The CAP urged the Biden Administration to change the interim final regulation for the No Surprises Act to align the law’s implementation with the original legislation. Through strong grassroots action from CAP members and a broad coalition of physician specialties, the CAP urged 116 members of Congress to ask senior members of the Biden Administration to change the interim regulations to ensure a balanced process to settle payment disputes. The CAP has 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 response to the recently released regulations, congressional champions pledged to intervene with the administration to clarify the intent of Congress and urge reform to the interim final regulation. In a November 5 letter from Congress to the secretaries of the departments of Health and Human Services, Labor, and Treasury urged the Administration “to amend the [regulation] in order to align the law’s implementation with the legislation Congress passed.” The members of Congress asked that, “the parameters of the [independent dispute resolution] IDR process in the [regulation] released on September 30 do not reflect the way the law was written, do not reflect a policy that could have passed Congress, and do not create a balanced process to settle payment disputes,” in the letter.

The interim final rule for the IDR process disregarded Congress’s intentions of creating a fair system where physicians and health insurers can resolve disputes without one single factor having more weight than another.

The Texas Medical Association (TMA) recently filed a lawsuit against the Biden Administration against the interim final regulation of the No Surprises Act. In the lawsuit filing, the TMA claims that the interim final rule “ignores congressional intent and unfairly gives health plans the upper hand in determining the final payment amount when a patient receives care from an out-of-network provider,” in terms of the IDR process.

However, there are some members of Congress who do support the current policy, such as Rep. Frank Palone (D-NJ), and Sen. Patty Murray (D-WA), who support the current interim final regulation of the No Surprises Act.

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