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November 04, 2021

The Center Asks Members of Congress to Urge the Administration to Revise Independent Dispute Resolution Rules

independent-dispute-resolution-rulesThe Center for Health Affairs last week reached out to the U.S. House delegation from Northeast Ohio, urging their support on an effort to modify rules on surprise medical billing. 

The interim final rule released on Sept. 30 represents part II of the regulations implementing the No Surprises Act, which passed as part of the year-end omnibus spending bill in 2020. Of concern are provisions related to the independent dispute resolution (IDR) process, which heavily weight the median in-network rate among the factors that should be considered. This is in opposition to congressional intent.

The Center requested members of the U.S. House representing districts in Northeast Ohio to sign on to a “Dear Colleague” letter circulating on the Hill last week. Led by Reps. Brad Wenstrup (R-OH) and Tom Suozzi (D-NY) and supported by numerous hospital and physician groups, the letter requests that the Departments of Health and Human Services, Treasury, and Labor revise the rule to align with the law as written by specifying that the certified IDR entity should not default to the median in-network rate and should instead consider all of the factors outlined in the statute without disproportionately weighting one.  

Also last week, the Texas Medical Association filed a complaint in U.S. District Court asking it to strike down provisions in the interim final rule. The complaint, among other things, claims that the departments acted unlawfully in defaulting to the median in-network rate and asks the court to strike those provisions.

While many of the policies in the interim final regulations are applicable Jan. 1, 2022, others are effective immediately upon publication in the Federal Register on Oct. 7, 2021. Specifically, the provisions related to the IDR process are now in effect and the departments have begun accepting applications from organizations interested in serving as certified IDR entities through the portal as of Sept. 30, 2021. 

For more information on the proposed billing regulations, contact us.