HR Policy and Institute Provide Comments on Surprise Billing Rulemaking

June 04, 2021

HR Policy and the American Health Policy Institute urged the Departments of Health and Human Services, Labor, and Treasury to ensure forthcoming rulemaking implementing a recently-passed surprise medical billing law reduces health care costs.

Background:  Effective January 1, 2022, the No Surprises Act aims to protect patients by ending the practice of surprise medical billing.  While the law will remove patients from the center of billing disputes, there are several provisions of the law that, if implemented in certain ways, could lead to increased costs on consumers and families through higher premiums and administrative costs.  

HR Policy and the Institute asked the Departments that any rulemaking be guided by two objectives: 1) minimizing administrative costs associated with the independent dispute resolution (IDR) process, and 2) reducing the cost of health care for employers, employees and their dependents.

We recommended to the Departments that they:

  • Preserve ERISA preemption and clearly establish when state law governs out-of-network payments;

  • Promote open negotiation between the parties to settle on a reimbursement amount rather than establishing standards regarding the initial payment amount and allow employers to continue to negotiate a settlement during the IDR process;

  • Define the Qualifying Payment Amount (QPA) as the median of contracted rates and establish it as the primary consideration in IDR proceedings;

  • Maximize transparency regarding publication of information related to the IDR process so the public and policymakers can easily identify problems and determine if changes are needed; and

  • Protect patients by providing consumer friendly notices ahead of out-of-network care.

Outlook:  An interim final rule is expected in July 2021.  We will continue providing the administration with feedback on behalf of employers.  HR Policy and the American Health Policy Institute also will join several business groups in a separate letter to the Departments outlining the importance of rulemaking that contains total health care costs and ensures patients are protected from surprise medical bills.