October 08, 2021
The No Surprises Act provided an important framework aimed at overall cost containment and consumer protection from surprise medical bills. Recent rulemaking by HHS, DOL/EBSA, and Treasury/IRS (“Requirements Related to Surprise Billing; Part II”) regarding independent dispute resolution (IDR) takes a thoughtful and balanced approach by requiring the arbitrator to presume that the Qualifying Payment Amount (QPA) is the appropriate out-of-network payment amount. In our view, this requirement is good for employer plan sponsors and the American health care system by encouraging early agreement and cooperation between payers and providers both in a dispute resolution proceeding and beforehand by maintaining the incentives for network participation. Additionally, we expect employers to benefit from improved cost predictability when the QPA is presumed to apply with narrow exceptions.
The Business Group on Health applauds the Administration and the Tri-Departments for their approach to IDR and in particular their recognition of the importance of the QPA to meaningful cost containment and consumer protection.
If you have questions, comments, or concerns about these or other regulatory and compliance issues, please contact us.
We provide this material for informational purposes only; it is not a substitute for legal advice.