Five groups representing hospitals and health systems across the U.S. filed an amicus brief Dec. 15 in support of the American Hospital Association and American Medical Association's legal challenge to the surprise-billing rule.
The lawsuit filed by the AHA and AMA challenges the dispute resolution process outlined in CMS' surprise-billing rule released Sept. 30. The groups allege that the independent dispute resolution process, which requires arbiters to first consider the health plan's median in-network rate as the appropriate reimbursement amount, unfairly favors health plans.
Five groups — the Federation of American Hospitals, the Association of American Medical Colleges, America's Essential Hospitals, the Catholic Health Association of the United States and the Children's Hospital Association — filed the brief in support of challenging the dispute resolution process.
The five groups argue that the dispute resolution process in the federal surprise-billing rule gives insurers unintended bargaining power and little incentive to negotiate fair in-network contracts with hospitals and physicians that treat complex, high-cost cases.
"The invalid IDR process that the defendant agencies have put into place will ultimately harm patients by incentivizing insurers to create narrower provider networks, undervaluing the services of specialized and essential hospitals, reducing providers' ability to negotiate fair reimbursement, and impeding access to care, particularly in underserved communities," the amicus brief reads.
The lawsuit from the AMA and AHA was filed in the U.S. District Court for the District of Columbia on Dec. 9 and names HHS, the Labor Department, Treasury Department and Office of Personnel Management as defendants.
The AHA and AMA are asking the court to prevent the dispute resolution process from taking effect, pending judicial review of the provision.