Lower Premiums, Faster Payments Act

Bill Number

H.R. 10788

Origin Chamber

House

Congress

119th Congress, Session 2

Status

Introduced

Latest Action

2026-10-09: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Last Updated

2026-10-10T08:23:24Z

AI-Generated Summary

Purpose This legislation, titled the "Lower Premiums, Faster Payments Act," amends federal laws governing surprise medical billing for private health insurance. Its primary aim is to phase out the independent dispute resolution (IDR) process for out-of-network services and revise the calculation of the qualifying payment amount (QPA) to promote faster payments and potentially lower insurance premiums.

Key Provisions

• Elimination of IDR Process: Starting January 1, 2028, the IDR process ends for items and services furnished on or after that date. For services before 2028, IDR remains available. Post-2027, the out-of-network rate defaults to the QPA, with payment required within 30 days after the bill is transmitted if the QPA applies.
• Revised QPA Calculation:
• For 2028 services: Based on the median contracted rate as of January 31, 2019 (including cost-sharing and certain incentive payments), increased by the consumer price index (CPI) for all urban consumers from 2019 through 2027.
• For 2029 and later: The prior year's QPA increased by the annual CPI.
• New plans or coverages not offered in 2019 use a Secretary-established methodology for the first year, then apply CPI adjustments.
• Updated Rulemaking: The Secretary of Health and Human Services (in consultation with Labor and Treasury) must issue updated rules within 180 days of enactment to revise QPA methodology for 2028 and beyond; interim final rules are permitted.
• Enhanced Audits: Annual audits expand to samples from at least 25 plans/issuers starting in 2028. Findings must be submitted to Congress and made publicly available. Audits are now mandatory ("shall") rather than discretionary ("may").
• No Judicial Review: The methodology for determining the QPA is not subject to judicial review.

Significant Changes to Existing Law The bill modifies the No Surprises Act framework (enacted in 2020) across the Public Health Service Act, Internal Revenue Code, and Employee Retirement Income Security Act. It removes the IDR option after 2027, shifting from a negotiation/arbitration model to a fixed QPA-based rate. It also updates QPA formulas from a 2019 baseline with inflation adjustments and strengthens oversight through mandatory, public audits. Air ambulance services receive parallel changes.

Potential Impacts

• Government Agencies: Increases rulemaking and audit responsibilities for the Departments of Health and Human Services, Labor, and Treasury.
• Citizens: May result in faster provider payments and lower premiums through stabilized rates, but could affect access or billing disputes for patients.
• International Relations: No direct effects identified in the legislation.
• Overall: Streamlines billing by reducing disputes but centralizes rate-setting authority.

Main Stakeholders Affected

• Health insurance issuers and group health plan sponsors.
• Healthcare providers and facilities (including air ambulance services).
• Patients and consumers enrolled in private health plans.
• Employers offering group health coverage.
• Federal agencies responsible for implementation and oversight.

Notable Legal, Constitutional, or Political Implications The legislation explicitly bars judicial review of the QPA methodology, limiting challenges to the rate-determination process. It introduces phased implementation dates (pre- and post-2028) to transition from the current IDR system.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Pallone, Frank [D-NJ-6]

Recent Actions

• 2026-10-09: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2026-10-09: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2026-10-09: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2026-10-09: Introduced in House
• 2026-10-09: Introduced in House

Bill Versions

• Lower Premiums, Faster Payments Act — issued 2026-10-09 — PDF (43 pages)