AAMS sues US Government over rules favoring insurers

AAMS sues US Government over rules favoring insurers

18-Nov-2021 Source: AAMS

The Association of Air Medical Services (AAMS) has filed a lawsuit in federal court challenging interim final regulations (IFRs) implementing the No Surprises Act. AAMS continues to support the goals of the No Surprises Act, including the removal of patients from the middle of billing disputes between air ambulance providers and their patients’ insurers. One of the most important aspects of this law is the Independent Dispute Resolution (IDR) process that was designed by Congress to allow healthcare providers and insurers, following a period of open negotiation between the two, to make their case for payment before an independent entity based on statutory factors. It was the intent of Congress when passing this law that no single statutory factor receives special weight in the IDR process.

However, the IFRs issued by the Departments of Labor, Treasury, and Health and Human Services ignore Congress’s intent, instead focusing on a single factor – the Qualified Payment Amount (QPA), or the insurer’s median in-network rate for only a subset of their contracts for a given service in each area. The QPA is to be the overriding factor in this decision-making process. This means that insurers will be able to know exactly how the IDR entities will resolve these disputes, making the IDR and the open negotiation that precedes it a forgone conclusion. Insurers will also leverage that QPA against future payments, lowering all payments, both in-and-out-of-network, over time.

“Air Medical Services transport the sickest, most severely injured patients in our healthcare system – we fully support protecting those patients from these payment disputes and worked with Members of Congress and our larger healthcare community partners to ensure that happens,” said Cameron Curtis, AAMS President and CEO. “However, the fair and transparent process that we all supported is not the process being implemented. Instead, we are faced with a scenario in which a patient is in an emergency, is transported by a helicopter at the request of a trained first responder or qualified physician, and that patient’s insurer gets to unilaterally determine the amount they pay. This will have disastrous consequences for access to emergency air ambulance services.”

AAMS believes that a fair process in which all factors – including the type of aircraft, the quality of the services provided, and the acuity of the patient, among others – are considered when deciding a payment dispute can ensure the sustainability of air medical services and the larger healthcare system.

“Healthcare providers, especially emergency healthcare providers, are currently faced with historic concerns – loss of an experienced workforce, disruptions in the medical supply chain, being asked to serve in a multitude of public health roles, and the ongoing threat of a global pandemic,” said AAMS Board Chair Deborah Boudreaux. “By building this process in favor of the payor, our healthcare systems will system will suffer through reduced payments for necessary services, deepening an ongoing public healthcare crisis.”

This litigation seeks to vacate the flawed provisions of the IFRs and return to the intent of Congress, which is plain on the face the law, and was most recently underscored to the Departments in a letter from Representatives Suozzi and Wenstrup, which included 152 signatures from likeminded members of Congress.

“The intent of this law is clear, and AAMS plans to fight for its members and their patients to ensure the sustainability of this necessary service,” said Mrs. Curtis.

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