In a strongly worded letter, Representatives Richard Neal and Kevin Brady, the Chairman and Ranking Member of the House Ways and Means Committee, urged three cabinet secretaries to take “swift action” to fix the No Surprises Act (NSA) final rule. Read the letter here.
The letter reminded the Secretaries that the No Surprises Act intentionally detailed a dispute resolution process that required arbitrators to equally consider several factors for their decision-making process, not just the Qualifying Payment Amount as some of our members are seeing in practice.
The final rule introduced a new “double counting” test that has no basis in the statutory text, directing IDR entities to “consider whether the additional information is already accounted for in the QPA… Even though the No Surprises Act explicitly requires an IDR entity to separately consider all of the statutory factors, the final rule precludes IDR entities from giving weight to factors like patient acuity and the complexity of furnishing the item or service at issue unless providers meet the heightened burden of disproving double-counting within the QPA.”
They further called out the Departments about their slow rollout of the Advanced Explanation of Benefits provision in the NSA.
EDPMA applauds the Ways and Means Committee leadership and stands with Representatives Neal and Brady in their demand to ensure the No Surprises Act aligns with the law and to “make the law’s transparency provisions a reality for patients.”