Wenstrup and bipartisan group ask Biden admin to fix surprise billing rule

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U.S. Representative Brad Wenstrup (R-OH) helped lead a bipartisan contingent of more than 150 members of Congress by asking the Biden administration to change an Interim Final Rule (IFR) on surprise billing so that it aligns with established law.

Specifically, lawmakers called for the IFR to be released on September 30 titled “Surprise Billing Requirements; Part II “be coordinated with the bipartisan No Surprises Act, which Congress passed in December 2020 to protect patients, according to a November 5 letter they sent to US Treasury Secretary Janet Yellen, US Secretary of the Treasury. Health and Human Services Xavier Beccera and US Labor Secretary Martin Walsh.

The “success of the law will depend on your departments following the letter of the law in its implementation,” wrote Representative Wenstrup, US Representative Tom Suozzi (D-NY) and 150 of their colleagues.

Lawmakers pointed out that Congress passed the No Surprises Act after lengthy bipartite and bicameral deliberation to protect patients from surprise medical bills and create a balanced process to resolve payment disputes between insurance plans and providers. health.

“During these deliberations, several proposals were considered, including a benchmark rate, an independent dispute resolution (IDR) and a hybrid,” wrote Representative Wenstrup and colleagues. “Congress rejected a benchmark rate and determined that the best path forward for patients was to allow an open negotiation period coupled with a balanced IDR process.”

The No Surprises Act, they wrote, specified an IDR process that takes patients out of the middle of payment disputes and allows providers and payers to offer any relevant information to support their payment offers, except for fees. billed and public payer information.

And while the process defined in the law directs the IDR certified entity to consider several specific factors, the parameters of the IDR process in the September 30 IFR “do not reflect the way the law was drafted, do not do not reflect a policy that could have passed Congress and do not create a balanced process for resolving payment disputes, ”according to their letter.

“We appreciate the complex nature of the patient protections that must be established and look forward to a final rule that accurately reflects the bipartite and multi-year bicameral work of Congress to pass this landmark legislation,” wrote Representative Wenstrup and members. “Therefore, we urge you to revise the IFR to align it with the law as drafted by specifying that the certified IDR entity should not by default use the network median rate and should instead take into account all the factors described in the law without weighting one disproportionately. factor.”

Meanwhile, the GOP Doctors Caucus also sent a letter Nov. 5 to officials in the Biden administration urging them to revise the proposed IFR to align it with the law and Congress’s intention to protect patients from harm. negative results. Caucus members who signed the letter include U.S. Representatives Wenstrup and Michael Burgess (R-TX), Caucus Co-Chairs, and U.S. Representatives Larry Bucshon (R-IN) and Buddy Carter (R-GA), as well as United States Senator Bill Cassidy (R-LA).


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