2026 Senate Resolution 100

Whereas, Surprise medical billing protections laws are designed to help patients avoid paying unexpectedly large sums for medical care rendered by nonparticipating providers and resolve disputes between insurers and these providers about the amount that should be charged for services. Michigan was one of the first states to enact a comprehensive surprise billing protections law, which took effect over a year before the implementation of the federal No Surprises Act (NSA). Since October 2020, Michigan has administered an arbitration process to resolve payment disputes between nonparticipating providers and insurers. Michigan’s surprise billing review process involves specific timelines, negotiation periods, a payment standard, and arbitration to resolve payment disputes. The federal NSA includes an independent dispute resolution (IDR) process that can be utilized in disputes that are not subject to state surprise billing protections laws; and

Whereas, Recent data from the Centers for Medicare and Medicaid Services (CMS) clearly illustrates how providers are increasing their usage of the federal process. According to CMS, in the last six months of 2024, providers, facilities, and air ambulance providers were the prevailing parties in 85 percent of arbitration decisions, and they secured payment decisions that far exceed qualifying payment amounts. Analysis from a study published using 2023 dispute and claims data from Elevance Health shows that settlement amounts for out-of-network care were substantially higher than qualifying payment amounts and median in-network prices, indicating that out-of-network providers are receiving substantially higher payments than in-network providers when they go through arbitration under the NSA; and

Whereas, Since implementation of the NSA and the federal IDR process, health plans in Michigan have noticed some growing, troubling practices that could be seen as providers avoiding Michigan’s surprise billing protections law. Rather than utilizing Michigan’s well-established dispute resolution process, providers have submitted a substantial number of ineligible claims through the federal IDR process. Ineligible claims can involve disputes arising from Medicare and Medicaid and disputes subject to state law, which are not subject to the federal IDR process. Of the over 1.3 million disputes closed nationwide during 2024, 19 percent were deemed ineligible; and

Whereas, In addition to these hundreds of thousands of claims found to be ineligible, it has been alleged that arbitrators incorrectly issue payment determinations in still more ineligible cases, indicating a lack of consistency and awareness of which claims are subject to state or federal IDR processes. Such improper payment determinations entice providers to submit even more claims and impose excessive costs on those providing insurance, threatening to drive up insurance costs for consumers; now, therefore, be it

Resolved by the Senate, That we urge the federal government to issue clarifying rules or guidance explaining that claims applicable to state surprise billing laws must go through the state dispute resolution process, rather than the federal independent dispute resolution process; and be it further

Resolved, That copies of this resolution be transmitted to the President of the United States, the Secretary of the United States Department of Health and Human Services, the Secretary of the United States Department of Labor, the United States Secretary of the Treasury, Congressman Tim Walberg, as the Chairman of the United States House of Representatives Committee on Education and Workforce, and the members of the Michigan congressional delegation.