The Federation of American Hospitals, the American Medical Association and the Texas Medical Association filed an amicus brief Oct. 7, urging the 5th Circuit U.S. Court of Appeals to reverse a judge's ruling that rendered decisions made under the No Surprises Act "unenforceable."
Under the NSA, providers and insurers who cannot agree on a reasonable payment amount for out-of-network services provided to a patient would go through an independent dispute resolution process. The August 2023 ruling found that there is no private cause of action to enforce awards that come out of an IDR process.
According to an Oct. 7 release from FAH, the amicus brief urges the Appeals Court to reverse the district court's decision and details "why the district court’s conclusion is inconsistent with longstanding canons of statutory interpretation and the NSA's plain text."
The brief also highlights the potential impacts of this decision on rural providers, including the story of one representative of a rural emergency physician group who was forced out of network by their insurers, fearing that they would have to "reduce salaries, reduce physician and advanced practice provider staffing hours, cut positions or make difficult decisions about what areas we can realistically serve," as a result of the ruling.
The brief concludes that without enforcement of IDR rewards, payers "will have no incentive to pay providers at all."