EDPMA Comments on Problematic Surprise Billing Rule

On October 1, 2021, EDPMA and others blasted the Interim Final Rule that contradicts both the intent and language of the No Surprises Act (NSA) in a windfall for profitable commercial insurers which threatens patient access to care.  Early versions of the NSA — which could not pass due to lack of Congressional support — tied out-of-network reimbursement to the plan’s in-network rate.  In order to garner enough Congressional support to pass the bill, the bill was amended to include a list of factors the arbiter may consider and a list of factors the arbiter may not consider.  The rule released on September 30th directs arbiters to ignore these lists and simply choose the payment amount that is closest to the plan’s in-network rate in most cases.  Moreover, the rules provide that the plan’s in-network rate (also known as the Qualifying Payment Amount (QPA)) should not reflect any bonus payments or other related compensation earned by providers.