AHA, AMA Ask Court to Vacate IDR Provisions in Surprise Billing Rule

The American Hospital Association (AHA) and the American Medical Association (AMA) have asked the US District Court for the District of Columbia to vacate the independent dispute resolution (IDR) provisions included in the HHS interim final rule on surprise billing.

The trade organizations first filed a lawsuit against the federal government regarding the rule in December 2021. The case challenged the provision stating that IDR entities must use the qualifying payment amount (QPA)—the payer’s median contracted rate for a given item or service—when determining reimbursement rates for out-of-network services.

In the No Surprises Act, Congress wrote that IDR entities should consider the QPA and other factors, such as provider training and experience, the provider’s market share, and how difficult it was to provide the service.

The 2021 lawsuit from AMA and AHA claimed that the interim final rule placed too much emphasis on the QPA as a determining factor when Congress intended for all factors to be considered equally. The plaintiffs asked HHS to only revise the IDR process under the interim rule and not overturn the No Surprises Act.

In the recent supplemental brief, the hospital groups reinforced their original ask.

“The government continues to insist that its atextual reading of the No Surprises Act is correct, and it has shown no indication whatsoever that its forthcoming final rule will be any less unlawful,” the brief stated. “A decision from this court can put an end to the government’s illegal interpretation once and for all. As such, plaintiffs respectfully ask the court to act as soon as practicable.”

The brief was submitted as a part of an ongoing case between the Association of Air Medical Services (AAMS) and HHS. AAMS claimed that the IDR process gives payers too much power to control reimbursement rates.

In February 2022, a federal judge in Texas sided with the Texas Medical Association (TMA) in a surprise billing lawsuit and ruled that the IDR provisions in the interim final rule violated the policies presented by Congress in the No Surprises Act.

Similar to AHA and AMA, TMA had filed a lawsuit against HHS alleging that the interim final rule put undue emphasis on the QPA when determining reimbursement rates.

The supplemental brief from AHA and AMA referenced the lack of action from HHS in response to the Texas ruling.

“The Departments have neither acquiesced to the decision of the Eastern District of Texas vacating portions of the September rule, nor suggested any intent to abandon their interpretation of the No Surprises Act in any final rule,” the groups wrote.

The brief urged the court to vacate the IDR provisions being challenged in the rule to promote judicial economy and avoid prejudice. The groups prompted the court to render one decision for the AAMS and TMA claims to avoid piecemeal appeals.

Additionally, AHA and AMA stressed that the court should not wait for HHS to issue a final rule before vacating these provisions. A prompt ruling would ensure that the sections would not be included in the final rule and would therefore help avoid future litigation, the brief said.

HHS recently told the court that it intends to issue a final rule by early summer.