Wenstrup, Suozzi Lead 150 Members in Demanding Administration Properly Implement Surprise Billing Legislation
Washington, November 5, 2021
WASHINTON – Today, Congressmen Brad Wenstrup (R-Ohio) and Tom Suozzi (D-N.Y.) led 150 Members of Congress in sending a letter to the Secretaries of the Health and Human Services, Treasury, and Labor Departments demanding that the Interim Final Rule for Surprise Billing reflect the landmark No Surprises Act as written:
“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,” the Members wrote.
You can read the full letter here:
November 5, 2021
The Honorable Xavier Becerra The Honorable Janet Yellen
The Honorable Martin J. Walsh
Dear Secretary Becerra, Secretary Yellen, and Secretary Walsh:
We write regarding the interim final rule (IFR) released on September 30 entitled “Requirements Related to Surprise Billing; Part II”. The bipartisan No Surprises Act, passed by Congress in December 2020, was one of the most important patient protection bills in American history, but its success will depend on your departments following the letter of law in its implementation. We urge you to amend the IFR in order to align the law’s implementation with the legislation Congress passed.
Congress passed the No Surprises Act after extensive bipartisan and bicameral deliberations to protect patients from surprise medical bills and create a balanced process to resolve payment disputes between insurance plans and health care providers. During these deliberations, multiple proposals were considered including a benchmark rate, an independent dispute resolution (IDR) process, and a hybrid. Following a comprehensive process that included hearings, markups, and extensive negotiations, Congress rejected a benchmark rate and determined the best path forward for patients was to authorize an open negotiation period coupled with a balanced IDR process.
The No Surprises Act specified an IDR process that takes patients out of the middle of payment disputes. It allows providers and payors to bring any relevant information to support their payment offers for consideration, except for billed charges and public payor information. Per this process, the certified IDR entity shall consider:
The process laid out in the law expressly directs the certified IDR entity to consider each of these listed factors should they be submitted, capturing the unique circumstance of each billing dispute without causing any single piece of information to be the default one considered.
Unfortunately, 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. The IFR directs IDR entities to begin with the assumption that the median in-network rate is the appropriate payment amount prior to considering other factors. This directive establishes a de-facto benchmark rate, making the median in-network rate the default factor considered in the IDR process. 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. It could also have a broad impact on reimbursement for in-network services, which could exacerbate existing health disparities and patient access issues in rural and urban underserved communities.
We appreciate the complex nature of the patient protections that must be established and look forward to a final rule that accurately reflects Congress’s multi-year bipartisan and bicameral work to pass this landmark legislation. Therefore, 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.
Thank you for your continued efforts on this important matter. We look forward to working with you to ensure the best outcomes for our patients and the health of our communities.
Representatives Thomas R. Suozzi, Brad R. Wenstrup, D.P.M., Raul Ruiz, M.D., Larry Bucshon, M.D., Alma S., Adams, Ph.D., Colin Allred, Jodey C. Arrington, Cindy Axne, Ami Bera, M.D., Jack Bergman, Andy Biggs, Dan Bishop, Sanford D. Bishop, Jr., Mike Bost, Julia Brownley, Vern Buchanan, Tim Burchett, Michael C. Burgess, M.D., Salud Carbajal, André Carson, Earl L. “Buddy” Carter, R.Ph., Liz Cheney, Judy Chu. Steve Cohen, Tom Cole, J. Luis Correa, Jim Costa, Charlie Crist, Jason Crow, Sharice L. Davids, Danny K. Davis, Madeleine Dean, Suzan DelBene, Mark DeSaulnier, Neal P. Dunn, M.D., Jake Ellzey. Tom Emmer, Adriano Espaillat, Ron Estes, Dwight Evans, Randy Feenstra, A. Drew Ferguson, IV, Brian Fitzpatrick, Chuck Fleischmann, John Garamendi, Andrew R. Garbarino, Louie Gohmert, Jimmy Gomez, Josh Gottheimer, Mark E. Green, M.D., Glenn Grothman, Michael Guest, Josh Harder, Andy Harris, M.D., Brian Higgins, French Hill, Ashley Hinson, Chrissy Houlahan, Richard Hudson, Ronny L. Jackson, M.D, Sheila Jackson Lee, Chris Jacobs, Dusty Johnson. Eddie Bernice Johnson, Henry C. “Hank” Johnson Jr., John Joyce, M.D., John Katko, Mike Kelly, Daniel T. Kildee, Derek Kilmer, Young Kim, Ron Kind, Raja Krishnamoorthi, Darin LaHood, Doug LaMalfa, Conor Lamb, Doug Lamborn, James R. Langevin, Jake LaTurner, Barbara Lee, Debbie Lesko, Julia Letlow, Mike Levin, Ted W. Lieu, Barry Loudermilk, Alan Lowenthal, Frank D. Lucas, Stephen F. Lynch, Nicole Malliotakis, Carolyn B. Maloney, Sean Patrick Maloney, Tracey Mann, Lucy McBath, James P. McGovern, David B. McKinley P.E, Peter Meijer, Grace Meng, Dan Meuser, Carol D. Miller, Mariannette J. Miller-Meeks, M.D., Alex X. Mooney, Joseph D. Morelle, Frank J. Mrvan, Gregory F. Murphy, M.D., Stephanie Murphy, Jerrold Nadler, Grace F. Napolitano, Dan Newhouse, Eleanor Holmes Norton, Devin Nunes, Jimmy Panetta, Bill Pascrell, Jr., Ed Perlmutter, Dean Phillips, Bill Posey, Tom Reed, Guy Reschenthaler, Tom Rice, David Rouzer, Lucille Roybal-Allard, Bobby L. Rush, Tim Ryan, Linda T. Sánchez, Bradley S. Schneider, David Schweikert, Austin Scott, David Scott, Pete Sessions, Terri A. Sewell, Brad Sherman, Mike Simpson, Albio Sires, Christopher H. Smith, Jason Smith, Lloyd Smucker, Elise Stefanik, Eric Swalwell, Van Taylor, Mike Thompson, Rashida Tlaib, Ritchie Torres, Michael R. Turner, Jefferson Van Drew, D.M.D., Beth Van Duyne, Nydia M. Velázquez, Jackie Walorski, Daniel Webster, Bruce Westerman, Robert J. Wittman, Steve Womack, John Yarmuth, and Don Young