December 21, 2021
Area(s) of Interest: Out of Network Billing
The American Medical Association (AMA) and American Hospital Association (AHA) have filed a lawsuit against the federal government over its misguided implementation of the NSA. The suit argues that the regulations are a clear deviation from the law as written and all but ensure that hospitals, physicians, and other providers will routinely be undercompensated by commercial insurers and patients will have fewer choices for access to in-network services.
AMA and AHA also asked the judge to stay the IDR process until a decision is made. Importantly, the lawsuit does not prevent the law’s core patient protections from moving forward and will not increase out-of-pocket costs to patients. It seeks only to force the Administration to bring the regulations in line with the law before the dispute negotiations begin. A decision on the stay is not likely until January 2022.
The Texas Medical Association (TMA) has also filed a lawsuit in Texas against the federal government over its implementation of the No Surprises Act. The TMA lawsuit asks the court to restore the fair, balanced dispute resolution process that Congress created. The lawsuit also alleges a violation of the Administrative Procedure Act, which requires a formal notice and comment period in advance of finalizing such a rule. The agencies failed to solicit and incorporate comments from stakeholders for this crucial aspect of the law. Through the Physicians Advocacy Institute, the California Medical Association is filing an amicus brief in support of the TMA lawsuit.
Also see: CMA publishes fact sheet on federal No Surprises Act