On May 26, we sent a letter to HHS and the Departments of Labor and Treasury with high-level recommendations for their consideration as they draft regulations to implement the No Surprises Act.
The letter reiterates our support for the provisions in the law that protect patients from surprise medical bills for out-of-network care and maintain the role of private negotiation between provider and insurer, with arbitration as a backstop. It also includes several recommendations focused on ways to better ensure that the unique costs related to pediatric specialty care are appropriately accounted for during the arbitration process to prevent unintended downstream implications for pediatric provider networks. In particular, we ask the agencies to refine the median payment rate calculations, which will be considered during arbitration; clarify that arbiters must consider all the unique aspects of each case; and incorporate more specificity related to patient and provider characteristics into the final payment determination factors. The first set of rules on the No Surprises Act are expected to be released by July 1.
CHA contact: Jan Kaplan