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AAMC Submits Comments on No Surprises Act Part II Regulations

December 10, 2021

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CONTACTS
Gayle Lee, Director, Physician Payment & Quality
Mary Mullaney, Director, Hospital Payment Policies

On Dec. 6, the AAMC submitted a letter to the U.S. Office of Personnel Management and the Departments of Health and Human Services, the Treasury, and Labor addressing the independent dispute resolution process, the good faith estimate requirements, and the provider-patient resolution process in the surprise billing part II interim final rule. The rule proposes regulations to implement certain provisions of the No Surprises Act enacted in December 2020 as part of the Consolidated Appropriations Act, 2021 (H.R. 116-260)[refer to Washington Highlights, Dec. 23, 2020]

While the AAMC supports protecting patients from out-of-network costs, the letter expressed significant concerns with the independent dispute resolution (IDR) process included in the rule that instructs IDR entities to presume the median in-network rate is the appropriate payment amount. It explained that this process limits the ability of providers to make a case for fair out-of-network payment and removes the incentive for health plans to include providers in their networks.

The letter further urged the administration to specify that IDR entities should not presume the median in-network rate is the appropriate payment rate and instead must give equal consideration to all other relevant factors included in the statute. It also emphasized the importance of the IDR process accounting for the unique qualities of teaching hospitals and the patients they serve. Additionally, the letter asked for more flexibility in the time frames for the IDR process and in batching claims.

The letter also expressed concern with the tight implementation timeline for good faith estimates for uninsured (or self-pay) patients and urged the departments to consider delaying enforcement for at least one year to provide sufficient time to implement system changes. It also recommended that providers be allowed to leverage their online price estimators to reduce the number of good faith estimates generated. The letter emphasized that departments should modify policies associated with good faith estimates for the uninsured to prevent delays in care while providers wait for determinations of eligibility for financial assistance, and it recommended that providers should inform patients about good faith estimates and that their scope should be limited to circumstances when there is a scheduled appointment and patients request one.

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