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Last week, the Biden Administration released its newest set of regulations to implement the federal “No Surprises Act.” While earlier rules addressed other sections of the law, this set of rules focuses on the independent dispute resolution (IDR) process – the mechanism that Congress created to adjudicate payment disputes between health insurance companies and physicians.
During last year’s Congressional debate about surprise medical bills, ASA co-led a medical specialty coalition focused on ensuring that physicians were empowered to secure fair payment rates from insurers for out-of-network payment disputes through the IDR process. ASA worked closely with Congressional allies on the final language included in the No Surprises Act, that captured Congress’ intent to create an IDR process that was appropriately balanced and did not favor either the insurer or the physician in claims disputes. ASA supported the final language, which required the arbiter to consider a full range of factors, including patient acuity or complexity of services, demonstrations of previous good faith efforts to negotiate in-network rates and previously contracted rates, in addition to the insurers’ median in-network rate.
With the release of the rule last week, we learned that the responsible federal departments ignored Congressional intent and statutory language and, instead, designed an IDR process that heavily favors health insurance companies in payment disputes. The language in the rule directs the arbiter to give priority to the insurer-calculated median in-network amount, called the qualifying payment amount (QPA), over the other considerations ASA worked to include in the law. The result is effectively rate-setting, which is entirely unacceptable to ASA.
Chairman of the House Ways and Means Committee Rep. Richard Neal (D-MA-01) and Ranking Member Rep. Kevin Brady (R-TX-08) sent a letter to Biden Administration officials expressing concern with the recently released set of regulations and asked for adjustments to the regulations.
On Friday, ASA issued a joint statement with other medical specialty organizations to denounce this plan. We have also begun to work jointly with other medical specialty organizations and hospital stakeholders to repair the QPA flaw. As first step, we need Congress to reengage to affirm their Congressional intent. Please contact your members of Congress to ask that they fix this flawed rule. Visit our Grassroots Action site and take action today. Stay tuned — we will keep you informed.
