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- CAP Urges CMS to Create Equitable, Balanced System with No Surprises Act Regulations
The CAP called for strong regulations to prevent health plan manipulation in a September 7 letter to the CMS regarding a recent surprise billing interim final rule. The CAP further called on the CMS to ensure “that regulations must 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.”
On July 1, the Department of Health and Human Services (HHS) and other agencies issued regulations implementing portions of the No Surprises Act that bars surprise billing. Prior to the regulation’s release, the CAP provided key recommendations to the HHS. The No Surprises Act, which became law in December 2020 and goes into effect on January 1, 2022, included several provisions advocated for by the CAP.
The interim final rule only addressed parts of the No Surprises Act, including areas where Congress set a specific statutory rulemaking deadline of July 1, 2021. The CAP expects that the rules detailing the IDR process will be released later this year.
In its official comment letter, the CAP asked the CMS to differentiate and clarify how the federal law would work with current state laws protecting patients from surprise medical bills. “The CAP generally supports allowing state laws to continue to operate and improve their patient protections,” the CAP stated in the letter. “However, we still feel that additional clarity would be helpful around where and explicitly how state law applies. We encourage the agency to provide ongoing education and resources in this area, beyond the initial examples.” The CAP also argued that relying on an initial/benchmark rate for out-of-network services, especially those based on median or mean in-network contract rates, is contrary to the legislative intent of the No Surprises Act and would create imbalance and threaten patient access in the U.S. health care system
The CAP will continue to work with the CMS and other agencies as they develop the final regulations for the No Surprises Act.