The No Surprises Act, which was passed in the Consolidated Appropriations Act, 2021 (P.L.116-260), and protects patients from surprise out-of-network medical bills, took effect on January 1. Meanwhile, lawmakers have asked the Administration to amend the second interim final rule, “Requirements Related to Surprise Billing: Part II,” to better reflect congressional intent. GNYHA agrees with these lawmakers and has been advocating for changes to the rule.
In arbitrating disputes over payment for out-of-network services, the No Surprises Act requires insurers and providers to negotiate payments or resolve the payment amount through the independent dispute resolution (IDR) process. While the law provides that during the IDR process the entity must consider numerous factors to determine the reasonableness of the proposed payments—one of which is the plan’s median in-network rate—the second interim final rule establishes the median in-network rate as the starting point for the IDR determination of the appropriate rate.
Members of Congress continue to express concerns about the harmful impact of the second interim final rule. On December 28, a group of Republican senators led by Senator Bill Cassidy (R-LA) sent a letter to the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury opposing the second interim final rule’s IDR framework, which establishes the median in-network rate as the primary factor to be considered by the IDR.
The letter emphasizes the guidance’s clear deviation from the statutory language, stating: “We have heard significant pushback from providers, hospitals and physicians alike, that the agencies’ approach gives certain stakeholders too much control over the outcome of the IDR in a manner that does not reflect the careful balance that we agreed to last December.” The letter asks the departments to revise the interim final rule to better reflect congressional intent.