After many years and far too many surprise bills, the patient protections included as part of the No Surprises Act are just weeks away from taking effect, providing welcome relief and peace of mind for millions of Americans. Private equity firms and out-of-network providers will be prohibited from sending surprise medical bills in cases where patients previously had no choice or say in their doctor or care. As we approach this historic milestone, the Biden Administration has received a clear signal from a diverse array of patient organizations, union and employer groups in support of the consumer protections outlined in the recent interim final rules.
The message is clear. Patients have been waiting far too long for these protections. The Administration’s approach throughout the rulemaking process is consistent with the statute and will ensure consumers see the full benefits of the law’s safeguards and cost-savings measures.
- Coalition Against Surprise Medical Billing
- “Core to the goal of reducing consumers’ premiums and achieving budget savings is a federal independent dispute resolution (IDR) process that reduces – not increases – health care costs. By reinforcing the importance of the qualifying payment amount (QPA) as the primary consideration for final payment determinations, the Biden-Harris Administration will ensure a more predictable arbitration process that can expand access to affordable, in-network care.”
- American Benefits Council
- “The Council strongly supports the Part II regulations in that they confirm the central role of the QPA in the IDR process, which we expect will minimize the costs and extent of IDR, encourage providers to resolve payment issues outside of the IDR process, and lead to an IDR process that, when used, arrives at reasonable, un-inflated amounts to support lower health care costs for consumers and plans.”
- American Benefits Council, Auto Care Alliance, Business Group on Health, The Leapfrog Group, National Alliance of Healthcare Purchaser Coalitions, National Retail Federation, Partnership for Employer Sponsored Coverage, Public Sector Healthcare Roundtable
- “The legislation makes clear that arbitrators should use the local market payment as the most important factor in making payment determinations… By providing clear and direct guidance to IDR entities regarding the use of the QPA, the rule will reduce the use of arbitration to resolve payment disputes and therefore reduce unnecessary administrative costs to employers.”
- AFL-CIO
- “We commend the Administration for a regulation that faithfully implements critical provisions of the legislation. We believe the IFR as drafted is a critical step in protecting working families from the burdensome practice of surprise billing without increasing premiums. We urge the tri-agencies involved in the implementation process not to make major changes to the regulation, particularly the payment determination provisions… We strongly support the basic design of the arbitration process detailed in the IFR, which starts with the presumption that the Qualified Payment Amount (QPA) is the appropriate payment amount.”
- American Heart Association
- “The AHA believes that the independent dispute resolution (IDR) process laid out in this IFR fulfills the NSA’s mission by protecting patients while also containing costs. As such, we urge you to maintain the IDR system as proposed. Because the arbitration system should be viewed as a last resort for payment disputes to keep overall costs down and prevent overuse and/or abuse of arbitration, the AHA believes that the system put forth in the IFR will encourage stakeholders to reach in-network agreements without having to utilize the IDR process. However, in instances where in-network agreements cannot be reached, the AHA believes that the IDR process laid out in the IFR will produce reliable and consistent results that do not have an inflationary impact on health care costs.”
- Business Group on Health
- “The IFR takes a thoughtful and balanced approach to the interests of the various stakeholders and provides pragmatic and effective guidance to implement Act’s framework and objectives. The Business Group applauds the Departments for their clear direction to the IFR entity regarding the primacy of the qualifying payment amount (QPA). In our view, this requirement is good for employer plan sponsors and the American health care system because it encourages early agreement and cooperation between payers and providers both in a dispute resolution proceeding and beforehand by maintaining the incentives for network participation. We urge the Departments to maintain focus on and deference to the QPA, and not weaken its importance, and thereby the efficacy of the No Surprises Act, in future rulemaking.”
- California Labor Federation, Health Access California, Purchaser Business Group on Health, and Blue Shield of California
- “We are also encouraged that the recent interim final rules recognize the need for a comprehensive approach to address out-of-network costs. Our experience in California with AB 72 reinforces the importance of reforms that directly address the inflationary cost pressures behind providers choosing to leave networks in order to surprise bill consumers while also expanding access to affordable, in-network care.”
- Families USA
- “Specifically, we appreciate that the primary consideration in the IDR process is based on local, in-network rates, through the qualifying payment amount (QPA) framework. Putting a market-driven value at the center of reimbursement negotiations will ensure fair payment to providers, while helping to reduce overall health care costs for patients.”
- Fair Health Costs Coalition
- “By providing clear direction to arbitrators, the IFR will reduce variability in IDR resolutions and thereby reduce the likelihood that either party will choose to take a claim to arbitration, reducing administrative costs for employers and purchasers.”
- HR Policy Association
- “We applaud the provisions in the interim final rule that protect patients from surprise medical bills while lowering health care premiums and administrative costs. Given the clear statutory language and competing congressional letters, the Association believes the IDR process and selection of offer provisions are a rational and reasonable construction of the statute. Congress clearly intended the legislation to protect consumers from surprise medical bills and the Association believes this protection extends to protecting consumers from higher health insurance premiums and deductibles that will occur if balance bills are merely shifted from consumers to employer and commercial plans without some process for determining a reasonable out-of-network rate.”
- U.S. PIRG
- “We commend the Departments for issuing the IFR in a timely manner and urge swift implementation on January 1, 2022…Congress enacted the No Surprises Act to protect consumers from balance billing while at the same time creating downward pressure on health care costs. This rulemaking honors that Congressional intent by centering the interests of consumers: holding families harmless from surprise medical bills and minimizing the inflationary impact of provider-insurer payment disputes so that families do not face higher health care costs as a result.”
- The ERISA Industry Committee
- “The IFR addresses the leading causes of surprise medical billing. The Departments issued a comprehensive and thoughtful approach to the IDR procedure so that it is fair, balanced, and prevents abuse and misuse. While some out-of-network providers and other Wall Street-backed stakeholders have sought to block or weaken the rule’s consumer protections, we want to reiterate that the Interim Final Rule Part II reforms are intricately linked to the comprehensive patient protections in the No Surprises Act and should take effect as intended on January 1, 2022.”
- Self-Insurance Institute of America
- “As the Part II IFR provides, Congress clearly articulated in the No Surprises Act that the Qualifying Payment Amount, or QPA, must be the baseline and primary payment factor that an IDR entity must consider when making a final payment determination. This finding is also supported by the Congressional Budget Office (CBO), which concluded that using the median in-network rate as the primary factor will decrease overall healthcare costs and incentivize providers to join networks, while also protecting patients from arbitrarily inflated surprise medical bills. These two considerations were at the core of what Congress intended when enacting the No Surprises Act: (1) lowering health care costs and (2) protecting patients and their families.”
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