To help control employer health care costs, HR Policy reiterated its support for the No Surprises Act’s independent dispute resolution process (IDR) in a coalition amicus brief filed this week, establishing the Qualifying Payment Amount (QPA) as the initial factor to consider when assessing competing offers over a disputed medical bill.
Background: Several provider organizations, including the American Medical Association, have challenged the Biden administration for its interpretation of the No Surprises Act, which addressed surprise billing. The organizations argue the administration's presumption that the QPA, a formula for reimbursement set by the Administration's rules, is the appropriate amount exceeds its statutory authority and discourages insurers from reaching agreements with providers.
The coalition brief argues the IFR closely follows the No Surprises Act statutory language which identifies the QPA as the first factor to consider before considering other information related to the appropriate rate for a medical item or service. HR Policy has previously outlined its support for the QPA as the central factor in the IDR process as it is the commercially agreed upon rate and establishes predictability in the outcome of the IDR process, lowering health care costs. Senator Patty Murray (D-WA) and Rep. Frank Pallone (D-NJ), two of the architects of the No Surprise Act, reiterated that the process outlined in the IFR is consistent with the legislation.
Outlook: The No Surprises Act went into effect January 1, 2022, meaning patients can no longer receive surprise medical bills from providers. However, it remains to be seen if the legal challenges to the IDR result in any changes to the implementation standards and procedures.