AHA and AMA withdraw lawsuit over enactment of No Surprises Act

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The AHA and American Medical Association have moved to dismiss their challenge to the federal government's September 2021 interim final rule governing the No Surprises Act's independent dispute resolution process.

However, the groups said they intended to "make our voices heard in the courts very soon" about continued problems with both the interim and final rules.

The final rule continues to favor insurers and does not line up with what Congress intended when it passed the law, the groups said.   

"We have serious concerns that the August 2022 final rule departs from congressional intent just as the September 2021 interim final rule did," the AHA and AMA said by joint statement. "Hospitals and doctors intend to make our voices heard in the courts very soon about these continued problems."

WHY THIS MATTERS

The lawsuit filed in December 2021 did not seek to prevent the No Surprises Act core patient protections from moving forward. It sought to force the administration to alter regulations over dispute negotiations between provider and payer.

The groups said the lawsuit became moot when the administration released a revised final rule on the independent dispute resolution process this August. 

Importantly for hospitals, the final rule reflected a District Court ruling vacating interim rules that required Independent Dispute Resolution entities to select the offer closest to the Qualified Payment Amount. This process favored insurers, hospitals argued.

The District Court vacated this requirement in rulings in February and July. 

Also, hospitals and physicians said that without the change, insurers would be encouraged to narrow their networks by not contracting with providers that had higher costs. This included teaching and other hospitals that provide trauma care, burn units and neonatal intensive care services. 

THE LARGER TREND

On December 27, 2020, the Consolidated Appropriations Act, which includes the No Surprises Act, was enacted to give protections against surprise billing by limiting out-of-network cost-sharing and by prohibiting balance-billing.

Most patients get a surprise bill for unknowingly seeing an out-of-network provider, such as in the emergency room or from a clinical lab. The No Surprises Act protects patients by taking them out of the middle of disputes over out-of-network payment rates between providers and payers. 

The Department of Health and Human Services issued an interim final rule Part I in July 2021 on consumer protections against surprise billing. It published an interim final rule on surprise billing, Part II, October 7, 2021.  

The rules ban surprise billing for emergency services, as well as certain non-emergency care provided by out-of-network providers at in-network facilities. This limits high, out-of-network cost-sharing for patients.

The No Surprises Act ensures that patients will not be billed in excess of the cost-sharing amounts they would pay to an in-network provider. Providers not in the network are required to negotiate reasonable payment directly with the insurer. If that negotiation is unsuccessful, the No Surprises Act provides for binding arbitration.

ON THE RECORD

In a joint statement, the AHA and AMA said, "No patient should fear receiving a surprise medical bill. That is why the AHA and AMA strongly supported the No Surprises Act to protect patients from unexpected medical bills and keep them out of the middle of any billing disputes between providers and commercial health insurance companies. Congress enacted the law with a balanced, patient-friendly approach, and it should be implemented that way."

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org