Wenstrup, bipartisan group call for Biden admin to fix surprise billing rule

U.S. Rep. Brad Wenstrup (R-OH) helped lead a bipartisan contingent of more than 150 congressional members in requesting that the Biden administration amend an interim final rule (IFR) on surprise billing so that it aligns with established law.

Specifically, the lawmakers requested that the IFR released on Sept. 30 entitled “Requirements Related to Surprise Billing; Part II” be coordinated with the bipartisan No Surprises Act, which Congress passed in December 2020 to protect patients, according to a Nov. 5 letter they sent to U.S. Treasury Secretary Janet Yellen, U.S. Health and Human Services Secretary Xavier Beccera, and U.S. Labor Secretary Martin Walsh.

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

The lawmakers pointed out that Congress passed the No Surprises Act after extensive bipartisan and bicameral deliberations to protect patients from surprise medical bills and to create a balanced process to resolve payment disputes between insurance plans and healthcare providers. 

“During these deliberations, multiple proposals were considered including a benchmark rate, an independent dispute resolution (IDR) process, and a hybrid,” Rep. Wenstrup and his colleagues wrote. “Congress rejected a benchmark rate and determined the best path forward for patients was to authorize 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 payors to offer any relevant information to support their payment offers for consideration, except for billed charges and public payor information.

And while the process laid out in the law directs the certified IDR entity to consider several specific factors, the parameters of the IDR process in the Sept. 30 IFR “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,” 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 Congress’s multi-year bipartisan and bicameral work to pass this landmark legislation,” wrote Rep. Wenstrup and the members. “Therefore, we urge you to revise the IFR to align with the law as written by specifying that the certified IDR entity should not default to the median in-network rate and should instead consider all of the factors outlined in the statute without disproportionately weighting one factor.”

Meanwhile, the GOP Doctors Caucus also sent a Nov. 5 letter to Biden Administration officials urging them to revise the proposed IFR to align with the statute and congressional intent to protect patients from negative outcomes. Caucus members who signed the letter include U.S. Reps. Wenstrup and Michael Burgess (R-TX), co-chairs of the caucus, and U.S. Reps. Larry Bucshon (R-IN) and Buddy Carter (R-GA), along with U.S. Sen. Bill Cassidy (R-LA).