The Washington State Office of the Insurance Commissioner (OIC) released a decision on Feb. 27 to delay the state’s transition to the federal No Surprises Act (NSA) independent dispute resolution (IDR) process for at least six months – an advocacy win for the College of American Pathologists, Washington State Pathology Society, and the Washington State Medical Association (WSMA).

The three organizations collaborated in advocating to delay the switch to the NSA IDR process. The WSMA and Washington State Pathology Society responded to a request for information by the insurance commissioner in deciding whether to transition to the federal IDR process on July 1, 2023, or continue to use the state’s arbitration system to resolve out-of-network disputes under the Balance Billing Protection Act (BBPA).

In a Feb. 15 letter to the OIC, the WSMA and its partner organizations urged the OIC to delay the implementation of the IDR process enacted by the NSA and maintain the arbitration system under the BBPA until at least July 1, 2024. The BBPA, similar to the IDR provision of the NSA, protects consumers from getting billed by out-of-network providers for emergency services and for nonemergency services performed by an out-of-network provider at an in-network hospital.

There have been legal challenges to the IDR provision of the NSA since its implementation on the grounds that it is inconsistent with underlying law. A Feb. 6 ruling by the U.S. District Court for the Eastern District of Texas invalidated the dispute resolution rules, prompting the Centers for Medicare & Medicaid Services (CMS) to pause all payment determinations under the NSA pending further guidance. On Feb. 27, CMS lifted its pause on processing payment determinations only for those certified IDR entities with items or services billed before Oct. 25, 2022.

Sean Graham, director of government affairs for WSMA, wrote in the Feb. 15 letter that it would be “prudent for the state to maintain its arbitration system under the BBPA while the legal challenges play out and the federal law continues to coalesce.” He cited functional challenges to the IDR process, including a backlog of claims that has often delayed reimbursement to clinicians for several months.

 

Sources:

https://www.cap.org/advocacy/latest-news-and-practice-data/march-7-2023

https://documents.cap.org/documents/WSMA-comment-BBPA-arbitration-RFI_final14.pdf