News Releases

American Hospital Association and American Medical Association Offer Support for No Surprises Act Lawsuit

Believing that patients should be kept out of any billing disputes between providers and commercial health insurance companies and that no patient should receive a surprise medical bill, the American Hospital Association (AHA) and American Medical Association (AMA) this month filed a “friend of the court” brief in support of a lawsuit filed by the Texas Medical Association.

In the lawsuit, the Texas Medical Association is claiming the revised independent dispute resolution (IDR) process for determining payment for out-of-network services under the No Surprises Act tilts the arbitration results in commercial insurers’ favor, violating the compromise Congress reached in its legislation.

The departments of Health and Human Services, Labor, and the Treasury revised the IDR process with a new final rule on Aug. 19. This occurred after the federal court in Texas vacated their instruction that IDR entities presume the appropriate payment amount for out-of-network services is the offer closest to the amount of the qualifying payment.

“Based on their own apparent policy preferences, the Departments continue to add atextual requirements to Congress’s simple framework,” AHA and AMA wrote. “Indeed, six months after this Court definitively interpreted the No Surprises Act, the Departments promulgated a Final Rule with numerous extra-statutory requirements that will interfere with a balanced consideration of Congress’s mandated factors and put a thumb on the scale in favor of the QPA. … The severe rate cuts enabled by the Departments’ insurer-friendly regulations threaten the viability of physician practices and the scope of medical services nationwide. Ultimately, the victims will be the patients who lose ready access to care.”

The AHA and AMA want to see the law’s core patient protections move forward and seek only to bring the regulations in line with the law.

The No Surprises Act took effect on Jan. 1, 2022, and requires insurers and providers that fail to agree on rates for out-of-network care to engage in independent dispute resolutions overseen by arbitrators. The Centers for Medicare and Medicaid Services (CMS) unveiled the federal mediation portal in April. As of August, mediators have decided on 1,200 of the 46,000 disputes submitted to the portal

According to CMS, of the 11 IDR entities, three are no longer accepting new cases. “If all of the potential revenue is just being delayed six months, nine months, who knows — that really does affect the bottom line,” said Dr. Lisa Maurer, a physician at Emergency Medicine Specialists in Milwaukee and chief medical officer for the medical management services organization, ConsensioHealth.

On Aug. 19, in addition to the final rule, the U.S. Department of Labor’s Employee Benefits Security Administration published a Federal Independent Dispute Resolution Process Status Update. The report states: “the departments understand that many disputing parties are still learning how to navigate the federal IDR process and how to comply with the federal No Surprises Act. The department’s approach to implementation of the federation IDR process is and will continue to be marked by an emphasis on helping parties understand the new law to facilitate compliance.” View the full update by visiting dol.gov.

To learn more about the No Surprises Act, visit shrm.org.