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U.S. district court sides with physicians for third straight time on No Surprises Act lawsuits
On Aug. 3, the United States District Court for the Eastern District of Texas ruled in favor (PDF) of the Texas Medical Association (TMA) in its challenge to the No Surprises Act’s increased $350 administrative fee and revised batching regulations, which were both announced in Dec. 2022 without prior public notice or opportunity for comment.
For now, the administrative fee to initiate the independent dispute resolution process will return to its original $50 and the batching rules will be vacated until the departments can provide the public sufficient notice and opportunity to comment. The following day, HHS temporarily suspended the Federal IDR process citing the lawsuit and did not list a date that it would reopen. HHS may choose to appeal the decision. This lawsuit represents the fourth brought by TMA regarding implementation of the No Surprises Act. The first two regarding the independent dispute resolution process were won by TMA, with HHS appealing the second. The third regarding the calculation methodology of the qualifying payment amount is still pending. Find more information.
AMA encourages legislators to take action on mental health and substance use disorder parity
Patients with a mental illness or substance use disorder continue to suffer from health plans’ violations of parity laws, the AMA testified to the National Conference of Insurance Legislators (NCOIL) at its summer policy meeting. The AMA, joined by representatives from the Kennedy Forum and the American Psychiatric Association, recently presented to NCOIL on the next steps needed to address parity violations, including:
- Improving state laws to provide regulators with increased enforcement authority
- Conducting oversight to ensure payers’ compliance
- Working with regulators and state attorneys general to ensure compliance with state laws
For more information, contact [email protected].
Scope victories in Arizona and South Carolina
State legislative sessions across the country continue to wrap up, with Scope of Practice Partnership (SOPP) grantees reporting numerous victories defending the practice of medicine against inappropriate scope expansions. Arizona and South Carolina are among those states.
This session, the Arizona Medical Association (ArMA) fought hard to defeat a half-dozen scope expansion bills and preserve patient access to physician-led care. This included:
- SB 1269 that would have removed the statutory requirement for a nurse anesthetist to practice without the direction and presence of a physician
- SB 1457 that would have allowed certified psychologists to prescribe psychotropic medications
- SB 1460 that would have allowed pharmacists to test for and treat flu and respiratory infections
- SB 1227 that would have removed the prohibition on optometrists performing surgeries and allowed the optometry board to determine surgeries they could perform.
ArMA also defeated a bill that would have adopted the APRN Compact, which the AMA vigorously opposes because unlike every other compact it supersedes state scope of practice laws. Finally, due to ArMA’s strong lobbying efforts, legislation that would have repealed Arizona’s sunrise review statute for scope of practice expansions was vetoed by Governor Hobbs.
Unfortunately, a physician assistant bill passed in Arizona, but ArMA’s efforts ensured key improvements were made to the bill as it worked its way through the legislature.
In addition to supporting ArMA’s efforts with a SOPP grant, the AMA took part in a sign-on letter spearheaded by the American Society of Anesthesiologists opposing SB 1269.
The South Carolina Medical Association (SCMA) also had a successful legislative session defeating several scope bills. This included legislation (H.B. 3785) that would have removed the physician supervision requirement for nurse anesthetists, as well as SB 517 that would have allowed APRNs to practice without any physician involvement. Finally, SCMA’s lobbying efforts were key in successfully defeating H.B. 4272 and SB 553, expansive scope bills that would have allowed APRNs to practice without any physician involvement, expanded the prescriptive authority of physician assistants, and authorized physician assistants to use the title “physician associate,” among other provisions.
Congratulations to ArMA and SCMA.
