CMA continues to fight ill-conceived HHS regulations on surprise medical bills

January 10, 2022

The California Medical Association (CMA), through the Physicians Advocacy Institute (PAI), has filed joint amicus curiae briefs in support of two lawsuits challenging federal regulators’ approach to dispute resolution in under the No Surprises Act.

The lawsuits – one filed by the American Medical Association (AMA) and the American Hospital Association (AHA) and the other by the Texas Medical Association – both dispute that the federal agencies charged with implementing The No Surprises Act did not follow clear direction from Congress on how arbitrators should resolve surprise medical billing disputes between physicians and insurers under the law.

The statutory language of the No Surprises Act established a balanced process for fairly resolving payment disputes between physicians and insurers for certain unforeseen off-grid medical bills, using several different criteria. Instead, federal regulators issued a rule that effectively reverses the law, giving insurers an unfair advantage by relying almost exclusively on insurers’ self-determined median billing rate, instead of considering the myriad of factors required by insurers. the law.

“The No Surprises Act requires arbitrators to treat physicians and insurers fairly when resolving billing disputes. The interim final rule backed by insurers effectively overrules the law. If maintained, it will increase insurer profits at the expense of physicians and patients, ”said Dustin Corcoran, CEO of CMA and President of PAI. “Physicians strongly support measures to ensure that the No Surprises Act is able to protect patients and promote fairness in the resolution of billing disputes, as Congress intended. “

The deeply flawed regulation represents an approach Congress has rejected, recognizing that it would be more difficult for patients to access care. Implementation of the regulation will lower physician pay rates and encourage insurers to continue to limit the number of “network” physicians. When more physicians are forced “out of the network,” patients pay much more for health care. This business strategy, along with insurers creating high-deductible health plans with increasingly higher deductibles, has been a major driver of surprise patient medical bills in recent years.

“Doctors have an obligation to point out to the court how far federal regulators have strayed from the No Surprises Act’s balanced approach to resolving payment disputes and to explain how circumvention of the law will unfairly allow insurers to the detriment of patients and their doctors, ”Corcoran said. .

It is important to note that lawsuits do not prevent the law’s fundamental patient protections from taking effect and will not increase out-of-pocket costs for patients. They are only intended to compel the Administration to bring the regulations into conformity with the law before the start of the negotiations of the dispute.

The CMA had also submitted detailed comments to regulators, warning that the rule would produce the same unintended consequences as doctors and patients suffered under California’s AB 72. forced physicians out of the network and reduced patient access to network physicians, especially on-call specialist physician groups who treat patients in emergencies.

The CMA will continue to aggressively pressure regulators, Congress and the courts for a more balanced system. In the meantime, to help physicians understand their rights and obligations under the NSA, the CMA released an overview titled “The No Surprises Act: What Physicians Need to Know.” The document is available for members only.

CMA Webinar on the No Surprises Act

The CMA is also hosting a webinar on Wednesday, January 19, 2022, which will discuss the impact of the No Surprises Act on physicians in California, including interaction with AB 72 and other California-level surprise / balance billing protections. . The hour-long webinar – No Surprises Act: The New Federal Law and Its Impact on California Physicians – is free for members and their staff, and $ 99 for all other participants. Click here for more information and to register.

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