On Dec. 9, 2021, the American Medical Association (AMA) and American Hospital Association (AHA), along with individual hospital and physicians’ plaintiffs, filed a lawsuit in federal district court against the federal government over what the plaintiffs believe is the ill-advised implementation of the federal No Surprises Act — legislation that both the AMA and AHA have previously supported to protect patients against surprise medical bills for out-of-network care.
At the center of this legal challenge is a narrow but key provision of a rule on surprise billing, issued Sept. 30, 2021, by the Department of Health and Human Services (HHS) and other federal agencies, implicating an arbitration/independent dispute resolution (IDR) process. The lawsuit does not stop the act’s fundamental patient protections from going forward but only seeks to hold federal regulators to align the regulation’s implementation with the original Congressional intent of the law — a balanced, patient-centered law without the heavy-handed influence of an IDR process that unfairly favors commercial health plans. This view is echoed by Congressional members in a Nov. 5 letter urging Secretaries Becerra, Yellen, and Walsh to implement a law that not only considers median in-network payment rates, but also considers all factors set out in the statute that can impact each unique billing dispute without defaulting to or unduly weighing one factor over another. If implemented as written, the law, which takes effect Jan. 1, 2022, could have unintended consequences for patients by aggravating prevailing health disparities and patient access issues in rural and urban underserved communities.
The AASM will continue to monitor these developments and provide more information as it becomes available. For more information, read the AASM analysis of the surprise billing interim final rule. Questions about surprise billing can be sent to coding@AASM.org.