September 10, 2021
ASA Provides Feedback on First Set of Federal Rules for No Surprises Act
On September 7, ASA sent a formal communication to Biden Administration officials in response to the first Interim Final Rule (IFR) implementing the No Surprises Act, a bill passed in December 2020 as part of the Consolidated Appropriations Act of 2021. The bill aims to eliminate surprise medical bills -- unexpected charges to patients for out-of-network care -- as well as help resolve payment disputes between physicians and insurers. ASA provided recommendations to ensure the law is implemented fairly and equitably.
The IFR, titled “Requirements Related to Surprise Billing; Part I,” was released in July 2021 as one of three expected rules on the No Surprises Act. ASA’s comments identified areas of improvement and communicated recommendations to Secretary of Health and Human Services Xavier Becerra, Secretary of the Treasury Janet Yellen, and Secretary of Labor Marty Walsh, leaders of the federal agencies responsible for issuing regulations to implement this legislation.
One major focus of ASA’s comments was centered on Qualified Payment Amount (QPA), a calculation drawn from in-network rates to determine patient cost-sharing for out-of-network care under the new legislation. ASA urged the relevant federal agencies to clarify that QPA is a tool designed for cost-sharing purposes only and is not intended to as an accurate reflection of market conditions for health care payments, as QPA does not consider the full range and prevalence of in-network payments. For that reason, ASA believes QPA should not be given outsized weight over other factors in the Independent Dispute Resolution (IDR) process mandated in the No Surprises Act as a backstop for prolonged payment disputes between physicians and payers. ASA called for requirements on the information provided by payers detailing how their QPA is calculated, and on determining which sources of input are appropriate for the calculation in cases of insufficient information.
ASA also recommended a measure to encourage fair and expedient payment negotiations, which would result in lower costs from decreased reliance on IDR. The measure would consist of a rule to consider a payer’s initial payment to be its final offer in IDR or alternatively consider a payer’s last offer in negotiations to be its final IDR offer.
ASA expects a second IFR on the No Surprises Act to be released within days and plans to submit comments on the forthcoming set of rules.
Read ASA’s comment letter.
Read the full text of the IFR.