In formal comments, the CAP urged the Biden Administration to revise the interim final rule for the No Surprises Act to align the law’s implementation with the original legislation. Specifically, the interim final rule for the independent dispute resolution (IDR) process disregarded Congress’s intentions to create a fair system where physicians and health insurers can resolve disputes without one factor having more weight over others in the final payment determination. The CAP strongly opposed the interim federal regulations that give insurance companies the upper hand during what should be an impartial, independent dispute resolution (IDR) process as set in the No Surprises Act.

In the December 6 letter to the Centers of Medicare & Medicaid Services (CMS), the CAP reinforced that the new regulations should protect patients from surprise bills “while appropriately balancing disputes between our members and insurers.” The CAP urged the CMS “to revise the decision to require the certified IDR entity to select the offer closest to the qualifying payment amount (QPA), and instead allow the authorized IDR entity to consider all relevant information thoroughly.” Especially in today’s environment, where “the majority of health insurance markets in the United States are highly concentrated, the CAP believes this decision is hugely problematic. “While it may take time to understand the full extent of resulting narrower networks, physician practice closures, and increased consolidation, these changes have the potential to decrease access to care for the most vulnerable, particularly in rural and underserved communities,” the CAP argued. Additionally, congressional champions pledged to intervene with the administration to clarify the intent of Congress and urge reform to the interim final regulation.

In the comment letter, the CAP also expressed their concerns regarding the good faith estimate requirements and the patient-provider dispute resolution process. Even though the CAP supports patient access to price information, the CAP argued to the CMS that “there are serious risks for patient harm and substantial difficulty in determining the cost of pathology services in advance of services.

The CAP will remain engaged with the administration to address the regulations and ensure they follow the statute.