House Lawmakers Express Serious Concern Regarding No Surprises Act Dispute Resolution Process

Leaders of the House Ways and Means Committee sent a letter to several agencies implementing the No Surprises Act calling for changes to the Independent Dispute Resolution (IDR) process.   Several entities have expressed concern over the IDR process defined under the legislation.

The initial guidance provided by CMS instructed IDR entities overseeing the process to place emphasis on Qualifying Payment Amount (QPA), which is defined as the median contracted rate as of January 31, 2019, based on the same service in the same market. IDR entities were instructed not to deviate from the QPA, absent credible evidence showing that the QPA was “materially different” from the appropriate rate. The District Court vacated these requirements in rulings in February and July 2022.  The Final Rule released in August instructs IDR entities to consider the QPA along with other credible factors.

The letter applauds the purpose of the No Surprises Act but expresses concern that portions of the Final Rule continue to deviate from the intent of the legislation.  In the letter, lawmakers wrote “Despite a federal district court correctly ruling that aspects of the interim final regulation were flawed in its implementation of the IDR requirements, we are severely disappointed to find that the August 2022 final rule violates the No Surprises Act in the same ways as before. Although the final rule makes some limited progress by no longer designating an unlawful “rebuttable presumption” towards the QPA as the interim final rule did (which a federal district court properly invalidated), we find that the new instruction to IDR entities largely would have the same effect.” 

For more information on the IDR process defined under the No Surprises Act, read the XiFin blog, No Surprises Act: Examining the Independent Dispute Resolution Process.

Source: https://aha.org/lettercomment/2022-11-21-key-house-committee-express-serious-concerns-regarding-latest-efforts-implement-bipartisan-no