150 members of Congress pressure administration to fix surprise billing rule they say favors insurers
Bipartisan members of the U.S. House are urging the Biden administration to amend a controversial component of a recent rule aimed at eliminating surprise medical bills.
All told, 150 representatives have signed on to the letter-writing campaign, addressed to secretaries at the departments of Health and Human Services, Treasury and Labor. Last December, lawmakers approved the No Surprises Act, spelling out a process to settle disputes between payers and out-of-network providers.
But members of Congress believe recently released rulemaking has failed to honor their intent and would tip the scales in favor of insurers. Their letter echoes concerns raised by numerous provider groups including the Texas Medical Association, which sued over the issue Oct. 29, and American College of Radiology, now considering doing the same.
“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,” representatives led by Thomas Suozzi, D-N.Y., Brad Wenstrup, R-Ohio, Raul Ruiz, MD, D-Calif., and Larry Bucshon, MD, R-Ind., wrote Nov. 5. “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.”
Lawmakers believe the interim final rule places too much emphasis on the “qualifying payment amount,” established by health insurers, in dispute resolutions. Generally, this would amount to the median contracted rate for the same or similar service in the geographic area. Instead, they believe it should consider several factors including quality of outcomes, market share, complexity of services, case mix, and prior contract history between the two sides. The original law “expressly directs” arbitrators to incorporate all such factors, the letter writers noted.
If the administration fails to act, the rule will take effect on Jan. 1. Meanwhile, members of the GOP Doctors Caucus (with some overlap from the other letter) also wrote to the three departments to voice their “deep concerns” over the issue. They also asked the administration to operate in a timely fashion when implementing other patient protections in the act, including requiring advanced estimates of benefits and cracking down on inaccurate provider directories.
“The medical professionals in Congress stand ready to collaborate with your offices to ensure implementation meets statutory requirements before regulations take effect on January 1, 2022,” the caucus wrote.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.