Health Plan News

Emergency Department Practice Management Association Files Amicus Brief, Supports Patient Protections

The Emergency Department Practice Management Association (EDPMA), an organization representing the practice of Emergency Medicine, filed an amicus brief, along with Texas ACEP and Virginia ACEP, in support of the Texas Medical Association’s and Dr. Adam Corley’s lawsuit against four federal agencies challenging the legality of an interim final rule issued in September implementing dispute resolution in the No Surprises Act (Rule).

Throughout the legislative process, stakeholders agreed that patients should be removed from billing disputes and held only to their in-network cost-sharing amounts. EDPMA strongly supports the patient protections. The lawsuit and amicus brief do not challenge these protections.

The amicus brief focuses on the process for resolving reimbursement disputes between insurance plans and physicians, with special emphasis on the adverse effects the Rule threatens to have on the delivery of emergency care. Early legislative proposals that relied on a benchmark set at the plan’s typical in-network rate were rejected in favor of a compromise that considered evidence submitted by both the plans and the physicians. The statute clearly provides that the arbiter “shall consider” eight factors before deciding appropriate payment. The interim final rule inappropriately prohibits the arbiter from considering seven of those required factors except in special circumstances. Instead, it requires the arbiter to pick the rate that is closest to the plan’s median in-network rate (a rate which is completely non-transparent to physicians).

“Congress was clear when it passed the landmark No Surprises Act last year: protect patients from unavoidable and unexpected costs without jeopardizing patient access to care,” said Don Powell, D.O., Board Chair of EDPMA. “The Rule will inevitably allow insurers to manipulate fair payment standards with little or no transparency on the health plan’s calculation of ‘median in-network’ rates. This will harm not just commercially insured patients, but the rural, medically vulnerable and indigent populations who rely on our nation’s emergency departments as an important safety net.

“With the COVID-19 pandemic, and the latest wave of new variants, emergency department safety net resources have been stretched to the breaking point. We see the Rule leading to dire effects on the overall viability of our emergency medical care system. We urged the Administration to amend the Rule to be consistent with the language of the statute and Congressional intent — and now we have filed an amicus brief in support of the lawsuit challenging the Rule’s legality.”

SOURCE Emergency Department Practice Management Association (EDPMA)

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