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 health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.
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 that implements portions of the surprise billing provisions included in the No Surprises Act.
In their letter, the authors make four main comments on the IFR:
- The authors commend the Departments for directing independent dispute resolution (IDR) entities to begin with the presumption that the qualifying payment amount (QPA) is the appropriate out-of-network rate. They argue that this approach will help ensure that IDR decisions are consistent and predictable, thereby helping parties resolve disputes without resorting to IDR, while also ensuring that the law reduces prices inflated by the ability to surprise bill and, in turn, reduces premiums.
- The authors suggest improvements to Departments’ guidance regarding when IDR entities should deviate from the QPA. They suggest that the Departments instruct IDR entities to base their deviations from the QPA on the prices that would prevail in an ideal market for the relevant services, rather than the undefined concept of “the appropriate out-of-network rate.”
- The authors recommend that the Departments modify the IFR’s approach to administrative fees by setting different maximum fees for cases where an IDR entity was assigned by the Secretary versus when it was chosen by the parties. Additionally, the authors endorse eliminating the minimum fee in all cases.
- The authors offer suggestions to improve public reporting on the IDR process. They advocate for identifying the IDR entity in the data published about each IDR case and for including information about IDR entities’ previous experience and decisions on the IDR portal.