Special Advocacy Update

• CAP Files Amicus Brief in Support of AMA, AHA No Surprises Lawsuit

The CAP filed an amicus brief supporting a lawsuit challenging the federal government’s flawed implementation of the No Surprises Act. In the amicus brief, the CAP warned the government’s actions will cause substantial harm and further drive more physicians out of their patients’ health plan networks.

“The College of American Pathologists worked closely with Congress during the development of the No Surprises Act, and we advocated for patient protections, including robust access to health care that’s in their health plan’s network,” said CAP President Emily Volk, MD, FCAP. “Importantly, we continue to believe that the subsequent regulations must support an equitable and balanced system for resolving out-of-network payment disputes. As of today, the rules heavily favor the insurers when their power is already too great. With new rules going into effect on January 1, physicians and hospitals have little choice but to ask the courts to fix regulations that strayed from the law.”

The lawsuit led by the American Medical Association (AMA) and American Hospital Association (AHA) focused on requirements in the federal government’s rules pertaining to the independent dispute resolution process in the No Surprises Act. The law clearly established a fair and impartial independent dispute resolution process where physicians and other providers can settle claims with insurers without patients receiving unexpected large medical bills.

However, the current administration’s rules favor the health insurance industry. The AMA and AHA lawsuit states that the federal government’s regulations deviated from the law but ensured that commercial insurers routinely undercompensate physicians and patients having fewer choices for in-network services.

The lawsuit does not challenge patient protections in the law but seeks alignment between statute and the regulations for the independent dispute resolution process.

The CAP’s amicus brief outlined how the adverse rules will disadvantage pathologists. Specifically, the government added to the No Surprises Act statute a material term that conflicts with Congress’s balanced design for the independent dispute resolution process. By making an insurer-controlled qualifying payment amount as the presumptive benchmark for the independent dispute resolution process, the government warped an independent inquiry into one that is harmful to pathologists and their patients.

The AHA, AMA, and their co-plaintiffs filed their lawsuit against the departments of HHS, Labor, and Treasury, along with the Office of Personnel Management in the U.S. District Court for the District of Columbia. Go to the AMA’s website for copies of the original complaint and a motion to stay.