Complete Story
11/21/2021
OSMA Signs Letter Asking for Revisions to the "No Surprises Act"
The sign-on letter asks for revisions to the requirements in the most recent Interim Final Rule (IFR) implementing the No Surprises Act (NSA) that require an Independent Dispute Resolution (IDR) entity to assume the Qualified Payment Amount (QPA) is a reasonable out-of-network rate, unless credible information submitted by the parties clearly demonstrates that the QPA is materially different from the appropriate out-of-network rate.
On October 7th, the Departments of Health and Human Services, Treasury and Labor issued a second IFR implementing, among other provisions, the dispute resolution process for out-of-network claims under the NSA. The AMA and others who have signed the letter are very concerned that the requirements in the rule establishing the QPA as a rebuttable out-of-network rate will make it more difficult for physicians to receive fair payment for out-of-network services and to enter into meaningful contract negotiations with health plans which now have little incentive to offer fair contracted rates.
The letter makes the narrow request that the Departments remove the directive to the IDR entities to anchor their determination to the QPA, and instead let the IDR entities consider all allowable information submitted by the parties to support their offer as permitted by the statute. To be clear, we are not asking for a delay or undoing of any of the patient protections in the NSA.
