Comments on No Surprises Act Rulemaking: Part I

Editor’s Note: This analysis is part of the USC-Brookings Schaeffer Initiative for Health Policy, which is a partnership between Economic Studies at Brookings and the University of Southern California Schaeffer Center for Health Policy & Economics. The Initiative aims to inform the national healthcare debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings. USC-Brookings Schaeffer Initiative research on surprise medical billing was supported by Arnold Ventures.

Loren Adler, Matthew Fiedler, and Benedic Ippolito offered comments on an interim final rule (IFR) issued by the Departments of Health and Human Services, Labor, and the Treasury implementing provisions of the No Surprises Act. Their letter commends the Departments for a generally thoughtful approach to implementing the No Surprises Act that will help ensure that the law achieve its goals of protecting patients from surprise bills and reducing premiums, while limiting administrative costs.

The authors also comment on three specific parts of the IFR:

  • Under the No Surprises Act, an insurer is required to send a provider an initial payment within 30 days after delivery of a service. The Departments seek comment on whether they should set a minimum amount for that payment. The letter argues that the Departments should not impose a minimum amount for this initial payment, as it would risk inappropriately inflating prices by causing arbitrators to treat the minimum payment as a “floor” on the appropriate price for the services involved, while conveying at most small benefits. The authors also outline ways to mitigate its potential downsides if the Departments do impose such a requirement.
  • The authors also respond to several specific comment solicitations related to the calculation of the qualifying payment amount (QPA), including: (1) detailing what standards an eligible database should be required to meet to be considered to have sufficient information to calculate a meaningful median in-network price; (2) recommending that agencies retain the current approach to calculating the QPA for new carriers in a market to minimize any attempts at gaming; and (3) offering options to mitigate the impact of large consolidated health care systems’ contracting practices on the QPA.
  • The authors also recommend that the Departments maintain the IFR’s approach of allowing self-insured group health plans to opt into a state law where applicable, while otherwise not allowing entities to opt-in to existing state law that would not otherwise apply.

Read the full comment letter here.