updated rulemaking within 180 days of enactment.
---