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Stakeholders Praise Wenstrup/Suozzi/Bucshon/Ruiz Letter to Admin Regarding Surprise Billing IFR

Washington, November 19, 2021 Contact:

WASHINGTON – Key stakeholders issued the following statements regarding a bipartisan letter led by Congressmen Brad Wenstrup, D.P.M., (R-Ohio) and Tom Suozzi (D-N.Y.) and 148 of their colleagues to the Biden administration demanding that the Interim Final Rule for Surprise Billing reflect the landmark No Surprises Act as written:

“America’s Essential Hospitals supports protecting patients from surprise medical bills. We agree with these bipartisan Congressional leaders that the Administration must implement the No Surprises Act as Congress intended and not default to a benchmark rate that undervalues the services our hospitals provide,” said Bruce Siegel, MD, MPH, President and CEO, America's Essential Hospitals.

“The fair and responsible implementation of the ban on surprise billing is vital to protecting patients from unexpected medical bills and to the ability of safety-net hospitals to continue to serve their communities. The National Alliance of Safety-Net Hospitals is grateful to the 152 representatives who signed this bipartisan letter reiterating that principle to the administration,” said Ellen Kugler, Executive Director, National Alliance of Safety-Net Hospitals.

“The No Surprises Act protects patients from surprise medical bills and establishes a balanced process to resolve payment disputes between insurance plans and health care providers,” said Greater New York Hospital Association GNYHA President, Kenneth E. Raske. “GNYHA is grateful to Representatives Suozzi, Wenstrup, Ruiz, and Bucshon for their bipartisan letter asking the Biden Administration to revise the surprise billing interim final rule to align regulatory implementation with Congress’s original intent and require consideration of all factors outlined in the statute. The 152 representatives who signed the letter recognize the importance of an impartial dispute process and supporting providers’ efforts to deliver care to patients,” said Kenneth E. Raske, President, Greater New York Hospital Association.

“HANYS strongly supported the passage of the bipartisan No Surprises Act, which like New York state law, promises to keep patients out of the middle of billing disputes in a fair and balanced manner, without setting a benchmark rate for payments to providers. We thank Reps. Suozzi, Wenstrup, Ruiz, and Bucshon for their persistent commitment to ensuring the federal government implements the law according to congressional intent. It is absolutely crucial that we get this policy right,” said Bea Grause, RN, JD, President, Healthcare Association of New York State.

“While the No Surprises Act and its implementing Interim Final Rule (IFR) protects patients from surprise bills, that same IFR dismisses nearly two years of negotiation and compromise in failing to provide the fair arbitration process prescribed by Congress. Today’s letter from over 150 Members of Congress makes it clear that their intent is to have an independent dispute resolution process that is truly independent. These members are expressing their concern that the September 30th IFR disregards that intent and that it should be revised. The FAH applauds the leadership of Reps. Suozzi, Wenstrup, Ruiz and Bucshon for leading this bipartisan group of Members in calling on the Administration to make the IFR fair and balanced. We hope the Administration will heed this direction and create a level playing field for the settlement of payment disputes that will ensure patient access to care,” said Chip Kahn, President & Chief Executive Officer, Federation of American Hospitals.

“The American Osteopathic Association commends Representatives Wenstrup, Suozzi, Ruiz, and Bucshon for their leadership in ensuring that the No Surprises Act is implemented in a manner that both protects patients from surprise medical bills and does not limit their access to physicians,” said Joseph A. Giaimo, DO, MACOI, FCCP, president of the AOA. “This law is the result of bipartisan negotiations, and if implemented as Congress intended, can resolve payment disputes without jeopardizing access to care,” said Joseph A. Giaimo, DO, MACOI, FCCP, President, American Osteopathic Association.

“When passing the No Surprises Act, Congress created a balanced process to resolve payment disputes between insurance plans and healthcare providers. We thank members of Congress for urging federal regulators to preserve this balance when implementing the law, and we share their concerns that the interim final rule, as written, ‘could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and jeopardize patient access to care,’” said Paul Salles, President & CEO, Louisiana Hospital Association.

“APMA supports efforts to protect patients from surprise medical bills and create a balanced process to resolve payment disputes between insurance plans and health care providers. Representatives Suozzi and Wenstrup correctly point out that Congress deemed the best path forward for patients was through an open negotiation period coupled with a balanced IDR process. We also agree that the current IDR process in the IFR does not reflect the way the law was written nor represent a policy that could have passed Congress, and that it fails to create a balanced process to settle payment disputes. We urge CMS to follow Congressional intent to align the law’s implementation with the legislation Congress passed to create a full and fair process for IDR,” said Jeffrey DeSantis, DPM, President, American Podiatric Medical Association.

“Thank you to members of Florida’s bipartisan congressional delegation in supporting this important letter that stresses the need for U.S. Departments of Health and Human Services to follow the letter of the law in implementing the No Surprises Act (NSA). The Florida Medical Association supports protecting patients from surprise bills, but the current regulatory framework surrounding the NSA is unsustainable, creates an unlevel playing field contrary the letter of the law and Congressional intent, and will ultimately reduce vital access to care," said Douglas Murphy, MD. President, Florida Medical Association.

“The No Surprises Act was passed with the goal of protecting patients from surprise medical bills and creating a fair and equitable process to resolve payment disputes between insurance plans and physicians. While the law requires all factors to be considered equally in an independent dispute resolution (IDR) process, the interim final rule to implement the No Surprises Act establishes a presumption that the median in-network rate, calculated by insurance companies, is the appropriate payment rate. Not only does the IDR process outlined in the rule ignore years of bipartisan and bicameral negotiations, but it also completely misreads Congressional intent, heavily benefiting insurers over physicians. ACS thanks Representatives Suozzi, Wenstrup, Ruiz, and Bucshon for their leadership in spearheading a bipartisan letter signed by more than 150 members of Congress urging the Administration to align the law’s implementation with the No Surprises Act as passed by Congress which includes a balanced independent dispute resolution process,” said David B. Hoyt, MD, FACS, Executive Director of the American College of Surgeons.

“Landmark legislation was carefully crafted to protect patients from receiving surprise medical bills while also maintaining physicians’ ability to negotiate in good faith,” said American Association of Orthopaedic Surgeons President, Daniel K. Guy, MD, FAAOS. “Current regulation unfairly benefits insurers and threatens access to care, undermining years of bicameral, bipartisan effort on the issue. The AAOS is committed to working with our allies in Congress to correct this misalignment and to ensure that the rule does not fall short of its promise,” said Daniel K. Guy, MD, FAAOS, President, American Association of Orthopaedic Surgeons.

“The Association of Air Medical Services (AAMS) strongly supports the letter and the position of Representative Suozzi, Representative Wenstrup, and the 150 other Members of Congress who voiced their support on this important issue. AAMS remains very supportive of the patient protections in the No Surprises Act, but the manner in which those protections are being implemented will have severe consequences to the emergency healthcare system, especially the air ambulance services upon which many communities rely to transport their sickest and most severely injured patients,” said Cameron Curtis, President and CEO, Association of Air Medical Services.

“As a passionate advocate for advancing the movement to value-based care, we strongly support Congressmen Bucshon, Ruiz, Souzzi and Wenstrup’s letter that opposes starting negotiations between insurers and providers with the assumption that the median in-network rate is the appropriate payment amount prior to considering other factors. This policy significantly strengthens an insurer’s hand. It will incent ratcheting fee-for-service rates down over time. At a time when we should be incenting moving to value-based care, this policy will incent insurers to double down on fee-for-service,” said Blair Childs, Senior Vice President, Public Affairs, Premier.

“Vizient continues to be supportive of efforts to protect patients from surprise bills, and we appreciate the extensive bipartisan negotiations in Congress to address the issue through the No Surprises Act. Unfortunately, the Interim Final Rule (IFR) from CMS disregards the spirit and the text of the No Surprises Act at the expense of our health care members and their patients. We are grateful to Reps. Suozzi, Wenstrup, Ruiz, Bucshon, and more than 150 of their colleagues, who have urged the administration to amend the IFR. We look forward to working together to address the challenges that the IFR poses around surprise billing,” said Shoshana Krilow, SVP Public Policy & Government Relations, Vizient.

“Surprise medical bills can interfere with the patient-physician relationship. The American College of Obstetricians and Gynecologists (ACOG) and its members firmly believe that the No Surprises Act can help protect our patients from unanticipated medical bills for the care they receive from out-of-network physicians. At the same time, physicians must be able to receive fair compensation for the quality care they provide. Thank you to Representatives Thomas Suozzi (D-NY), Brad Wenstrup, DPM (R-OH), Raul Ruiz, MD (D-CA), Larry Bucshon, MD (R-IN), and colleagues for their leadership to ensure that implementation of the law preserves its intent to protect both patients and access to care,” said J. Martin Tucker, MD, FACOG, President, American College of Obstetricians and Gynecologists.

"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. Unfortunately, the parameters of the independent dispute resolution process in the proposed final rule released on September 30th do not reflect the way the law was written, do not reflect a policy that Congress would have enacted, and do not create a balanced process to settle payment disputes. The American College of Gastroenterology appreciates Representative Suozzi and Dr. Wenstrup’s leadership in ensuring that the No Surprises Act is implemented as intended. Congress explicitly called for an independent payment dispute process that recognizes the quality of patient care. Consistent with the No Surprises Act, providers and payors must be allowed to bring any relevant information to support their payment offers and they should be considered equally,” said Samir A. Shah, MD, FACG, President, American College of Gastroenterology.

“The No Surprises Act was an important step forward in protecting patients from surprise medical bills and resolving billing disputes in a balanced way. Unfortunately, the administration’s interim final rule is a windfall for insurers. It moves away from Congressional intent and unfairly favors insurers at the expense of the hospitals and physicians that actually care for patients. The American Hospital Association thanks Congressman Wenstrup for his efforts to ensure the No Surprises Act is implemented as intended by pushing back against harmful proposals Congress has already rejected,” said Stacey Hughes, Executive Vice President, American Hospital Association.

 “This rule directly conflicts with both the letter and intent of the law by prioritizing median in-network payment rates. There is no question that health plans will now drastically lower payment rates and drop more physicians from their provider networks. It is therefore incumbent upon the Biden Administration to revise the new rules before they take effect to prevent patients from losing timely access to care,” said John K. Ratliff, MD, a practicing neurosurgeon from Stanford University, speaking on behalf of the American Association of Neurological Surgeons and Congress of Neurological Surgeons.

“On behalf of 40,000 emergency physicians who remain on the frontlines in communities across the country, the American College of Emergency Physicians (ACEP) sincerely appreciates the efforts of Representatives Suozzi, Wenstrup, Ruiz, and Bucshon, and their nearly 150 colleagues to ensure all parties have access to a fair and unbiased independent dispute resolution process,” said Gillian Schmitz, MD, FACEP, ACEP president. “The administration’s current plan to implement the legislation is almost entirely inconsistent with the careful balance struck by Congress last year, and will likely drive rates lower, encourage plans to narrow their networks even further, and ultimately threaten the viability of emergency physician practices that help provide the health care safety net, especially in rural and small communities,” said Gillian Schmitz, MD, FACEP, President, American College of Emergency Physicians.

“The rules governing the No Surprises Act should protect patients and create a playing field between providers and payers that is more level than what has been presented in the interim final rule for surprise billing. The law is clear that when the independent dispute resolution process is triggered, qualifying payment amounts and additional circumstances, such as experience and level of training, should be considered when determining an appropriate out-of-network provider rate. If there was any question about the intent of Congress when it created the independent dispute resolution process, 152 members of the U.S. House of Representatives in a letter to the Secretaries of the Health and Human Services, Treasury, and Labor Departments have made clear the law was never intended to tip the scales in favor of insurance companies. The American Society for Gastrointestinal Endoscopy thanks Congressmen Brad Wenstrup and Tom Suozzi for their leadership to make sure the spirit of the law is followed during the implementation process,” said Doug Rex, MD, President, American Society for Gastrointestinal Endoscopy.

“The strong bipartisan support for the Suozzi/Wenstrup letter reinforces Congress’s intent to protect patients from billing disputes that arise when insurance companies are unwilling to pay for patient care. California’s hospitals appreciate the support of the 25 members of the California delegation who signed on to help ensure patients have access to the care they need and that insurance companies are held accountable to pay for that care,” said Carmela Coyle, President & CEO, California Hospital Association.

“Our physician anesthesiologists, the majority of whom practice in small and medium size community practices and academic institutions, are very disappointed by the agencies’ decision to weaken the arbiter’s ability to fairly resolve payment disputes with insurance companies. What was intended to be an independent, unbiased arbiter is now nothing more than a mechanism to rubber stamp the insurer’s self-calculated payment rate. We urge the agencies to heed the message of the “Suozzi-Wenstrup-Ruiz-Bucshon” letter, fix the rule and affirm the independence of the arbiter,“ said Randall Clark, M.D., President, American Society of Anesthesiologists.

“The American Medical Association welcomes the strong, bipartisan message that the interim final rule not only reflects policy that could not pass Congress, but it puts the thumb firmly on the scale for insurance companies when settling payment disputes. In the end, this gift to the insurance industry will reduce health care options for patients by encouraging more consolidation in the health care marketplace. Enhanced consolidation can lead to higher health care costs for patients, which is counter to the underlying goal of curbing unanticipated medical bills. The AMA supports a robust independent dispute resolution process to maintain market balance and preserve access to care. The Administration should heed the call of Congress and go back to the drawing board. We applaud Reps. Tom Suozzi (D-NY), Brad Wenstrup (R-OH), Raul Ruiz, M.D. (D-CA) and Larry Bucshon, M.D. (R-IN) for leading this important effort,” said Gerald E. Harmon, MD, President, American Medical Association.

“The new rules to implement the No Surprises Act ignore congressional intent. Congress was quite clear that to ensure an equitable and balanced system to resolve disputes no single factor should be given preference over others. However, the new rules will favor payment rates developed by insurance companies, which will only exacerbate ongoing health plan manipulation and disincentivize insurers from offering fair contracts to physicians caring for patients,” said Emily E. Volk, MD, FCAP, President, College of American Pathologists.

“The recently released second IFR implements a dispute resolution process unfairly weighted in favor of insurers. This will affect future negotiations between physicians and insurers that extend well beyond surprise billing. We thank Representative Suozzi, Dr. Wenstrup, and the 150 bipartisan members of the House of Representatives who supported this initiative for their leadership in protecting patients from the burden of surprise medical bills,” said James C. Denneny, III, MD, Executive Vice President/CEO, American Academy of Otolaryngology-Head and Neck Surgery.

“In its implementation of the “No Surprises Act”, HHS has clearly sought to put its thumb on the scale of the already deep-pocketed health insurance industry. Failing to fix this egregious error by HHS in implementing this rule could have serious adverse consequence for the ability of patients to receive needed care from their physicians and hospitals. MSSNY thanks Representatives Suozzi, Wenstrup, Ruiz and Bucshon for their leadership in co-authorizing the letter to the Biden Administration urging them to align the law’s implementation with the legislation passed by Congress, and to the many other members of the New York Congressional Delegation who signed on in support,” said Dr. Joseph Sellers, MD, President, New York State Medical Society (MSSNY).

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