In addition to the work the AMA is doing on the Recovery Plan, we are also advocating at the federal and state levels to remove obstacles to care.

• Led effort with national specialties and state medical associations to build consensus and impact the No Surprises Act regulations.
• Initiated the filing of a lawsuit in Federal District Court (along with the American Hospital Association) arguing that the government’s interim final rule is contrary to the law and exceeds statutory authority by creating a rebuttable presumption that the arbiter in the Independent Dispute Resolution process consider the “qualifying payment amount” (essentially the median in-network rate) as the appropriate out-of-network payment amount. A federal judge in TX ruled in favor of a similar case brought by the Texas Medical Association case, effectively removing the rebuttable presumption.
• Filed an amicus brief in Federal District Court (along with the American Hospital Association) in support of a Texas Medical Association lawsuit arguing that the government’s final rule remains contrary to the law and exceeds statutory authority by adding various extra-statutory language that overweights the “qualifying payment amount” (essentially the median in-network rate) in favor of health plans and conflicts with Congress’ intentional design of the Independent Dispute Resolution process.
• Released an initial toolkit (PDF) on the implementation of the No Surprises Act and a second toolkit (PDF) on implementation of the billing process for certain out-of-network care under the No Surprises Act.
• Held two national webinars on the No Surprises Act, the first on its implementation and the second on the payment process for physicians and other providers in surprise medical billing situations.
• Continues to advocate for a fair IDR process, recently arguing in a letter (PDF) to the Administration that a balanced IDR process is not anti-patient, pushing back on payer and employer efforts to undermine the process.
• Working directly with CMS to address operational challenges with additional physician and provider resources.

• In response to significant concerns raised by the AMA, the U.S. Department of Health and Human Services (HHS) has withdrawn the Securing Updated and Necessary Statutory Evaluations Timely (SUNSET) final rule, which would have diverted limited HHS resources to mandated reviews of economically significant regulations and subject every regulation to expiration 10 years after passage or its last review.
• CMS will be discontinuing (PDF) the use of Certificates of Medical Necessity and Durable Medical Equipment Information Forms for several items, including oxygen, with dates of service on or after Jan. 1, 2023. This change will reduce regulatory burden, streamline the coverage process and improve access to quality, affordable care.

• Developed guidance to health app developers to help implement the AMA’s Privacy Principles (PDF).
• Sent a joint letter (PDF) to the heads of the Office of the National Coordinator for Health Information Technology and the Centers for Medicare & Medicaid Services requesting that federal agencies review their policies around application programming interfaces.
• Sent letter to the Vermont Legislation supporting a senate bill prohibiting life, disability and long-term care insurers from discriminating against persons based on genetic information.

• Published the 2022 update to Medical Liability Reform NOW! (PDF).
• Assisted Utah Medical Association in enacting CANDO legislation.
• Provided comprehensive state-based MLR resources to the California Medical Association (CMA), supporting efforts leading to the enactment of the MICRA Modernization Act.
• At the request of state medical associations, completed legislative template assisting those medical associations in enacting liability protections during public health emergencies and disasters.
• Drafted model legislation protecting physicians from criminal liability relating to medical liability allegations.

• Published the 20th edition of Competition in Health Insurance: A Comprehensive Study of U.S. Markets (PDF) which demonstrated that more than 70% of health insurance markets continue to be highly concentrated.
• Encouraged (PDF) the Department of Justice and Federal Trade Commission to develop policy that protects against mergers that create or augment health insurer buyer power in physician markets.

Published AMA Policy Research Perspectives:

• Examined national health care spending (PDF) in 2020 and included a first look at estimates for 2021.
• Called attention to the high proportions of medical liability insurance premiums that have increased year-to-year.
• Presented a descriptive analysis of pharmacy benefit manager (PBM) markets (PDF) and the provision of PBM services to health insurers using novel 2020 data on commercial drug coverage lives based on five PBM functions.
• Used AMA’s nationally representative Physician Practice Benchmark Survey to provide a detailed look at physician compensation methods (PDF) from 2012 to 2020.

Learn more about our efforts issues covered in the AMA Recovery Plan for America’s Physicians, public health and pandemic response and population care and health disparities .