WASHINGTON – Following a September hearing examining the fallout from the flawed implementation of surprise medical billing protections and an October roundtable with Biden Administration officials highlighting the problems with the Administration’s implementation of the No Surprises Act, Ways and Means Republicans are continuing to speak up for patients. In a new letter, signed by every Ways and Means Republican, to Health and Human Services Secretary Xavier Becerra, Treasury Secretary Janet Yellen, and Acting Labor Secretary Julie Su, Committee Republicans demand the Administration follow the law’s clear intent in implementing this historic patient protection legislation.
“We ask that you swiftly revisit the final rule, ensure that it aligns with the law as written, and take immediate steps to make the law’s transparency provisions a reality for patients,” wrote Ways and Means Committee Republicans, led by Chairman Jason Smith (MO-08).
In the No Surprises Act, Congress created an arbitration process to ensure a fair balance when settling payment disputes between health insurers and out-of-network providers while protecting patients from surprise medical bills. As the Committee discovered during its hearing about the Biden Administration’s flawed implementation of the law, the independent dispute resolution (IDR) process established by the Administration’s rulemaking is failing to fulfill Congress’ intent:
“The statutory text of the law is unambiguous – despite that, the Departments failed to implement a final rule that accurately reflects the law and this inconsistency has been proven in court four times where the Departments have lost each lawsuit…American patients and our greater health care system should not need to rely on Federal courts to litigate what their elected representatives unquestionably wrote into law. At our hearing, we heard specific examples of how these implementation flaws are harming patients and impacting medical providers, independent dispute resolution (IDR) entities, and health insurers.” wrote Ways and Means Republicans.
The Administration’s implementation of the law has led to a new surprise for patients: fewer medical providers are covered by health insurance plans. Providers remaining in-network with a health insurance company have increasingly been forced to accept a lower reimbursement rate, putting access to quality patient care in jeopardy. Medical providers have been affected regardless of size, whether it be a small provider in a rural community or a large urban hospital system.
“Small medical practices in rural and underserved communities that had been in-network with health insurers are now receiving network cancellations. Even larger providers, like hospitals, are suffering similar consequences from the downward pressure of reduced reimbursement from the skewed QPA [qualified payment amount]. Worse yet, challenges when grouping IDR claims, the growing backlog of cases, and cases in which large health insurers fail to pay medical providers any amount after arbitration combine to place a significant financial burden on medical providers, forcing them to reduce available staff and services for patients” wrote Committee Republicans.
Read the full letter here.