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Lawmakers raise objections to latest surprise billing rule

Written on Nov 30, 2022

House lawmakers expressed their discontent with a final rule on surprise billing and urged federal regulators to make changes. 

House Ways and Means Committee Chairman Richard Neal, D-MA, and ranking member Kevin Brady, R-Texas, sent a letter to HHS Secretary Xavier Becerra and other department heads again expressing disappointment with a much-contested section of the surprise billing ban. 

The lawmakers “are severely disappointed to find that the August 2022 final rule violates the No Surprises Act in the same ways as before,” Neal and Brady said in a letter. 

In an initial draft of the ban on surprise bills, regulators outlined how payment disputes would be resolved between payers and providers. The initial draft instructed third-party arbiters to start with the presumption that the qualifying payment amount, or median in-network rate, is the appropriate payment amount for providers. 

A federal judge in Texas struck down that instruction, a narrow part of the ban on surprise billing, leaving intact the rest of the law. The judge ruled in favor of providers, saying it goes against the No Surprises Act passed by Congress. 

In the final rule released in August, regulators nixed the contested language. 

But Neal and Brady said the final rule “largely would have the same effect” as the initial draft. 

The final rule created a “double counting” test “that has no basis in the statutory text,” the letter states. The final rule says arbiters should not give weight to information if it was already used to calculate the qualifying payment amount. 

This will skew payments toward the median in-network rate, Neal and Brady argued, “we implore you to take swift action to remedy the latest rule.”