February 23, 2021

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WASHINGTON — President Biden's pick to lead the Department of Health and Human Services faces a dizzying array of challenges. Many senators rightfully have COVID-19 and vaccine distribution top of mind. However, the next Health and Human Services secretary will also have the important responsibility of overseeing the implementation of the No Surprises Act. With that, the essential task of structuring the law's independent dispute resolution (IDR) process is at hand.

An extraordinary amount of effort went into writing and passing this law with the intent that there be an accessible and fair IDR process for unresolved bill disputes. As the Senate Health, Education, Labor, and Pensions (HELP) Committee begins to consider this morning Xavier Becerra as the next HHS secretary, Action for Health proposes the following five questions.

1. Process: Will the IDR be regulated and directed to be a fair process and to not prejudice one side over the other?

2. Factors: Can you confirm that no one factor or data point will be given primary or more consideration than any other regarding the decision the IDR will make (i.e., that the law does not call for rate-setting)?

3. Data: Will all data presented to the IDR (other than charges and government fee data) be given equal and fair consideration?

4. Access: Can you confirm that there will be simple and readily available access to the IDR for any unresolved disputes claims?

5. Investigation: Will HHS agree to investigate whether health insurance plans are gaming the in-network physician rates by paying hospitals overly high technical fees, which are then kicked back to hospital-employed physicians who are accepting artificially low in-network rates?