In the letter, the hospital group said a number of provisions in the act need oversight, including whether health plans accurately calculate the qualifying payment amount; whether health plans are delaying bills by inappropriately rejecting claims for cleanliness; whether insurers are making appropriate initial payments to providers; and whether insurers are maintaining access to in-network providers. The AHA said that using the quality payment amount as the starting point of an out-of-network rate “skews decisions in favor of plans and insurers.”
“The government will need robust oversight and enforcement of health plans and issuers to ensure that they are not abusing the NSA provisions in ways that harm patients or the providers who care for them,” the AHA said.
The AHA added that oversight and enforcement of the No Surprises Act is intended to be a shared responsibility of federal and state governments, which will have its own challenges. The AHA is seeking clarity from CMS about which entity will enforce what requirement and what that process will look like.
The AHA also said the No Surprises Act provisions leave a lot of lingering questions, and, as a result, it is urging CMS to continue to support implementation of the law through releasing more guidance and technical assistance before turning to “investigation and enforcement.”
“The NSA requires substantial changes in how providers, facilities, plans, and issuers operate,” the AHA said. “Providers and facilities will need to change workflows, update technology and establish and implement new patient communication processes. We urge the Centers for Medicare & Medicaid Services … to assist providers and facilities in this work and give time for these changes to take effect before beginning enforcement.”
Access the full letter here.
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