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- CAP Gives Administration Guidance for No Surprises Act Regulations
The CAP provided key recommendations for implementing the No Surprises Act to the Department of Health and Human Services (HHS) as it will issue regulations and guidance before the law goes into effect January 1, 2022. The CAP sought to ensure patients are protected from surprise medical bills while appropriately settling disputes between pathologists and insurers. The No Surprises Act, which became law in December 2020, contained several provisions advocated for by the CAP.
In a June 21 letter to HHS Secretary Xavier Becerra, the CAP argued that strong regulations are needed to prevent health plan manipulation. “Even now, health plans are finding ways to circumvent the protections provided in the No Surprises Act; for example, by proposing to subject patients to full liability for services received at facilities listed as being in-network, but not additionally ‘designated’ as eligible for coverage. We need strong regulations to prevent such health plan manipulation and gaming that harms patients, while ensuring robust oversight and audit/complaint processes.” The CAP further asked the regulatory agencies to “support an equitable and balanced system for resolving payment disputes, so as to ensure fair reimbursement for out-of-network services and an independent dispute resolution (IDR) process that is accessible to all.”
In particular, the CAP asked Secretary Becerra to consider the range of activities within pathology services and the variety of associated costs and resources across different provider settings when considering qualifying payment amounts for services provided. The CAP also asked for added measures in the IDR process that would ensure efficiency and minimize administrative costs while providing access to the process for physicians no matter their situation. For example, providing an entirely online/virtual process will allow providers to participate more fully no matter their schedule or resources.
Finally, the CAP reiterated that inadequate insurer networks are the cause of surprise medical bills. If networks were comprehensive, patients would not need to worry about out-of-network providers' surprise medical bills. The CAP appreciated that the Government Accountability Office will study network adequacy and asked for continued enforcement from the agency as we can better evaluate the implementation and success of the No Surprises Act.