Thread by @MarilynHeineMD

🧵⁦@AmerMedicalAssn⁩ ⁦@ahahospitals⁩ representing physicians, hospitals, and health systems sued the federal government today over the misguided implementation of the federal surprise billing law, No Surprises Act. The final rules jeopardize access to patient care.

2/ The associations are joined in the suit by plaintiffs including Renown Health, UMass Memorial Health and 2 physicians based in North Carolina.

The lawsuit challenges a narrow but critical provision of a rule issued on 9/30/2021 by @HHSGov @USDOL @USTreasury.

3/ The AMA press release states:

• “The provision being challenged ignores requirements specified in the No Surprises Act and would result in reduced access to care for patients. The rule and this flawed provision are set to take effect Jan. 1, 2022.”

4/ • “The AHA and AMA strongly support protecting patients from unanticipated medical bills and were instrumental in passing the landmark No Surprises Act to protect patients from billing disputes between providers and commercial health insurers.”

5/ • “The legal challenge became necessary because the federal regulators’ interpretation upends the careful compromise Congress deliberately chose for resolving billing disputes.”

6/ • “According to the lawsuit, the new rule places a heavy thumb on the scale of an independent dispute resolution process, unfairly benefiting commercial health insurance companies.”

7/ • The skewed process will ultimately ⬇️ access to care by:

•⬇️ meaningful contracting negotiations

•⬇️ provider networks

•➡️ unsustainable compensation for teaching hospitals, physician practices, other providers that significantly benefit patients and communities.

8/ • “Congress created an independent dispute resolution process that is required when providers and insurers are unable to reach agreement on payment for out-of-network services from providers who are not under contract with the insurer.”

9/ • “However, federal regulators have directed arbiters under independent dispute resolution to presume that the median in-network rate is the appropriate out-of-network rate and limiting when and how other factors come into play.”

10/•”The suit argues that the regulations are a clear deviation from the law as written & all but ensure that hospitals, physicians, & other providers will routinely be undercompensated by commercial insurers & patients will have fewer choices for access to in-network services.”

11/👉 •“Importantly, today’s challenge does not prevent the law’s core patient protections from moving forward and will not increase out-of-pocket costs to patients.”

[KEY POINT]

12/ 👉 • “[Today’s challenge] seeks only to force the Administration to bring the regulations in line with the law before the dispute negotiations begin.”

13/ • Statements by Presidents of @ahahospitals and @AmerMedicalAssn👇

14/ Last month, a bipartisan group of 152 lawmakers urged the Administration to fix the independent dispute resolution provisions:

👉 Read: tinyurl.com/yckwt35a

15/ >1/3 of the House wrote that the rule’s approach:

“is contrary to statute and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and jeopardize patient access to care – the exact opposite of the goal of the law.”

16/ @ahahospitals @AmerMedicalAssn and their co-plaintiffs filed their lawsuit against @HHSGov @USDOL @USTreasury @USOPM in the U.S. District Court for the District of Columbia.

To read the complaint: tinyurl.com/yckus74m

To read the motion to stay: tinyurl.com/2p96dsm5