FOR IMMEDIATE RELEASE
August 22, 2022
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WASHINGTON — On Friday, federal regulators issued their final rule related to the No Surprises Act's independent dispute resolution (IDR) process. These regulations from the Departments of Health and Human Services, Treasury, and Labor are in response to District Court decisions in February and July vacating provisions of the agencies' October 2021 interim final rule.
Unfortunately, the departments have chosen to ignore these federal court rulings by writing new language that continues to favor health plans' qualifying payment amount (QPA).
In response to the rule's release, Action for Health President Christopher Sheeron issued the following statement.
"While this final rule is better than last year's interim final rule, the agencies have once again missed the boat. Texas' Eastern District Court ruled that regulators must withdraw the portions of their previous IDR rulemaking that pre-weighted the QPA. But the departments have now found a new way to favor health insurance companies in these payment disputes. They have prohibited IDR entities from considering any non-QPA data unless it is demonstrated that that data is not already factored into the QPA. This provision is found nowhere in the statute. And we believe it is in direct opposition to the Texas Medical Association and LifeNet decisions."
He continued, "Buried within 146 pages, this new language appears to create a different rebuttable presumption that the QPA is the correct out-of-network payment amount IDR entities should be selecting. That was exactly what was struck down in court. Moreover, we continue to be troubled by the fact that QPA data is created by health plans in a black box. Neither the IDR entity nor the other party in the dispute can assess this information. That's highly unfair. Despite the rework, we still feel the agencies are pushing for IDR entities to rule in the insurance companies' favor. Luckily, there are four more federal lawsuits that have been stayed pending the release of this final rule that plaintiffs will now pick back up in earnest."
