On Nov. 5, a bipartisan coalition of 150 members of Congress sent a letter to the secretaries of Health and Human Services, Treasury, and Labor Departments pushing back strongly against the Surprise Billing Interim Final Rule
(IFR) issued on Sept. 30.
As covered in a past edition
of The Valued Voice
, the IFR included a very controversial process for resolving billing disputes between insurers and providers. While the statute passed by Congress in the No Surprises Act established an independent dispute resolution (IDR) process that puts providers and insurers on an even playing field, the proposed IFR would establish a benchmark rate that would greatly tip the scales in favor of insurers despite Congress explicitly rejecting such a process during surprise billing legislative deliberations in the 116th Congress.
The No Surprises Act statute passed by Congress allowed the median in-network rate to be just one piece of information gathered in the IDR process among many other factors, including the level of training, experience, quality and outcomes of the provider; the market share held by the provider and/or the plan; patient acuity; and teaching status, case mix, and scope of services of the provider. However, the IFR would make the median in-network rate the single most important factor, presumed to be the amount a provider should receive in IDR process.
, led by Congressmen Brad Wenstrup (R-OH) and Tom Suozzi (D-NY), stated,
"The parameters of the IDR process in the IFR released on September 30 do not reflect the way the law was written, do not reflect a policy that could have passed Congress, and do not create a balanced process to settle payment disputes. This approach is contrary to statute and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and jeopardize patient access to care—the exact opposite of the goal of the law. We urge you to revise the IFR to align with the law as written by specifying that the certified IDR entity should not default to the median in-network rate and should instead consider all of the factors outlined in the statute without disproportionately weighting one factor."
Congressmen Ron Kind and Glenn Grothman joined the letter from Wisconsin's Congressional delegation. Both members have strongly supported allowing providers and insurers to negotiate on an even playing field and serve on Congressional committees that reviewed various surprise billing proposals in the 116th Congress.
WHA will continue to follow this issue closely and join efforts to push back against this flawed regulation that violates the federal statute. Contact WHA Vice President of Federal and State Relations Jon Hoelter