ISMS Backs Legal Challenge to Federal Rules Implementing the No Surprises Act

January 21, 2022

ISMS has joined the Physician Advocacy Institute, nine national specialty societies, and 15 other state medical societies in an amicus brief supporting an American Medical Association (AMA) and American Hospital Association (AHA) lawsuit pertaining to the federal No Surprises Act.

The lawsuit challenges provisions of the No Surprises Act rule concerning out-of-network payments. The amicus brief supports the AMA-AHA argument that the federal regulators' implementation rules upend the careful compromise Congress deliberately put in place for resolving billing disputes.

The lawsuit argues that the new rule:

  • Unfairly weights the scale of an independent dispute resolution process to the benefit of commercial health insurance companies.

  • Reduces access to care by discouraging meaningful contracting negotiations, thereby, reducing provider networks – which means patients have fewer choices for access to in-network services.

  • Encourages unsustainable compensation for teaching hospitals and physician practices; hospitals, physicians and other healthcare professionals would be routinely undercompensated by commercial insurers.

ISMS will keep you informed of any developments in this legal challenge. If you have questions, please contact ISMS' Legal Division by email.

Member resource

Many of the provisions of the No Surprises Act took effect Jan. 1, 2022. What do physicians need to do right now?

Even as the outcome of the above-mentioned lawsuit is not yet determined, physicians still have obligations under the No Surprises Act. ISMS' new Issue Brief, Surprise Billing: An Overview of the Federal No Surprises Act and Its Interaction with Illinois' Law, describes current state laws related to surprise billing and offers guidance about what physicians need to address immediately to be in compliance with the No Surprises Act.

If you have questions, please contact the ISMS Health Policy Research and Advocacy team by email.

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